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Shoemaker JK, Gros R. A century of exercise physiology: key concepts in neural control of the circulation. Eur J Appl Physiol 2024; 124:1323-1336. [PMID: 38441688 PMCID: PMC11055701 DOI: 10.1007/s00421-024-05451-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/26/2024] [Indexed: 04/28/2024]
Abstract
Early in the twentieth century, Walter B. Cannon (1871-1945) introduced his overarching hypothesis of "homeostasis" (Cannon 1932)-the ability to sustain physiological values within a narrow range necessary for life during periods of stress. Physical exercise represents a stress in which motor, respiratory and cardiovascular systems must be integrated across a range of metabolic stress to match oxygen delivery to oxygen need at the cellular level, together with appropriate thermoregulatory control, blood pressure adjustments and energy provision. Of these, blood pressure regulation is a complex but controlled variable, being the function of cardiac output and vascular resistance (or conductance). Key in understanding blood pressure control during exercise is the coordinating role of the autonomic nervous system. A long history outlines the development of these concepts and how they are integrated within the exercise context. This review focuses on the renaissance observations and thinking generated in the first three decades of the twentieth century that opened the doorway to new concepts of inquiry in cardiovascular regulation during exercise. The concepts addressed here include the following: (1) exercise and blood pressure, (2) central command, (3) neurovascular transduction with emphasis on the sympathetic nerve activity and the vascular end organ response, and (4) tonic neurovascular integration.
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Affiliation(s)
- J Kevin Shoemaker
- School of Kinesiology, The University of Western Ontario, London, ON, N6A 3K7, Canada.
- Department of Physiology and Pharmacology, The University of Western Ontario, London, ON, N6A 3K7, Canada.
| | - Robert Gros
- Department of Physiology and Pharmacology, The University of Western Ontario, London, ON, N6A 3K7, Canada
- Department of Medicine, The University of Western Ontario, London, ON, N6A 3K7, Canada
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2
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Méndez JC, Perry BAL, Premereur E, Pelekanos V, Ramadan T, Mitchell AS. Variable cardiac responses in rhesus macaque monkeys after discrete mediodorsal thalamus manipulations. Sci Rep 2023; 13:16913. [PMID: 37805650 PMCID: PMC10560229 DOI: 10.1038/s41598-023-42752-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 09/14/2023] [Indexed: 10/09/2023] Open
Abstract
The control of some physiological parameters, such as the heart rate, is known to have a role in cognitive and emotional processes. Cardiac changes are also linked to mental health issues and neurodegeneration. Thus, it is not surprising that many of the brain structures typically associated with cognition and emotion also comprise a circuit-the central automatic network-responsible for the modulation of cardiovascular output. The mediodorsal thalamus (MD) is involved in higher cognitive processes and is also known to be connected to some of the key neural structures that regulate cardiovascular function. However, it is unclear whether the MD has any role in this circuitry. Here, we show that discrete manipulations (microstimulation during anaesthetized functional neuroimaging or localized cytotoxin infusions) to either the magnocellular or the parvocellular MD subdivisions led to observable and variable changes in the heart rate of female and male rhesus macaque monkeys. Considering the central positions that these two MD subdivisions have in frontal cortico-thalamocortical circuits, our findings suggest that MD contributions to autonomic regulation may interact with its identified role in higher cognitive processes, representing an important physiological link between cognition and emotion.
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Affiliation(s)
- Juan Carlos Méndez
- Department of Clinical and Biomedical Sciences, University of Exeter, College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Brook A L Perry
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Mansfield Road, Oxford, OX1 3TH, UK
| | - Elsie Premereur
- Laboratory for Neuro- and Psychophysiology, KU Leuven, Leuven, Belgium
| | | | - Tamara Ramadan
- Department of Biological Sciences, University of Oxford, Oxford, UK
| | - Anna S Mitchell
- Department of Psychology, Speech and Hearing, University of Canterbury, Christchurch, 8041, New Zealand.
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3
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Esfahani MJ, Farboud S, Ngo HVV, Schneider J, Weber FD, Talamini LM, Dresler M. Closed-loop auditory stimulation of sleep slow oscillations: Basic principles and best practices. Neurosci Biobehav Rev 2023; 153:105379. [PMID: 37660843 DOI: 10.1016/j.neubiorev.2023.105379] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/05/2023]
Abstract
Sleep is essential for our physical and mental well-being. During sleep, despite the paucity of overt behavior, our brain remains active and exhibits a wide range of coupled brain oscillations. In particular slow oscillations are characteristic for sleep, however whether they are directly involved in the functions of sleep, or are mere epiphenomena, is not yet fully understood. To disentangle the causality of these relationships, experiments utilizing techniques to detect and manipulate sleep oscillations in real-time are essential. In this review, we first overview the theoretical principles of closed-loop auditory stimulation (CLAS) as a method to study the role of slow oscillations in the functions of sleep. We then describe technical guidelines and best practices to perform CLAS and analyze results from such experiments. We further provide an overview of how CLAS has been used to investigate the causal role of slow oscillations in various sleep functions. We close by discussing important caveats, open questions, and potential topics for future research.
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Affiliation(s)
| | - Soha Farboud
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, the Netherlands
| | - Hong-Viet V Ngo
- Department of Psychology, University of Essex, United Kingdom; Department of Psychology, University of Lübeck, Germany; Center for Brain, Behaviour and Metabolism, University of Lübeck, Germany
| | - Jules Schneider
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Frederik D Weber
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, the Netherlands; Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Lucia M Talamini
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behaviour, Radboudumc, the Netherlands.
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4
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Reynolds CA, Minic Z. Chronic Pain-Associated Cardiovascular Disease: The Role of Sympathetic Nerve Activity. Int J Mol Sci 2023; 24:5378. [PMID: 36982464 PMCID: PMC10049654 DOI: 10.3390/ijms24065378] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/26/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Chronic pain affects many people world-wide, and this number is continuously increasing. There is a clear link between chronic pain and the development of cardiovascular disease through activation of the sympathetic nervous system. The purpose of this review is to provide evidence from the literature that highlights the direct relationship between sympathetic nervous system dysfunction and chronic pain. We hypothesize that maladaptive changes within a common neural network regulating the sympathetic nervous system and pain perception contribute to sympathetic overactivation and cardiovascular disease in the setting of chronic pain. We review clinical evidence and highlight the basic neurocircuitry linking the sympathetic and nociceptive networks and the overlap between the neural networks controlling the two.
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Affiliation(s)
- Christian A. Reynolds
- Department of Emergency Medicine, Wayne State University School of Medicine, 540 E Canfield St., Detroit, MI 48201, USA
- Department of Biotechnology, University of Rijeka, 51000 Rijeka, Croatia
| | - Zeljka Minic
- Department of Emergency Medicine, Wayne State University School of Medicine, 540 E Canfield St., Detroit, MI 48201, USA
- Department of Biotechnology, University of Rijeka, 51000 Rijeka, Croatia
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5
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Ogren JA, Allen LA, Roy B, Diehl B, Stern JM, Eliashiv DS, Lhatoo SD, Harper RM, Kumar R. Regional variation in brain tissue texture in patients with tonic-clonic seizures. PLoS One 2022; 17:e0274514. [PMID: 36137154 PMCID: PMC9499268 DOI: 10.1371/journal.pone.0274514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/28/2022] [Indexed: 11/19/2022] Open
Abstract
Patients with epilepsy, who later succumb to sudden unexpected death, show altered brain tissue volumes in selected regions. It is unclear whether the alterations in brain tissue volume represent changes in neurons or glial properties, since volumetric procedures have limited sensitivity to assess the source of volume changes (e.g., neuronal loss or glial cell swelling). We assessed a measure, entropy, which can determine tissue homogeneity by evaluating tissue randomness, and thus, shows tissue integrity; the measure is easily calculated from T1-weighted images. T1-weighted images were collected with a 3.0-Tesla MRI from 53 patients with tonic-clonic (TC) seizures and 53 healthy controls; images were bias-corrected, entropy maps calculated, normalized to a common space, smoothed, and compared between groups (TC patients and controls using ANCOVA; covariates, age and sex; SPM12, family-wise error correction for multiple comparisons, p<0.01). Decreased entropy, indicative of increased tissue homogeneity, appeared in major autonomic (ventromedial prefrontal cortex, hippocampus, dorsal and ventral medulla, deep cerebellar nuclei), motor (sensory and motor cortex), or both motor and autonomic regulatory sites (basal-ganglia, ventral-basal cerebellum), and external surfaces of the pons. The anterior and posterior thalamus and midbrain also showed entropy declines. Only a few isolated regions showed increased entropy. Among the spared autonomic regions was the anterior cingulate and anterior insula; the posterior insula and cingulate were, however, affected. The entropy alterations overlapped areas of tissue changes found earlier with volumetric measures, but were more extensive, and indicate widespread injury to tissue within critical autonomic and breathing regulatory areas, as well as prominent damage to more-rostral sites that exert influences on both breathing and cardiovascular regulation. The entropy measures provide easily-collected supplementary information using only T1-weighted images, showing aspects of tissue integrity other than volume change that are important for assessing function.
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Affiliation(s)
- Jennifer A. Ogren
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Luke A. Allen
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, United Kingdom
| | - Bhaswati Roy
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Beate Diehl
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, London, United Kingdom
| | - John M. Stern
- Department of Neurology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Dawn S. Eliashiv
- Department of Neurology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Samden D. Lhatoo
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Ronald M. Harper
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, California, United States of America
- Brain Research Institute, University of California Los Angeles, Los Angeles, California, United States of America
| | - Rajesh Kumar
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Brain Research Institute, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Bioengineering, University of California Los Angeles, Los Angeles, California, United States of America
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6
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Skora LI, Livermore JJA, Roelofs K. The functional role of cardiac activity in perception and action. Neurosci Biobehav Rev 2022; 137:104655. [PMID: 35395334 DOI: 10.1016/j.neubiorev.2022.104655] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 04/01/2022] [Accepted: 04/03/2022] [Indexed: 01/12/2023]
Abstract
SKORA, L.I., J.J.A. LIVERMORE and K. Roelofs. The functional role of cardiac activity in perception and action. NEUROSCI BIOBEHAV REV X(X) XXX-XXX, 2022. Patterns of cardiac activity continuously vary with environmental demands, accelerating or decelerating depending on circumstances. Simultaneously, cardiac cycle affects a host of higher-order processes, where systolic baroreceptor activation largely impairs processing. However, a unified functional perspective on the role of cardiac signal in perception and action has been lacking. Here, we combine the existing strands of literature and use threat-, anticipation-, and error-related cardiac deceleration to show that deceleration is an adaptive mechanism dynamically attenuating the baroreceptor signal associated with each heartbeat to minimise its impact on exteroceptive processing. This mechanism allows to enhance attention afforded to external signal and prepare an appropriate course of action. Conversely, acceleration is associated with a reduced need to attend externally, enhanced action tendencies and behavioural readjustment. This novel account demonstrates that dynamic adjustments in heart rate serve the purpose of regulating the level of precision afforded to internal versus external evidence in order to optimise perception and action. This highlights that the importance of cardiac signal in adaptive behaviour lies in its dynamic regulation.
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Affiliation(s)
- L I Skora
- Institute for Biological Psychology of Decision Making, Experimental Psychology, Heinrich-Heine-Universität, 40225 Düsseldorf, Germany; School of Psychology, University of Sussex, Brighton BN1 9RH, UK; Sackler Centre for Consciousness Science, University of Sussex, Brighton BN1 9RH, UK.
| | - J J A Livermore
- School of Psychology, University of Sussex, Brighton BN1 9RH, UK; Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525EN Nijmegen, The Netherlands
| | - K Roelofs
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525EN Nijmegen, The Netherlands; Behavioural Science Institute, Radboud University, 6525HE Nijmegen, The Netherlands
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7
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Be still my heart: Cardiac regulation as a mode of uncertainty reduction. Psychon Bull Rev 2021; 28:1211-1223. [PMID: 33755894 DOI: 10.3758/s13423-021-01888-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 01/26/2023]
Abstract
Decreased heart rate (HR) and variability (HRV) are well-established correlates of attention; however, the functional significance of these dynamics remains unclear. Here, we investigate whether attention-related cardiac modulation is sensitive to different varieties of uncertainty. Thirty-nine adults performed a binocular rivalry-replay task in which changes in visual perception were driven either internally (in response to constant, conflicting stimuli; rivalry) or externally (in response to physically alternating stimuli; replay). Tonic HR and high-frequency HRV linearly decreased as participants progressed from resting-state baseline (minimal visual uncertainty) through replay (temporal uncertainty) to rivalry (temporal uncertainty and ambiguity). Time-resolved frequency estimates revealed that cardiac deceleration was sustained throughout the trial period and modulated by ambiguity, novelty, and switch rate. These findings suggest cardiac regulation during active attention may play an instrumental role in uncertainty reduction.
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8
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Guo Z, Fan C, Li T, Gesang L, Yin W, Wang N, Weng X, Gong Q, Zhang J, Wang J. Neural network correlates of high-altitude adaptive genetic variants in Tibetans: A pilot, exploratory study. Hum Brain Mapp 2020; 41:2406-2430. [PMID: 32128935 PMCID: PMC7267913 DOI: 10.1002/hbm.24954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/16/2020] [Accepted: 02/09/2020] [Indexed: 02/05/2023] Open
Abstract
Although substantial progress has been made in the identification of genetic substrates underlying physiology, neuropsychology, and brain organization, the genotype–phenotype associations remain largely unknown in the context of high‐altitude (HA) adaptation. Here, we related HA adaptive genetic variants in three gene loci (EGLN1, EPAS1, and PPARA) to interindividual variance in a set of physiological characteristics, neuropsychological tests, and topological attributes of large‐scale structural and functional brain networks in 135 indigenous Tibetan highlanders. Analyses of individual HA adaptive single‐nucleotide polymorphisms (SNPs) revealed that specific SNPs selectively modulated physiological characteristics (erythrocyte level, ratio between forced expiratory volume in the first second to forced vital capacity, arterial oxygen saturation, and heart rate) and structural network centrality (the left anterior orbital gyrus) with no effects on neuropsychology or functional brain networks. Further analyses of genetic adaptive scores, which summarized the overall degree of genetic adaptation to HA, revealed significant correlations only with structural brain networks with respect to local interconnectivity of the whole networks, intermodule communication between the right frontal and parietal module and the left occipital module, nodal centrality in several frontal regions, and connectivity strength of a subnetwork predominantly involving in intramodule edges in the right temporal and occipital module. Moreover, the associations were dependent on gene loci, weight types, or topological scales. Together, these findings shed new light on genotype–phenotype interactions under HA hypoxia and have important implications for developing new strategies to optimize organism and tissue responses to chronic hypoxia induced by extreme environments or diseases.
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Affiliation(s)
- Zhiyue Guo
- Institute of Brain Diseases and Cognition, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Cunxiu Fan
- Institute of Brain Diseases and Cognition, School of Medicine, Xiamen University, Xiamen, Fujian, China.,Department of Neurology, Shanghai Changhai Hospital, Navy Medical University, Shanghai, China
| | - Ting Li
- Institute of Brain Diseases and Cognition, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Luobu Gesang
- Institute of High Altitude Medicine, Tibet Autonomous Region People's Hospital, Lhasa, Tibet Autonomous Region, China
| | - Wu Yin
- Department of Radiology, Tibet Autonomous Region People's Hospital, Lhasa, Tibet Autonomous Region, China
| | - Ningkai Wang
- Department of Psychology, Hangzhou Normal University, Hangzhou, China
| | - Xuchu Weng
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, South China Normal University, Institute for Brain Research and Rehabilitation, Guangzhou, China
| | - Qiyong Gong
- Huaxi Magnetic Resonance Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaxing Zhang
- Institute of Brain Diseases and Cognition, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jinhui Wang
- Guangdong Key Laboratory of Mental Health and Cognitive Science, Center for Studies of Psychological Application, South China Normal University, Institute for Brain Research and Rehabilitation, Guangzhou, China
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9
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The mind-body problem: Circuits that link the cerebral cortex to the adrenal medulla. Proc Natl Acad Sci U S A 2019; 116:26321-26328. [PMID: 31871146 DOI: 10.1073/pnas.1902297116] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Which regions of the cerebral cortex are the origin of descending commands that influence internal organs? We used transneuronal transport of rabies virus in monkeys and rats to identify regions of cerebral cortex that have multisynaptic connections with a major sympathetic effector, the adrenal medulla. In rats, we also examined multisynaptic connections with the kidney. In monkeys, the cortical influence over the adrenal medulla originates from 3 distinct networks that are involved in movement, cognition, and affect. Each of these networks has a human equivalent. The largest influence originates from a motor network that includes all 7 motor areas in the frontal lobe. These motor areas are involved in all aspects of skeletomotor control, from response selection to motor preparation and movement execution. The motor areas provide a link between body movement and the modulation of stress. The cognitive and affective networks are located in regions of cingulate cortex. They provide a link between how we think and feel and the function of the adrenal medulla. Together, the 3 networks can mediate the effects of stress and depression on organ function and provide a concrete neural substrate for some psychosomatic illnesses. In rats, cortical influences over the adrenal medulla and the kidney originate mainly from 2 motor areas and adjacent somatosensory cortex. The cognitive and affective networks, present in monkeys, are largely absent in rats. Thus, nonhuman primate research is essential to understand the neural substrate that links cognition and affect to the function of internal organs.
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10
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Visceral Signals Shape Brain Dynamics and Cognition. Trends Cogn Sci 2019; 23:488-509. [DOI: 10.1016/j.tics.2019.03.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 01/17/2023]
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11
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Basantsova NY, Tibekina LM, Shishkin AN. [A role of the autonomic nervous system in cerebro-cardiac disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 117:153-160. [PMID: 29265102 DOI: 10.17116/jnevro2017117111153-160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors consider anatomical/physiological characteristics and a role of different autonomic CNS regions, including insula cortex, amygdala complex, anterior cingulate cortex, ventral medial prefrontal cortex, hypothalamus and epiphysis, involved in the regulation of cardiovascular activity. The damage of these structures, e.g., due to the acute disturbance of cerebral blood circulation, led to arrhythmia, including fatal arrhythmia, in previously intact myocardium; systolic and diastolic dysfunction, ischemic changes considered in the frames of cerebro-cardial syndrome. On the cellular level, the disturbance of autonomic regulation resulted in catechol amine excitotoxicity, oxidative stress and free radical myocardium injury.
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Affiliation(s)
| | - L M Tibekina
- St. Petersburg State University, St. Petersburg, Russia
| | - A N Shishkin
- St. Petersburg State University, St. Petersburg, Russia
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12
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Al-Khazraji BK, Shoemaker JK. The human cortical autonomic network and volitional exercise in health and disease. Appl Physiol Nutr Metab 2018; 43:1122-1130. [PMID: 30058352 DOI: 10.1139/apnm-2018-0305] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The autonomic nervous system elicits continuous beat-by-beat homeostatic adjustments to cardiovascular control. These modifications are mediated by sensory inputs (e.g., baroreceptors, metaboreceptors, pulmonary, thermoreceptors, and chemoreceptors afferents), integration at the brainstem control centres (i.e., medulla), and efferent autonomic neural outputs (e.g., spinal, preganglionic, and postganglionic pathways). However, extensive electrical stimulation and functional imaging research show that the brain's higher cortical regions (e.g., insular cortex, medial prefrontal cortex, anterior cingulate cortex) partake in homeostatic regulation of the cardiovascular system at rest and during exercise. We now appreciate that these cortical areas form a network, namely the "cortical autonomic network" (CAN), which operate as part of a larger central autonomic network comprising 2-way communication of cortical and subcortical areas to exert autonomic influence. Interestingly, differential patterns of CAN activity and ensuing cardiovascular control are present in disease states, thereby highlighting the importance of considering the role of CAN as an integral aspect of cardiovascular regulation in health and disease. This review discusses current knowledge on human cortical autonomic activation during volitional exercise, and the role of exercise training on this activation in both health and disease.
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Affiliation(s)
- Baraa K Al-Khazraji
- a School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,b Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - J Kevin Shoemaker
- a School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,b Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,c Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, London, Ontario, Canada
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13
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A review of human neuroimaging investigations involved with central autonomic regulation of baroreflex-mediated cardiovascular control. Auton Neurosci 2017; 207:10-21. [DOI: 10.1016/j.autneu.2017.05.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/10/2017] [Accepted: 05/13/2017] [Indexed: 12/30/2022]
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14
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Allen LA, Harper RM, Kumar R, Guye M, Ogren JA, Lhatoo SD, Lemieux L, Scott CA, Vos SB, Rani S, Diehl B. Dysfunctional Brain Networking among Autonomic Regulatory Structures in Temporal Lobe Epilepsy Patients at High Risk of Sudden Unexpected Death in Epilepsy. Front Neurol 2017; 8:544. [PMID: 29085330 PMCID: PMC5650686 DOI: 10.3389/fneur.2017.00544] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/27/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sudden unexpected death in epilepsy (SUDEP) is common among young people with epilepsy. Individuals who are at high risk of SUDEP exhibit regional brain structural and functional connectivity (FC) alterations compared with low-risk patients. However, less is known about network-based FC differences among critical cortical and subcortical autonomic regulatory brain structures in temporal lobe epilepsy (TLE) patients at high risk of SUDEP. METHODS 32 TLE patients were risk-stratified according to the following clinical criteria: age of epilepsy onset, duration of epilepsy, frequency of generalized tonic-clonic seizures, and presence of nocturnal seizures, resulting in 14 high-risk and 18 low-risk cases. Resting-state functional magnetic resonance imaging (rs-fMRI) signal time courses were extracted from 11 bilateral cortical and subcortical brain regions involved in autonomic and other regulatory processes. After computing all pairwise correlations, FC matrices were analyzed using the network-based statistic. FC strength among the 11 brain regions was compared between the high- and low-risk patients. Increases and decreases in FC were sought, using high-risk > low-risk and low-risk > high-risk contrasts (with covariates age, gender, lateralization of epilepsy, and presence of hippocampal sclerosis). RESULTS High-risk TLE patients showed a subnetwork with significantly reduced FC (t = 2.5, p = 0.029) involving the thalamus, brain stem, anterior cingulate, putamen and amygdala, and a second subnetwork with significantly elevated FC (t = 2.1, p = 0.031), which extended to medial/orbital frontal cortex, insula, hippocampus, amygdala, subcallosal cortex, brain stem, thalamus, caudate, and putamen. CONCLUSION TLE patients at high risk of SUDEP showed widespread FC differences between key autonomic regulatory brain regions compared to those at low risk. The altered FC revealed here may help to shed light on the functional correlates of autonomic disturbances in epilepsy and mechanisms involved in SUDEP. Furthermore, these findings represent possible objective biomarkers which could help to identify high-risk patients and enhance SUDEP risk stratification via the use of non-invasive neuroimaging, which would require validation in larger cohorts, with extension to patients with other epilepsies and subjects who succumb to SUDEP.
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Affiliation(s)
- Luke A Allen
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Ronald M Harper
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,UCLA Brain Research Institute, Los Angeles, CA, United States
| | - Rajesh Kumar
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,UCLA Brain Research Institute, Los Angeles, CA, United States.,Department of Anaesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Department of Bioengineering, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Maxime Guye
- Aix Marseille University, CNRS, CRMBM UMR 7339, Marseille, France
| | - Jennifer A Ogren
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Samden D Lhatoo
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Epilepsy Centre, Neurological Institute, University Hospitals Case Medical Centre, Cleveland, OH, United States
| | - Louis Lemieux
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom
| | - Catherine A Scott
- Institute of Neurology, University College London, London, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Sjoerd B Vos
- Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Translational Imaging Group, University College London, London, United Kingdom
| | - Sandhya Rani
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Epilepsy Centre, Neurological Institute, University Hospitals Case Medical Centre, Cleveland, OH, United States
| | - Beate Diehl
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
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15
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Metzler M, Govindan R, Al-Shargabi T, Vezina G, Andescavage N, Wang Y, du Plessis A, Massaro AN. Pattern of brain injury and depressed heart rate variability in newborns with hypoxic ischemic encephalopathy. Pediatr Res 2017; 82:438-443. [PMID: 28376079 PMCID: PMC5570625 DOI: 10.1038/pr.2017.94] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 03/17/2017] [Indexed: 12/27/2022]
Abstract
BackgroundDecreased heart rate variability (HRV) is a measure of autonomic dysfunction and brain injury in newborns with hypoxic ischemic encephalopathy (HIE). This study aimed to characterize the relationship between HRV and brain injury pattern using magnetic resonance imaging (MRI) in newborns with HIE undergoing therapeutic hypothermia.MethodsHRV metrics were quantified in the time domain (αS, αL, and root mean square at short (RMSS) and long (RMSL) timescales) and frequency domain (relative low-(LF) and high-frequency (HF) power) over 24-27 h of life. The brain injury pattern shown by MRI was classified as no injury, pure cortical/white matter injury, mixed watershed/mild basal ganglia injury, predominant basal ganglia or global injury, and death. HRV metrics were compared across brain injury pattern groups using a random-effects mixed model.ResultsData from 74 infants were analyzed. Brain injury pattern was significantly associated with the degree of HRV suppression. Specifically, negative associations were observed between the pattern of brain injury and RMSS (estimate -0.224, SE 0.082, P=0.006), RMSL (estimate -0.189, SE 0.082, P=0.021), and LF power (estimate -0.044, SE 0.016, P=0.006).ConclusionDegree of HRV depression is related to the pattern of brain injury. HRV monitoring may provide insights into the pattern of brain injury at the bedside.
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Affiliation(s)
- Marina Metzler
- Division of Fetal and Transitional Medicine, Children’s National Health System, Washington, DC
| | - Rathinaswamy Govindan
- Division of Fetal and Transitional Medicine, Children’s National Health System, Washington, DC,The George Washington University School of Medicine, Washington, DC
| | - Tareq Al-Shargabi
- Division of Fetal and Transitional Medicine, Children’s National Health System, Washington, DC
| | - Gilbert Vezina
- Division of Diagnostic Imaging and Radiology, Children’s National Health System, Washington, DC,The George Washington University School of Medicine, Washington, DC
| | - Nickie Andescavage
- Divsion of Neonatology, Children’s National Health System, Washington, DC,The George Washington University School of Medicine, Washington, DC
| | - Yunfei Wang
- Division of Biostatistics and Study Methodology, Children’s National Health System, Washington, DC,The George Washington University School of Medicine, Washington, DC
| | - Adre du Plessis
- Division of Fetal and Transitional Medicine, Children’s National Health System, Washington, DC,The George Washington University School of Medicine, Washington, DC
| | - An N Massaro
- Division of Fetal and Transitional Medicine, Children’s National Health System, Washington, DC,Divsion of Neonatology, Children’s National Health System, Washington, DC,The George Washington University School of Medicine, Washington, DC
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16
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Chouchou F, Bouet R, Pichot V, Catenoix H, Mauguière F, Jung J. The neural bases of ictal tachycardia in temporal lobe seizures. Clin Neurophysiol 2017; 128:1810-1819. [PMID: 28709879 DOI: 10.1016/j.clinph.2017.06.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/03/2017] [Accepted: 06/02/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Due to limited information from scalp electroencephalographic (EEG) recordings, brain areas driving changes in cardiac rhythm during Temporal lobe (TL) seizures are not clearly identified. Using stereotactic EEG (SEEG) recordings, we aimed at identifying which of the brain regions involved in autonomic control trigger ictal tachycardia. METHODS The neural activity of several mesial temporal lobe structures including amygdala, hippocampus, insula, and lateral temporal lobe recorded with SEEG were collected during 37 TL seizures in 9 patients, using indices based on High Frequency Activity (HFA). R-R intervals (RR) monitoring and time-frequency spectral analysis were performed to assess parasympathetic (High frequency power (HF)) and sympathetic (Low frequency/High frequency (LF/HF) ratio) reactivities. RESULTS Tachycardia was associated with a significant increase in LF/HF ratio and decrease in HF. Autonomic cardiac changes were accompanied by simultaneous SEEG signal changes with an increase in seizure-related HFA in anterior hippocampal formation and amygdala, but not in insula. CONCLUSION In our sample, TL seizures are thus accompanied by an early decrease in parasympathetic control of cardiac rhythm and by an increase of sympathetic tone, concomitant to seizure activity in anterior hippocampus and amygdala. SIGNIFICANCE These results support a pivotal role of hippocampus and amygdala in tachycardia occurring during TL seizures.
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Affiliation(s)
- Florian Chouchou
- NeuroPain Lab, Lyon Neuroscience Research Center - Inserm U 1028/CNRS UMR 5292, University of Lyon, France.
| | - Romain Bouet
- Dycog Lab, Lyon Neuroscience Research Center - Inserm U 1028/CNRS UMR 5292, University of Lyon, France
| | - Vincent Pichot
- Clinical Physiology Department, CHU Nord, Saint-Etienne, France; EA 4607 SNA-EPIS Lab, University of Jean Monnet, University of Lyon, Saint-Etienne, France
| | - Hélène Catenoix
- Epilepsy and Functional Neurology Department, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - François Mauguière
- NeuroPain Lab, Lyon Neuroscience Research Center - Inserm U 1028/CNRS UMR 5292, University of Lyon, France; Epilepsy and Functional Neurology Department, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Claude Bernard Lyon 1 University, Lyon, France
| | - Julien Jung
- Dycog Lab, Lyon Neuroscience Research Center - Inserm U 1028/CNRS UMR 5292, University of Lyon, France; Epilepsy and Functional Neurology Department, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
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17
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Ginty AT, Kraynak TE, Fisher JP, Gianaros PJ. Cardiovascular and autonomic reactivity to psychological stress: Neurophysiological substrates and links to cardiovascular disease. Auton Neurosci 2017; 207:2-9. [PMID: 28391987 DOI: 10.1016/j.autneu.2017.03.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 12/30/2022]
Abstract
Psychologically stressful experiences evoke changes in cardiovascular physiology that may influence risk for cardiovascular disease (CVD). But what are the neural circuits and intermediate physiological pathways that link stressful experiences to cardiovascular changes that might in turn confer disease risk? This question is important because it has broader implications for our understanding of the neurophysiological pathways that link stressful and other psychological experiences to physical health. This review highlights selected findings from brain imaging studies of stressor-evoked cardiovascular reactivity and CVD risk. Converging evidence across these studies complements animal models and patient lesion studies to suggest that a network of cortical, limbic, and brainstem areas for central autonomic and physiological control are important for generating and regulating stressor-evoked cardiovascular reactivity via visceromotor and viscerosensory mechanisms. Emerging evidence further suggests that these brain areas may play a role in stress-related CVD risk, specifically by their involvement in mediating metabolically-dysregulated or extreme stressor-evoked cardiovascular reactions. Contextually, the research reviewed here offers an example of how brain imaging and health neuroscience methods can be integrated to address open and mechanistic questions about the neurophysiological pathways linking psychological stress and physical health.
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Affiliation(s)
- Annie T Ginty
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.
| | - Thomas E Kraynak
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - James P Fisher
- School of Sport, Exercise, and Rehabiliation Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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18
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Fassini A, Resstel LBM, Corrêa FMA. Prelimbic cortex GABA A receptors are involved in the mediation of restraint stress-evoked cardiovascular responses. Stress 2016; 19:576-584. [PMID: 27582393 DOI: 10.1080/10253890.2016.1231177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Stress is a response of the organism to homeostasis-threatening stimuli and is coordinated by two main neural systems: the hypothalamic-pituitary-adrenal and the autonomic nervous system. Acute restraint stress (RS) is a model of unavoidable stress, which is characterized by autonomic responses including an increase in mean arterial pressure (MAP) and heart rate (HR), as well as a drop in tail temperature. The prelimbic cortex (PL) has been implicated in the modulation of functional responses caused by RS. The present study aimed to evaluate the role of PL GABAergic neurotransmission in the modulation of autonomic changes induced by RS. Bilateral microinjection of the GABAA receptor antagonist bicuculline methiodide into the PL reduced pressor and tachycardic responses evoked by RS, in a dose-dependent manner, without affecting the tail temperature drop evoked by RS. In order to investigate which peripheral autonomic effector modulated the reduction in RS-cardiovascular responses caused by the blockade of PL GABAA receptors, rats were intravenously pretreated with either atenolol or homatropine methylbromide. The blockade of the cardiac sympathetic nervous system with atenolol blunted the reducing effect of PL treatment with bicuculline methiodide on RS-evoked pressor and tachycardic responses. The blockade of the parasympathetic nervous system with homatropine methylbromide, regardless of affecting the beginning of the tachycardic response, did not impact on the reduction of RS-evoked tachycardic and pressor responses caused by the PL treatment with bicuculline methiodide. The present results indicate that both cardiac sympathetic and parasympathetic activities are involved in the reduction of RS-evoked cardiovascular responses evidenced after the blockade of PL GABAA receptors by bicuculline methiodide.
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Affiliation(s)
- Aline Fassini
- a Department of Pharmacology of the School of Medicine of Ribeirão Preto , University of São Paulo , Ribeirão Preto , São Paulo , Brazil
| | - Leonardo B M Resstel
- a Department of Pharmacology of the School of Medicine of Ribeirão Preto , University of São Paulo , Ribeirão Preto , São Paulo , Brazil
| | - Fernando M A Corrêa
- a Department of Pharmacology of the School of Medicine of Ribeirão Preto , University of São Paulo , Ribeirão Preto , São Paulo , Brazil
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19
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Motor, cognitive, and affective areas of the cerebral cortex influence the adrenal medulla. Proc Natl Acad Sci U S A 2016; 113:9922-7. [PMID: 27528671 DOI: 10.1073/pnas.1605044113] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Modern medicine has generally viewed the concept of "psychosomatic" disease with suspicion. This view arose partly because no neural networks were known for the mind, conceptually associated with the cerebral cortex, to influence autonomic and endocrine systems that control internal organs. Here, we used transneuronal transport of rabies virus to identify the areas of the primate cerebral cortex that communicate through multisynaptic connections with a major sympathetic effector, the adrenal medulla. We demonstrate that two broad networks in the cerebral cortex have access to the adrenal medulla. The larger network includes all of the cortical motor areas in the frontal lobe and portions of somatosensory cortex. A major component of this network originates from the supplementary motor area and the cingulate motor areas on the medial wall of the hemisphere. These cortical areas are involved in all aspects of skeletomotor control from response selection to motor preparation and movement execution. The second, smaller network originates in regions of medial prefrontal cortex, including a major contribution from pregenual and subgenual regions of anterior cingulate cortex. These cortical areas are involved in higher-order aspects of cognition and affect. These results indicate that specific multisynaptic circuits exist to link movement, cognition, and affect to the function of the adrenal medulla. This circuitry may mediate the effects of internal states like chronic stress and depression on organ function and, thus, provide a concrete neural substrate for some psychosomatic illness.
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20
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Bär KJ, Herbsleb M, Schumann A, de la Cruz F, Gabriel HW, Wagner G. Hippocampal-Brainstem Connectivity Associated with Vagal Modulation after an Intense Exercise Intervention in Healthy Men. Front Neurosci 2016; 10:145. [PMID: 27092046 PMCID: PMC4823309 DOI: 10.3389/fnins.2016.00145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/21/2016] [Indexed: 12/29/2022] Open
Abstract
Regular physical exercise leads to increased vagal modulation of the cardiovascular system. A combination of peripheral and central processes has been proposed to underlie this adaptation. However, specific changes in the central autonomic network have not been described in human in more detail. We hypothesized that the anterior hippocampus known to be influenced by regular physical activity might be involved in the development of increased vagal modulation after a 6 weeks high intensity intervention in young healthy men (exercise group: n = 17, control group: n = 17). In addition to the determination of physical capacity before and after the intervention, we used resting state functional magnetic resonance imaging and simultaneous heart rate variability assessment. We detected a significant increase of the power output at the anaerobic threshold of 11.4% (p < 0.001), the maximum power output Pmax of 11.2% (p < 0.001), and VO2max adjusted for body weight of 4.7% (p < 0.001) in the exercise group (EG). Comparing baseline (T0) and post-exercise (T1) values of parasympathetic modulation of the exercise group, we observed a trend for a decrease in heart rate (p < 0.06) and a significant increase of vagal modulation as indicated by RMSSD (p < 0.026) during resting state. In the whole brain analysis, we found that the connectivity pattern of the right anterior hippocampus (aHC) was specifically altered to the ventromedial anterior cortex, the dorsal striatum and to the dorsal vagal complex (DVC) in the brainstem. Moreover, we observed a highly significant negative correlation between increased RMSSD after exercise and decreased functional connectivity from the right aHC to DVC (r = -0.69, p = 0.003). This indicates that increased vagal modulation was associated with functional connectivity between aHC and the DVC. In conclusion, our findings suggest that exercise associated changes in anterior hippocampal function might be involved in increased vagal modulation.
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Affiliation(s)
- Karl-Jürgen Bär
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena Jena, Germany
| | - Marco Herbsleb
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital JenaJena, Germany; Clinical Exercise Physiology, Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of JenaJena, Germany
| | - Andy Schumann
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena Jena, Germany
| | - Feliberto de la Cruz
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena Jena, Germany
| | - Holger W Gabriel
- Clinical Exercise Physiology, Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of Jena Jena, Germany
| | - Gerd Wagner
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena Jena, Germany
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21
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Kapa S, DeSimone CV, Asirvatham SJ. Innervation of the heart: An invisible grid within a black box. Trends Cardiovasc Med 2016; 26:245-57. [PMID: 26254961 PMCID: PMC4706824 DOI: 10.1016/j.tcm.2015.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 02/07/2023]
Abstract
Autonomic control of cardiovascular function is mediated by a complex interplay between central, peripheral, and innate cardiac components. This interplay is what mediates the normal cardiovascular response to physiologic and pathologic stressors, including blood pressure, cardiac contractile function, and arrhythmias. However, in order to understand how modern therapies directly affecting autonomic function may be harnessed to treat various cardiovascular disease states requires an intimate understanding of anatomic and physiologic features of the innervation of the heart. Thus, in this review, we focus on defining features of the central, peripheral, and cardiac components of cardiac innervation, how each component may contribute to dysregulation of normal cardiac function in various disease states, and how modulation of these components may offer therapeutic options for these diseases.
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Affiliation(s)
- Suraj Kapa
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Christopher V DeSimone
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN; Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN.
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22
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Oppenheimer S, Cechetto D. The Insular Cortex and the Regulation of Cardiac Function. Compr Physiol 2016; 6:1081-133. [DOI: 10.1002/cphy.c140076] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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23
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Anazodo UC, Shoemaker JK, Suskin N, Ssali T, Wang DJJ, St Lawrence KS. Impaired Cerebrovascular Function in Coronary Artery Disease Patients and Recovery Following Cardiac Rehabilitation. Front Aging Neurosci 2016; 7:224. [PMID: 26779011 PMCID: PMC4700211 DOI: 10.3389/fnagi.2015.00224] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/19/2015] [Indexed: 01/01/2023] Open
Abstract
Coronary artery disease (CAD) poses a risk to the cerebrovascular function of older adults and has been linked to impaired cognitive abilities. Using magnetic resonance perfusion imaging, we investigated changes in resting cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to hypercapnia in 34 CAD patients and 21 age-matched controls. Gray matter volume (GMV) images were acquired and used as a confounding variable to separate changes in structure from function. Compared to healthy controls, CAD patients demonstrated reduced CBF in the superior frontal, anterior cingulate (AC), insular, pre- and post-central gyri, middle temporal, and superior temporal regions. Subsequent analysis of these regions demonstrated decreased CVR in the AC, insula, post-central and superior frontal regions. Except in the superior frontal and precentral regions, regional reductions in CBF and CVR were identified in brain areas where no detectable reductions in GMV were observed, demonstrating that these vascular changes were independent of brain atrophy. Because aerobic fitness training can improve brain function, potential changes in regional CBF were investigated in the CAD patients after completion of a 6-months exercise-based cardiac rehabilitation program. Increased CBF was observed in the bilateral AC, as well as recovery of CBF in the dorsal aspect of the right AC, where the magnitude of increased CBF was roughly equal to the reduction in CBF at baseline compared to controls. These exercise-related improvements in CBF in the AC is intriguing given the role of this area in cognitive processing and regulation of cardiovascular autonomic control.
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Affiliation(s)
- Udunna C Anazodo
- Lawson Health Research Institute, LondonON, Canada; Department of Medical Biophysics, Western University, LondonON, Canada; Laboratory for Brain and Heart Health, School of Kinesiology, Western University, LondonON, Canada
| | - J K Shoemaker
- Department of Medical Biophysics, Western University, LondonON, Canada; Laboratory for Brain and Heart Health, School of Kinesiology, Western University, LondonON, Canada
| | - Neville Suskin
- London Health Sciences Cardiology Rehabilitation Program, London ON, Canada
| | - Tracy Ssali
- Lawson Health Research Institute, LondonON, Canada; Department of Medical Biophysics, Western University, LondonON, Canada
| | - Danny J J Wang
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles CA, USA
| | - Keith S St Lawrence
- Lawson Health Research Institute, LondonON, Canada; Department of Medical Biophysics, Western University, LondonON, Canada
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24
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Shoemaker JK, Badrov MB, Al-Khazraji BK, Jackson DN. Neural Control of Vascular Function in Skeletal Muscle. Compr Physiol 2015; 6:303-29. [PMID: 26756634 DOI: 10.1002/cphy.c150004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The sympathetic nervous system represents a fundamental homeostatic system that exerts considerable control over blood pressure and the distribution of blood flow. This process has been referred to as neurovascular control. Overall, the concept of neurovascular control includes the following elements: efferent postganglionic sympathetic nerve activity, neurotransmitter release, and the end organ response. Each of these elements reflects multiple levels of control that, in turn, affect complex patterns of change in vascular contractile state. Primarily, this review discusses several of these control layers that combine to produce the integrative physiology of reflex vascular control observed in skeletal muscle. Beginning with three reflexes that provide somewhat dissimilar vascular patterns of response despite similar changes in efferent sympathetic nerve activity, namely, the baroreflex, chemoreflex, and muscle metaboreflex, the article discusses the anatomical and physiological bases of postganglionic sympathetic discharge patterns and recruitment, neurotransmitter release and management, and details of regional variations of receptor density and responses within the microvascular bed. Challenges are addressed regarding the fundamentals of measurement and how conclusions from one response or vascular segment should not be used as an indication of neurovascular control as a generalized physiological dogma. Whereas the bulk of the article focuses on the vasoconstrictor function of sympathetic neurovascular integration, attention is also given to the issues of sympathetic vasodilation as well as the impact of chronic changes in sympathetic activation and innervation on vascular health. © 2016 American Physiological Society.
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Affiliation(s)
- J K Shoemaker
- School of Kinesiology, Western University, London, Ontario, Canada.,Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - M B Badrov
- School of Kinesiology, Western University, London, Ontario, Canada
| | - B K Al-Khazraji
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - D N Jackson
- Department of Medical Biophysics, Western University, London, Ontario, Canada
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25
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Aleksandrov VG, Aleksandrova NP. The role of the insular cortex in the control of visceral functions. ACTA ACUST UNITED AC 2015. [DOI: 10.1134/s0362119715050023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Shoemaker JK, Goswami R. Forebrain neurocircuitry associated with human reflex cardiovascular control. Front Physiol 2015; 6:240. [PMID: 26388780 PMCID: PMC4555962 DOI: 10.3389/fphys.2015.00240] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/10/2015] [Indexed: 12/30/2022] Open
Abstract
Physiological homeostasis depends upon adequate integration and responsiveness of sensory information with the autonomic nervous system to affect rapid and effective adjustments in end organ control. Dysregulation of the autonomic nervous system leads to cardiovascular disability with consequences as severe as sudden death. The neural pathways involved in reflexive autonomic control are dependent upon brainstem nuclei but these receive modulatory inputs from higher centers in the midbrain and cortex. Neuroimaging technologies have allowed closer study of the cortical circuitry related to autonomic cardiovascular adjustments to many stressors in awake humans and have exposed many forebrain sites that associate strongly with cardiovascular arousal during stress including the medial prefrontal cortex, insula cortex, anterior cingulate, amygdala and hippocampus. Using a comparative approach, this review will consider the cortical autonomic circuitry in rodents and primates with a major emphasis on more recent neuroimaging studies in awake humans. A challenge with neuroimaging studies is their interpretation in view of multiple sensory, perceptual, emotive and/or reflexive components of autonomic responses. This review will focus on those responses related to non-volitional baroreflex control of blood pressure and also on the coordinated responses to non-fatiguing, non-painful volitional exercise with particular emphasis on the medial prefrontal cortex and the insula cortex.
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Affiliation(s)
- J Kevin Shoemaker
- School of Kinesiology, The University of Western Ontario London, ON, Canada ; Department of Physiology and Pharmacology, The University of Western Ontario London, ON, Canada
| | - Ruma Goswami
- School of Kinesiology, The University of Western Ontario London, ON, Canada
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27
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Heinonen I, Kalliokoski KK, Hannukainen JC, Duncker DJ, Nuutila P, Knuuti J. Organ-specific physiological responses to acute physical exercise and long-term training in humans. Physiology (Bethesda) 2015; 29:421-36. [PMID: 25362636 DOI: 10.1152/physiol.00067.2013] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Virtually all tissues in the human body rely on aerobic metabolism for energy production and are therefore critically dependent on continuous supply of oxygen. Oxygen is provided by blood flow, and, in essence, changes in organ perfusion are also closely associated with alterations in tissue metabolism. In response to acute exercise, blood flow is markedly increased in contracting skeletal muscles and myocardium, but perfusion in other organs (brain and bone) is only slightly enhanced or is even reduced (visceral organs). Despite largely unchanged metabolism and perfusion, repeated exposures to altered hemodynamics and hormonal milieu produced by acute exercise, long-term exercise training appears to be capable of inducing effects also in tissues other than muscles that may yield health benefits. However, the physiological adaptations and driving-force mechanisms in organs such as brain, liver, pancreas, gut, bone, and adipose tissue, remain largely obscure in humans. Along these lines, this review integrates current information on physiological responses to acute exercise and to long-term physical training in major metabolically active human organs. Knowledge is mostly provided based on the state-of-the-art, noninvasive human imaging studies, and directions for future novel research are proposed throughout the review.
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Affiliation(s)
- Ilkka Heinonen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Turku University Hospital, Turku, Finland; Department of Cardiology, Division of Experimental Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kari K Kalliokoski
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Jarna C Hannukainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Dirk J Duncker
- Department of Cardiology, Division of Experimental Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Department of Medicine, University of Turku and Turku University Hospital, Turku, Finland; and
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
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28
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Wandschneider B, Koepp M, Scott C, Micallef C, Balestrini S, Sisodiya SM, Thom M, Harper RM, Sander JW, Vos SB, Duncan JS, Lhatoo S, Diehl B. Structural imaging biomarkers of sudden unexpected death in epilepsy. Brain 2015; 138:2907-19. [PMID: 26264515 PMCID: PMC4671481 DOI: 10.1093/brain/awv233] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 06/26/2015] [Indexed: 01/23/2023] Open
Abstract
The mechanisms underlying sudden unexpected death in epilepsy (SUDEP) remain unclear. Wandschneider et al. reveal increased amygdalo-hippocampal volume in cases of SUDEP and in individuals at high risk, compared to individuals at low risk and people without epilepsy. Findings are consistent with histopathological reports in sudden infant death syndrome. Sudden unexpected death in epilepsy is a major cause of premature death in people with epilepsy. We aimed to assess whether structural changes potentially attributable to sudden death pathogenesis were present on magnetic resonance imaging in people who subsequently died of sudden unexpected death in epilepsy. In a retrospective, voxel-based analysis of T1 volume scans, we compared grey matter volumes in 12 cases of sudden unexpected death in epilepsy (two definite, 10 probable; eight males), acquired 2 years [median, interquartile range (IQR) 2.8] before death [median (IQR) age at scanning 33.5 (22) years], with 34 people at high risk [age 30.5 (12); 19 males], 19 at low risk [age 30 (7.5); 12 males] of sudden death, and 15 healthy controls [age 37 (16); seven males]. At-risk subjects were defined based on risk factors of sudden unexpected death in epilepsy identified in a recent combined risk factor analysis. We identified increased grey matter volume in the right anterior hippocampus/amygdala and parahippocampus in sudden death cases and people at high risk, when compared to those at low risk and controls. Compared to controls, posterior thalamic grey matter volume, an area mediating oxygen regulation, was reduced in cases of sudden unexpected death in epilepsy and subjects at high risk. The extent of reduction correlated with disease duration in all subjects with epilepsy. Increased amygdalo-hippocampal grey matter volume with right-sided changes is consistent with histo-pathological findings reported in sudden infant death syndrome. We speculate that the right-sided predominance reflects asymmetric central influences on autonomic outflow, contributing to cardiac arrhythmia. Pulvinar damage may impair hypoxia regulation. The imaging findings in sudden unexpected death in epilepsy and people at high risk may be useful as a biomarker for risk-stratification in future studies.
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Affiliation(s)
- Britta Wandschneider
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK
| | - Matthias Koepp
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK
| | - Catherine Scott
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK
| | - Caroline Micallef
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK
| | - Simona Balestrini
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK 3 Neuroscience Department, Polytechnic University of Marche, Ancona, Italy
| | - Sanjay M Sisodiya
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK 4 The Centre for SUDEP Research, National Institute of Neurological Disorders and Stroke, USA
| | - Maria Thom
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK 4 The Centre for SUDEP Research, National Institute of Neurological Disorders and Stroke, USA
| | - Ronald M Harper
- 4 The Centre for SUDEP Research, National Institute of Neurological Disorders and Stroke, USA 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Josemir W Sander
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK 4 The Centre for SUDEP Research, National Institute of Neurological Disorders and Stroke, USA 5 Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sjoerd B Vos
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK 6 Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - John S Duncan
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK
| | - Samden Lhatoo
- 4 The Centre for SUDEP Research, National Institute of Neurological Disorders and Stroke, USA 7 Translational Imaging Group, Centre for Medical Image Computing, University College London, London, UK
| | - Beate Diehl
- 1 NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London WC1N 3BG, UK 2 Epilepsy Society, Chalfont St Peter SL9 0RJ, UK 4 The Centre for SUDEP Research, National Institute of Neurological Disorders and Stroke, USA
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Charkoudian N, Wallin BG. Sympathetic neural activity to the cardiovascular system: integrator of systemic physiology and interindividual characteristics. Compr Physiol 2014; 4:825-50. [PMID: 24715570 DOI: 10.1002/cphy.c130038] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The sympathetic nervous system is a ubiquitous, integrating controller of myriad physiological functions. In the present article, we review the physiology of sympathetic neural control of cardiovascular function with a focus on integrative mechanisms in humans. Direct measurement of sympathetic neural activity (SNA) in humans can be accomplished using microneurography, most commonly performed in the peroneal (fibular) nerve. In humans, muscle SNA (MSNA) is composed of vasoconstrictor fibers; its best-recognized characteristic is its participation in transient, moment-to-moment control of arterial blood pressure via the arterial baroreflex. This property of MSNA contributes to its typical "bursting" pattern which is strongly linked to the cardiac cycle. Recent evidence suggests that sympathetic neural mechanisms and the baroreflex have important roles in the long term control of blood pressure as well. One of the striking characteristics of MSNA is its large interindividual variability. However, in young, normotensive humans, higher MSNA is not linked to higher blood pressure due to balancing influences of other cardiovascular variables. In men, an inverse relationship between MSNA and cardiac output is a major factor in this balance, whereas in women, beta-adrenergic vasodilation offsets the vasoconstrictor/pressor effects of higher MSNA. As people get older (and in people with hypertension) higher MSNA is more likely to be linked to higher blood pressure. Skin SNA (SSNA) can also be measured in humans, although interpretation of SSNA signals is complicated by multiple types of neurons involved (vasoconstrictor, vasodilator, sudomotor and pilomotor). In addition to blood pressure regulation, the sympathetic nervous system contributes to cardiovascular regulation during numerous other reflexes, including those involved in exercise, thermoregulation, chemoreflex regulation, and responses to mental stress.
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Affiliation(s)
- N Charkoudian
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
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30
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Autonomic responses to exercise: where is central command? Auton Neurosci 2014; 188:3-4. [PMID: 25458428 DOI: 10.1016/j.autneu.2014.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/18/2014] [Accepted: 10/13/2014] [Indexed: 11/24/2022]
Abstract
A central command is thought to involve a signal arising in a central area of the brain eliciting a parallel activation of the autonomic nervous system and skeletal muscle contraction during exercise. Although much of the neural circuitry involved in autonomic control has been identified, defining the specific higher brain region(s) serving in a central command capacity has proven more challenging. Investigators have been faced with redundancies in regulatory systems, feedback mechanisms and the complexities ofhuman neural connectivity. Several studies have attempted to address these issues and provide more definitive neuroanatomical information. However, none have clearly answered the question, "where is central command?"
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Allen B, Jennings JR, Gianaros PJ, Thayer JF, Manuck SB. Resting high-frequency heart rate variability is related to resting brain perfusion. Psychophysiology 2014; 52:277-87. [PMID: 25174686 DOI: 10.1111/psyp.12321] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/28/2014] [Indexed: 12/13/2022]
Abstract
We examined the neural correlates of resting cardiac vagal activity in a sample of 432 participants (206 male; 61 African American; mean age 42 years). Pulsed arterial spin labeling was used to quantify whole brain and regional cerebral blood flow at rest. High-frequency heart rate variability (HF-HRV) was used to measure cardiac vagal activity at rest. The primary aim was to determine whether brain regions implicated in regulating cardiac vagal reactions were also related to cardiac vagal activity at rest, and whether these associations varied by sex or race. Brain areas previously related to vagal reactivity were related to resting HF-HRV. Directionality of relationships differed between overall and regional flows. Some relationships were only observed in women and African Americans. There appears to be communality between brain regions associated with task-induced vagal reactivity and those associated with resting cardiac vagal activity.
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Affiliation(s)
- Ben Allen
- Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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32
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Sclocco R, Kim J, Garcia RG, Sheehan JD, Beissner F, Bianchi AM, Cerutti S, Kuo B, Barbieri R, Napadow V. Brain Circuitry Supporting Multi-Organ Autonomic Outflow in Response to Nausea. Cereb Cortex 2014; 26:485-97. [PMID: 25115821 DOI: 10.1093/cercor/bhu172] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
While autonomic outflow is an important co-factor of nausea physiology, central control of this outflow is poorly understood. We evaluated sympathetic (skin conductance level) and cardiovagal (high-frequency heart rate variability) modulation, collected synchronously with functional MRI (fMRI) data during nauseogenic visual stimulation aimed to induce vection in susceptible individuals. Autonomic data guided analysis of neuroimaging data, using a stimulus-based (analysis windows set by visual stimulation protocol) and percept-based (windows set by subjects' ratings) approach. Increased sympathetic and decreased parasympathetic modulation was associated with robust and anti-correlated brain activity in response to nausea. Specifically, greater autonomic response was associated with reduced fMRI signal in brain regions such as the insula, suggesting an inhibitory relationship with premotor brainstem nuclei. Interestingly, some sympathetic/parasympathetic specificity was noted. Activity in default mode network and visual motion areas was anti-correlated with parasympathetic outflow at peak nausea. In contrast, lateral prefrontal cortical activity was anti-correlated with sympathetic outflow during recovery, soon after cessation of nauseogenic stimulation. These results suggest divergent central autonomic control for sympathetic and parasympathetic response to nausea. Autonomic outflow and the central autonomic network underlying ANS response to nausea may be an important determinant of overall nausea intensity and, ultimately, a potential therapeutic target.
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Affiliation(s)
- Roberta Sclocco
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jieun Kim
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Ronald G Garcia
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - James D Sheehan
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Florian Beissner
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Anna M Bianchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Sergio Cerutti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Braden Kuo
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Riccardo Barbieri
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vitaly Napadow
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA Department of Biomedical Engineering, Kyunghee University, Yongin, Korea
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33
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Khalsa SS, Shahabi L, Ajijola OA, Bystritsky A, Naliboff BD, Shivkumar K. Synergistic application of cardiac sympathetic decentralization and comprehensive psychiatric treatment in the management of anxiety and electrical storm. Front Integr Neurosci 2014; 7:98. [PMID: 24427121 PMCID: PMC3878030 DOI: 10.3389/fnint.2013.00098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/07/2013] [Indexed: 11/13/2022] Open
Abstract
We report here, for the first time, two cases demonstrating a synergistic application of bilateral cardiac sympathetic decentralization and multimodal psychiatric treatment for the assessment and management of anxiety following recurrent Implantable Cardioverter Defibrillator (ICD) shocks. In a first case the combination of bilateral cardiac sympathetic decentralization (BCSD), cognitive behavioral psychotherapy and anxiolytic medication was sufficient to attenuate the patient's symptoms and maladaptive behaviors, with a maintained benefit at 1 year. Among the more prominent subjective changes in the post-lesion state we observed a decrease in aversive interoceptive sensations, particularly of the heartbeat. The patient continued to experience cognitive threat appraisals on a frequent basis, although these were no longer incapacitating. In a second case, we report the effect of BCSD on autonomic tone and subjective state. In the post-lesion state we observed attenuated sympathetic responses to the valsalva maneuver, isometric handgrip and mental arithmetic stressor, including decreased systolic and diastolic blood pressure and, decreased skin conductance. Collectively, these preliminary findings suggest that an integrative, multidisciplinary approach to treating anxiety disorders in the setting of ventricular arrhythmias and recurrent ICD shocks can result in sustained improvements in physical, psychological, and functional status. These findings raise the possibility of a potential role for the stellate ganglion in the modulation of emotional experience and afferent transmission of interoceptive information to the central nervous system.
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Affiliation(s)
- Sahib S Khalsa
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, CA, USA ; Department of Medicine, UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California Los Angeles Los Angeles, CA, USA
| | - Leila Shahabi
- Department of Medicine, Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California Los Angeles Los Angeles, CA, USA
| | - Olujimi A Ajijola
- Department of Medicine, UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California Los Angeles Los Angeles, CA, USA
| | - Alexander Bystritsky
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Bruce D Naliboff
- Department of Medicine, Oppenheimer Family Center for Neurobiology of Stress, David Geffen School of Medicine, University of California Los Angeles Los Angeles, CA, USA
| | - Kalyanam Shivkumar
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, CA, USA ; Department of Medicine, UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California Los Angeles Los Angeles, CA, USA
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34
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Zhang J, Zhang H, Chen J, Fan M, Gong Q. Structural modulation of brain development by oxygen: evidence on adolescents migrating from high altitude to sea level environment. PLoS One 2013; 8:e67803. [PMID: 23874449 PMCID: PMC3706444 DOI: 10.1371/journal.pone.0067803] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 05/27/2013] [Indexed: 01/08/2023] Open
Abstract
The present study aimed to investigate structural modulation of brain by high level of oxygen during its peak period of development. Voxel-based morphometry analysis of gray matter (GM) and white matter (WM) volumes and Tract-Based Spatial Statistics analysis of WM fractional anisotropy (FA) and mean diffusion (MD) based on MRI images were carried out on 21 Tibetan adolencents (15-18 years), who were born and raised in Qinghai-Tibetan Plateau (2900-4700 m) and have lived at sea level (SL) in the last 4 years. The control group consisted of matched Tibetan adolescents born and raised at high altitude all the time. SL immigrants had increased GM volume in the left insula, left inferior parietal gyrus, and right superior parietal gyrus and decreased GM in the left precentral cortex and multiple sites in cerebellar cortex (left lobule 8, bilateral lobule 6 and crus 1/2). Decreased WM volume was found in the right superior frontal gyrus in SL immigrants. SL immigrants had higher FA and lower MD at multiple sites of WM tracts. Moreover, we detected changes in ventilation and circulation. GM volume in cerebellum lobule 8 positively correlated with diastolic pressure, while GM volume in insula positively correlated vital capacity and hypoxic ventilatory response. Our finding indicate that the structural modulations of GM by high level of oxygen during its peak period of development are related to respiratory and circulatory regulations, while the modulation in WM mainly exhibits an enhancement in myelin maturation.
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Affiliation(s)
- Jiaxing Zhang
- Department of Physiology and Neurobiology, Medical College of Xiamen University, Xiamen, China
| | - Haiyan Zhang
- Department of Physiology and Neurobiology, Medical College of Xiamen University, Xiamen, China
- Department of Physiology, Weifang Nursing Vocational College, Weifang, China
| | - Ji Chen
- Department of Physiology and Neurobiology, Medical College of Xiamen University, Xiamen, China
| | - Ming Fan
- Department of Brain Protection and Plasticity, Institute of Basic Medical Sciences, Beijing, China
| | - Qiyong Gong
- Department of Radiology, Huaxi Magnetic Resonance Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China
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