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The Effects of Renal Nerve Denervation on Blood Pressure and Target Organs in Different Hypertensive Rat Models. Int J Hypertens 2021; 2021:8615253. [PMID: 33884205 PMCID: PMC8041559 DOI: 10.1155/2021/8615253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 01/25/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background Hypertension contributes to the progression of cardiac remodeling and renal damage. In turn, renal sympathetic hyperactivation showed elevated sympathetic nervous system activity and led to blood pressure increase in certain patients. The purpose of this study was to observe the effect of renal nerve denervation on blood pressure and target organ changes in two hypertensive rat models. Methods Hypertensive rats were randomly divided into a renal denervation (RDN) group and sham operation group. Wistar–Kyoto (WKY) rats of the same age were set as the baseline control group. In the secondary hypertension model, SD rats were randomly divided into five groups. Blood pressure and bodyweight were measured every week until they were euthanized. Results The two rat models underwent RDN at key timepoints. At these timepoints, the hearts and kidneys were collected for norepinephrine and angiotensin II measurements and histological analysis. Conclusion RDN performed before development of hypertension showed a significant antihypertensive effect on the secondary hypertension model.
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Bertog S, Sharma A, Mahfoud F, Pathak A, Schmieder RE, Sievert K, Papademetriou V, Weber MA, Haratani N, Lobo MD, Saxena M, Kandzari DE, Fischell TA, Sievert H. Alcohol-Mediated Renal Sympathetic Neurolysis for the Treatment of Hypertension: The Peregrine™ Infusion Catheter. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 24:77-86. [PMID: 32958438 DOI: 10.1016/j.carrev.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/15/2020] [Accepted: 09/01/2020] [Indexed: 01/12/2023]
Abstract
Renal sympathetic denervation using conventional non-irrigated radiofrequency catheters has potential technical shortcomings, including limited penetration depth and incomplete circumferential nerve damage, potentially impacting therapeutic efficacy. Against this background, second generation multi-electrode, radiofrequency and ultrasound renal denervation systems have been developed to provide more consistent circumferential nerve ablation. Irrigated catheters may allow deeper penetration while minimizing arterial injury. In this context, catheter-based chemical denervation, with selective infusion of alcohol, a potent neurolytic agent, into the perivascular space, may minimize endothelial, intimal and medial injury while providing circumferential neurolysis. Animal studies demonstrate pronounced renal norepinephrine level reductions and consistent renal nerve injury after perivascular alcohol infusion using the Peregrine Catheter. Early clinical studies demonstrated significant blood pressure reductions and a reasonable safety profile. Randomized sham-controlled trials (NCT03503773, NCT02910414) are underway to examine whether the aforementioned theoretical advantages of alcohol-medicated denervation with the Peregrine System™ Kit translate into clinical benefits.
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Affiliation(s)
- Stefan Bertog
- CardioVascular Center Frankfurt, Frankfurt, Germany; Minneapolis Veterans Affairs Medical Center, Minneapolis, USA
| | - Alok Sharma
- Minneapolis Veterans Affairs Medical Center, Minneapolis, USA
| | - Felix Mahfoud
- Saarland University Hospital, Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Homburg/Saar, Germany; Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Atul Pathak
- Department of Cardiovascular Medicine, Princess Grace Hospital, Monaco
| | - Roland E Schmieder
- University Hospital of the Friedrich Alexander University Erlangen-Nürnberg, Germany
| | - Kolja Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany; Johannes Gutenberg Universität, Mainz, Germany
| | | | | | | | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London, UK
| | - Manish Saxena
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London, UK
| | | | | | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, UK.
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Gupta A, Prince M, Bob-Manuel T, Jenkins JS. Renal denervation: Alternative treatment options for hypertension? Prog Cardiovasc Dis 2019; 63:51-57. [PMID: 31884099 DOI: 10.1016/j.pcad.2019.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 12/17/2022]
Abstract
Hypertension affects millions of Americans and has adverse long-term consequences increasing morbidity and mortality. Resistant hypertension (RH) continues to be difficult to treat with medications alone which may be associated with significant side effects. Alternate therapies have been evaluated for treating RH and renal denervation has been investigated extensively. We review the data from renal denervation trials and other novel technologies which are not FDA approved to date.
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Affiliation(s)
- Aashish Gupta
- Department of Cardiology at Ochsner Clinic Foundation, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America.
| | - Marloe Prince
- Department of Cardiology at Ochsner Clinic Foundation, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - Tamunoinemi Bob-Manuel
- Department of Cardiology at Ochsner Clinic Foundation, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America
| | - J Stephen Jenkins
- Department of Cardiology at Ochsner Clinic Foundation, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, United States of America
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Peregrin JH, Novotný J, Rohál T, Šochman J. Renal sympathetic denervation in resistant arterial hypertension: long term and updated results. Physiol Res 2019; 68:129-133. [PMID: 30848155 DOI: 10.33549/physiolres.934008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present paper is an extension to our earlier publication (Šochman et al. 2016) documenting a beneficial effect of renal sympathetic denervation on pharmacologically uncontrollable hypertension in a group of seven patients followed up for 1-2 years post-procedure. The same patients remained on ambulatory follow-up for another 5-6 years, with the beneficial effect persisting throughout the follow-up period while on the same medication.
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Affiliation(s)
- J H Peregrin
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague 4, Czech Republic.
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Harris RBS. Denervation as a tool for testing sympathetic control of white adipose tissue. Physiol Behav 2018; 190:3-10. [PMID: 28694155 PMCID: PMC5758439 DOI: 10.1016/j.physbeh.2017.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
This review summarizes the evidence derived from studies utilizing denervation procedures to demonstrate sympathetic control of white adipose tissue metabolism and body fat mass. A majority of the work demonstrating neural control of white fat was performed in the Bartness laboratory with Siberian hamsters as the predominant experimental model. These animals experience dramatic changes in body fat mass in response to changes in photoperiod, however, the mechanisms identified in hamsters have been reproduced or further elucidated by experiments with other animal models. Evidence for the role of sympathetic innervation contributing to the control of white adipocyte lipolysis and preadipocyte proliferation is summarized. In addition, evidence from denervation experiments for neural communication between different white fat depots as well as for a feedback control loop between sensory afferents from individual fat depots and sympathetic efferents to the same or distant white fat depots is discussed.
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Affiliation(s)
- Ruth B S Harris
- Medical College of Georgia, Augusta University, Augusta, GA 30912, United States.
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Freyhardt P, Donners R, Riemert A, Schnorr J, Stolzenburg N, Rinnenthal JL, Bernhardt U, Hamm B, Günther RW, Streitparth F. Renal denervation by CT-guided periarterial injection of hyperosmolar saline, vincristine, paclitaxel and guanethidine in a pig model. EUROINTERVENTION 2017; 12:e2262-e2270. [PMID: 27890860 DOI: 10.4244/eij-d-15-00354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the study was to evaluate the feasibility, safety and efficacy of renal sympathetic denervation with CT-guided periarterial injection of potentially neurolytic agents in pigs. METHODS AND RESULTS Unilateral injection of formulations containing either 5M hyperosmolar saline, vincristine, paclitaxel or guanethidine around the renal artery was performed in 24 normotensive pigs with six animals per group. Needle placement and injections were performed under CT fluoroscopy guidance. Blood pressure measurements and CT scans were performed immediately before and after the intervention and four weeks after treatment. After euthanasia, norepinephrine (NE) concentrations of both kidneys were determined. The renal arteries and surrounding tissue were examined histologically to evaluate nerve fibre degeneration. Procedures were technically successful with good periarterial distribution of the injectant in all but one pig in the guanethidine group. No major adverse events or post-interventional complications occurred. In the vincristine group, NE concentrations of the renal parenchyma were lower on the treated side in all pigs with a mean decrease of 53% (38%-62%, p<0.01) compared to the contralateral control. Correspondingly, histological examination revealed neural degeneration in all animals treated with vincristine. In the other groups, no significant drop of NE values, or histological signs of nerve fibre degeneration were found. CONCLUSIONS CT-guided periarterial injection of the different substances was feasible and safe. Renal sympathetic denervation was achieved with vincristine. In contrast, hyperosmolar saline, paclitaxel and guanethidine do not seem to be appropriate for renal denervation in a pig model at the dosage used.
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Affiliation(s)
- Patrick Freyhardt
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Mai TH, Garland EM, Diedrich A, Robertson D. Hepatic and renal mechanisms underlying the osmopressor response. Auton Neurosci 2017; 203:58-66. [PMID: 28143710 DOI: 10.1016/j.autneu.2017.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/09/2016] [Accepted: 01/18/2017] [Indexed: 02/07/2023]
Abstract
Increased blood pressure (BP) is observed in patients with impaired baroreflexes after water drinking. The stimulus for this effect is low blood osmolality, and it has been termed the osmopressor response (OPR). The BP increase is associated with activation of the sympathetic nervous system and a requirement for transient receptor potential vanilloid 4 (TRPV4) channels. However, the mechanisms underlying the OPR are poorly understood. We tested the hypothesis that hypotonicity is sensed in the portal area to initiate the OPR. Sino-aortic denervated mice were used and BP was monitored for 30min after fluid infusion while mice were under anesthesia. Infusion of hypotonic fluid (0.45% saline), but not of isotonic 0.9% saline, directly into the portal vein, produced an immediate OPR (increase in BP with saline 0.45%: 15±13 vs. 0.9%: -7±2mmHg, p=0.003; AUC: 0.45%: 150±99, n=7 vs. 0.9%: -74±60mmHg·min, n=5, p=0.003). However, 0.45% saline was not able to trigger a similar response in TRPV4-/- mice (ΔBPTRPV4: -2±5mmHg, n=8, p=0.009). Hypotonic saline did not raise BP when infused at the same speed and volume into the jugular vein (jugular: -5±6mmHg, p=0.002, compared to portal). Denervation of the splanchnic nerve by celiac ganglionectomy (CGX) did not abolish the OPR (CGX: 15±11 vs. Sham: 16±6mmHg, p=0.34). Renal denervation diminished the OPR elicited by duodenal water infusion (denervation: 9±4 vs. sham: 31±15mmHg, p=0.016). Therefore, hypotonicity in the portal circulation, probably sensed by TRPV4 channels, triggers the OPR and intact renal nerves are needed for the full response.
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Affiliation(s)
- Tu H Mai
- Department of Pharmacology, Vanderbilt University, Nashville, TN, United States; Department of Clinical Pharmacology, Vanderbilt University, Nashville, TN, United States
| | - Emily M Garland
- Department of Medicine, Vanderbilt University Medical Center, United States; Department of Clinical Pharmacology, Vanderbilt University, Nashville, TN, United States
| | - André Diedrich
- Department of Medicine, Vanderbilt University Medical Center, United States; Department of Biomedical Engineering, Vanderbilt University, United States; Department of Clinical Pharmacology, Vanderbilt University, Nashville, TN, United States
| | - David Robertson
- Department of Pharmacology, Vanderbilt University, Nashville, TN, United States; Department of Medicine, Vanderbilt University Medical Center, United States; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Clinical Pharmacology, Vanderbilt University, Nashville, TN, United States.
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Liu Y, Li B, Li M, Yu Y, Wang Z, Chen S. Improvement of cardiac dysfunction by bilateral surgical renal denervation in animals with diabetes induced by high fructose and high fat diet. Diabetes Res Clin Pract 2016; 115:140-9. [PMID: 26997210 DOI: 10.1016/j.diabres.2015.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/28/2015] [Accepted: 12/26/2015] [Indexed: 02/07/2023]
Abstract
AIMS Insulin resistance (IR) and sympathetic over-activation play a critical role in diabetic cardiomyopathy (DCM). Percutaneous renal sympathetic denervation (RDN) was tested to treat refractory hypertension. However, the benefits of RDN for DCM and IR still remain unknown. The present study aimed to investigate the effect and associated mechanisms of bilateral surgical RDN (bsRDN) on cardiac function and glucose metabolism in animals with diabetes. METHODS Thirty-two male New Zealand white rabbits were randomly assigned to Chow (n=8, normal diet) and TEST (n=24, high-fructose fat diet [HFD]) groups. At 48 weeks after HFD feeding, animals in the TEST group were randomized to the Sham, HFD, and RDN subgroups and were fed a HFD for an additional 8 weeks. Repeated measurements of cardiac function, IR, apoptosis/autophagy, and histopathological assessment were performed at 48 and 56 weeks. RESULTS HFD feeding for 56 weeks induced IR and diastolic cardiac dysfunction with hypertrophy in septum but well preserved eject fraction in the animals. Impaired IR further deteriorated over the time in the RDN group, featured by a more profound reduction in GLUT4 mRNA and its translocation to the plasma membrane. Successful denervation was associated with improvement of cardiac function via preventing myocardial fibrosis and over-expression of procollagen III, mammalian target of rapamycin, and cardiac apoptosis. Cardiac autophagy, assessed by either electron microscopy or Western blot, was enhanced by bsRDN. CONCLUSIONS Renal sympathetic denervation led to a significant improvement of HFD-induced cardiac dysfunction by shifting the cardiac apoptosis to autophagy, but worsening IR. Further study is required to identify the clinical benefits of RDN.
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Affiliation(s)
- YanRong Liu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, China
| | - Bing Li
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, China
| | - MingHui Li
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, China
| | - YiHui Yu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, China
| | - ZhiMei Wang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, China
| | - ShaoLiang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, China.
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Nair GKK, Massé S, Asta J, Sevaptisidis E, Azam MA, Lai PFH, Veluppillaim A, Magtibay K, Jackson N, Nanthakumar K. The need for and the challenges of measuring renal sympathetic nerve activity. Heart Rhythm 2016; 13:1166-1171. [PMID: 26806582 DOI: 10.1016/j.hrthm.2016.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Indexed: 12/14/2022]
Abstract
Renal denervation (RDN) was primarily developed to treat hypertension and is potentially a new method for treating arrhythmias. Because of the lack of a standardized protocol to measure renal sympathetic nerve activity, RDN is administered in a blind manner. This inability to assess efficacy at the time of treatment delivery may be a large contributor to the ambiguity of RDN outcomes reported in the hypertension literature. The advancement of RDN as a treatment of hypertension or arrhythmias will be hampered by the lack of delivery assessment, a deficiency that the cardiovascular electrophysiology community, with its expertise in recording and mapping, may have a role in addressing and overcoming. The development of endovascular recording of renal nerve action potentials may provide a useful accessory tool for RDN. Innovation in this area will be crucial as we as a community reconsider the therapeutic value of RDN.
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Affiliation(s)
| | | | - John Asta
- University Health Network, Toronto, Ontario, Canada
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Stefanadis C, Synetos A, Tsioufis C, Drakopoulou M, Tsiamis E, Tousoulis D, Agrogiannis G, Patsouris E, Toutouzas K. Chemical renal denervation by vincristine: the role of the flow rate of delivery. Cardiovasc Intervent Radiol 2014; 37:1336-42. [PMID: 25112883 DOI: 10.1007/s00270-014-0958-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/19/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Vincristine has been proven promising regarding its safety and efficacy for the renal artery denervation both in experimental models and in humans. The aim of the study was to compare in an experimental model the efficacy of constant versus random flow rate delivery of vincristine on renal sympathetic denervation. METHODS We used 10 juvenile Landrace swine. After the introduction of a 7F sheath into the femoral artery, a guide wire was advanced into the distal part of the renal artery. Then the first delivery balloon catheter, which delivers vincristine in random flow rate, was advanced at the proximal part of the artery, and the balloon was inflated in order to locally deliver vincristine to the media of the renal artery. The process was repeated in the contralateral renal artery, with the use of the double balloon catheter that delivers vincristine with a constant flow rate. Euthanasia of the animals was performed at 28 days. All sections were processed for histological and immunohistochemical analysis. RESULTS The delivery of vincristine with both catheters was successful and uncomplicated. Immunohistochemistry showed that the mean number of intact nerves in all sections was significantly lower in the group of vincristine delivered with constant flow catheter compared to the group that the delivery was performed in a random fashion. (1.48 ± 0.37 vs. 1.70 ± 0.41, p = 0.04). CONCLUSION Chemical renal denervation with vincristine by a constant flow rate catheter is more effective compared to the denervation performed by a catheter that delivers vincristine in a random fashion.
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Affiliation(s)
- Christodoulos Stefanadis
- First Department of Cardiology, Athens Medical School, Hippokration Hospital, 9 Tepeleniou str., Paleo Psychico, 15452, Athens, Greece,
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Čurila K, Rosa J, Toušek P, Widimský J, Widimský P. Technical and safety aspects of renal denervation. COR ET VASA 2014. [DOI: 10.1016/j.crvasa.2014.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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