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Bründl E, Proescholdt M, Schödel P, Rosengarth K, Störr EM, Bele S, Kieninger M, Malsy M, Schmidt NO, Schebesch KM. Both coiling and clipping induce the time-dependent release of endogenous neuropeptide Y into serum. Front Neurol 2024; 14:1325950. [PMID: 38425753 PMCID: PMC10902915 DOI: 10.3389/fneur.2023.1325950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/14/2023] [Indexed: 03/02/2024] Open
Abstract
Background The vaso- and psychoactive endogenous Neuropeptide Y (NPY) has repeatedly been shown to be excessively released after subarachnoid hemorrhage and in numerous psychiatric disorders. NPY is stored in sympathetic perivascular nerve fibers around the major cerebral arteries. This prospective study was designed to analyze the impact of microsurgical and endovascular manipulation of the cerebral vasculature versus cranio- and durotomy alone on the serum levels of NPY. Methods 58 patients (drop-out n = 3; m:f = 26:29; mean age 52.0 ± 14.1 years) were prospectively enrolled. The vascular group underwent repair for unruptured intracranial aneurysms (UIA) of the anterior circulation [endovascular aneurysm occlusion (EV) n = 13; microsurgical clipping (MS) n = 17]; in the non-vascular group, 14 patients received microsurgical resection of a small-sized convexity meningioma (CM), and 11 patients with surgically treated degenerative lumbar spine disease (LD) served as control. Plasma was drawn (1) before treatment (t0), (2) periprocedurally (t1), (3) 6 h postprocedurally (t2), (4) 72 h postprocedurally (t3), and (5) at the 6-week follow-up (FU; t4) to determine the NPY levels via competitive enzyme immunoassay in duplicate serum samples. We statistically evaluated differences between groups by calculating one-way ANOVA and for changes along the time points using repeated measure ANOVA. Results Except for time point t0, the serum concentrations of NPY ranged significantly higher in the vascular than in the non-vascular group (p < 0.001), with a slight decrease in both vascular subgroups 6 h postprocedurally, followed by a gradual increase above baseline levels until FU. At t3, the EV subgroup showed significantly higher NPY levels (mean ± standard deviation) than the MS subgroup (0.569 ± 0.198 ng/mL vs. 0.415 ± 0.192 ng/mL, p = 0.0217). The highest NPY concentrations were measured in the EV subgroup at t1, t3, and t4, reaching a climax at FU (0.551 ± 0.304 ng/mL). Conclusion Our study reveals a first insight into the short-term dynamics of the serum levels of endogenous NPY in neurosurgical and endovascular procedures, respectively: Direct manipulation within but also next to the major cerebral arteries induces an excessive release of NPY into the serum. Our findings raise the interesting question of the potential capacity of NPY in modulating the psycho-behavioral outcome of neurovascular patients.
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Affiliation(s)
- Elisabeth Bründl
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Martin Proescholdt
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Petra Schödel
- Department of Orthopedics, Trauma and Hand Surgery, Section Neurosurgery, Medical Center St. Elisabeth, Straubing, Germany
| | - Katharina Rosengarth
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Eva-Maria Störr
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Sylvia Bele
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Martin Kieninger
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Manuela Malsy
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Karl-Michael Schebesch
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
- Department of Neurosurgery, Paracelsus Medical Private University, Nuremberg, Germany
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2
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Guenes-Altan M, Schmid A, Kannenkeril D, Linz P, Ott C, Bosch A, Schiffer M, Uder M, Schmieder RE. Skin sodium content as a predictor of blood pressure response to renal denervation. Hypertens Res 2024; 47:361-371. [PMID: 37880499 PMCID: PMC10838764 DOI: 10.1038/s41440-023-01450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 10/27/2023]
Abstract
Patients with treatment resistant hypertension (TRH) are known to have elevated sodium (Na) content in muscle and skin. Renal denervation (RDN) emerged as an adjacent therapeutic option in this group of patients. This analysis aimed at evaluating whether tissue Na content predicts blood pressure (BP) response after RDN in patients with TRH. Radiofrequency-device based RDN was performed in 58 patients with uncontrolled TRH. Office and 24-h ambulatory BP were measured at baseline and after 6 months. To assess tissue Na content Na magnetic resonance imaging (Na-MRI) was performed at baseline prior to RDN. We splitted the study cohort into responders and non-responders based on the median of systolic 24-h ambulatory blood pressure (ABP) reduction after 6 months and evaluated the association between BP response to RDN and tissue Na content in skin and muscle. The study was registered at http://www.clinicaltrials.gov (NCT01687725). Six months after RDN 24-h ABP decreased by -8.6/-4.7 mmHg. BP-Responders were characterized by the following parameters: low tissue sodium content in the skin (p = 0.040), female gender (p = 0.027), intake of aldosterone antagonists (p = 0.032), high baseline 24-h night-time heart rate (p = 0.045) and high LDL cholesterol (p < 0.001). These results remained significant after adjustment for baseline 24-h systolic BP. Similar results were obtained when the median of day-time and night-time ABP reduction after 6 months were used as cut-off criteria for defining BP response to RDN. We conclude that in addition to clinical factors including baseline 24-h ABP Na-MRI may assist to select patients with uncontrolled TRH for RDN treatment.
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Affiliation(s)
- Merve Guenes-Altan
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Axel Schmid
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Dennis Kannenkeril
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Agnes Bosch
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Mario Schiffer
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany.
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3
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Stress-related dysautonomias and neurocardiology-based treatment approaches. Auton Neurosci 2022; 239:102944. [DOI: 10.1016/j.autneu.2022.102944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/13/2021] [Accepted: 01/16/2022] [Indexed: 11/21/2022]
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4
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Zoccali C, Ortiz A, Blumbyte IA, Rudolf S, Beck-Sickinger AG, Malyszko J, Spasovski G, Carriazo S, Viggiano D, Kurganaite J, Sarkeviciene V, Rastenyte D, Figurek A, Rroji M, Mayer C, Arici M, Martino G, Tedeschi G, Bruchfeld A, Spoto B, Rychlik I, Wiecek A, Okusa M, Remuzzi G, Mallamaci F. Neuropeptide Y as a risk factor for cardiorenal disease and cognitive dysfunction in CKD: translational opportunities and challenges. Nephrol Dial Transplant 2021; 37:ii14-ii23. [PMID: 34724060 PMCID: PMC8713155 DOI: 10.1093/ndt/gfab284] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Neuropeptide Y (NPY) is a 36-amino-acid peptide member of a family also including peptide YY and pancreatic polypeptide, which are all ligands to Gi/Go coupled receptors. NPY regulates several fundamental biologic functions including appetite/satiety, sex and reproduction, learning and memory, cardiovascular and renal function and immune functions. The mesenteric circulation is a major source of NPY in the blood in man and this peptide is considered a key regulator of gut–brain cross talk. A progressive increase in circulating NPY accompanies the progression of chronic kidney disease (CKD) toward kidney failure and NPY robustly predicts cardiovascular events in this population. Furthermore, NPY is suspected as a possible player in accelerated cognitive function decline and dementia in patients with CKD and in dialysis patients. In theory, interfering with the NPY system has relevant potential for the treatment of diverse diseases from cardiovascular and renal diseases to diseases of the central nervous system. Pharmaceutical formulations for effective drug delivery and cost, as well as the complexity of diseases potentially addressable by NPY/NPY antagonists, have been a problem until now. This in part explains the slow progress of knowledge about the NPY system in the clinical arena. There is now renewed research interest in the NPY system in psychopharmacology and in pharmacology in general and new studies and a new breed of clinical trials may eventually bring the expected benefits in human health with drugs interfering with this system.
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Affiliation(s)
- Carmine Zoccali
- Renal Research Institute, New York,USA and Associazione Ipertensione Nefrologia Trapianto Renale (IPNET) Reggio Cal., Italy c/o CNR-IFC, Ospedali Riuniti, Reggio Calabria, Italy
| | - Alberto Ortiz
- Institute of Biochemistry, Leipzig University, Faculty of Life Sciences, Leipzig, Germany
| | - Inga Arune Blumbyte
- Lithuanian University of Health Sciences, Nephrology Department, Kaunas, Lithuania
| | - Sarina Rudolf
- Institute of Biochemistry, Leipzig University, Faculty of Life Sciences, Leipzig, Germany
| | | | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Goce Spasovski
- Department of Nephrology, University "Sts. Cyril and Methodius", Skopje, MK, Republic of Macedonia
| | - Sol Carriazo
- Institute of Biochemistry, Leipzig University, Faculty of Life Sciences, Leipzig, Germany
| | - Davide Viggiano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy. and Biogem Scarl, Ariano Irpino, Italy
| | - Justina Kurganaite
- Lithuanian University of Health Sciences, Nephrology Department, Kaunas, Lithuania
| | - Vaiva Sarkeviciene
- Lithuanian University of Health Sciences, Nephrology Department, Kaunas, Lithuania
| | - Daiva Rastenyte
- Lithuanian University of Health Sciences, Neurology Department, Kaunas, Lithuania
| | - Andreja Figurek
- Department of Nephrology, University "Sts. Cyril and Methodius", Skopje, MK, Republic of Macedonia
| | - Merita Rroji
- Department of Nephrology, University "Sts. Cyril and Methodius", Skopje, MK, Republic of Macedonia
| | - Christopher Mayer
- Health and Bioresources, Biomedical Systems, Austrian Institute of Technology, Vienna, Austria
| | - Mustapha Arici
- Department of Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Gianvito Martino
- Neurology Department, San Raffaele Scientific Institute and Vita-Salute University San Raffaele, Milan, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, and 3T-MRI Research Center, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden and Department of Renal Medicine, CLINTEC Karolinska Institutet, Stockholm, Sweden
| | | | - Ivan Rychlik
- Department of Medicine, Third Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady,Prague, Czech Republic
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland
| | - Mark Okusa
- Division of Nephrology and Center for Immunity, Inflammation, and Regenerative Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Aldo & Cele Daccò Clinical Research Center for Rare Diseases, Bergamo, Italy
| | - Francesca Mallamaci
- Nephrology and Transplantation Unit, Grande Ospedale Metropolitano and CNR-IFC, Reggio Cal, Italy
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5
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Qiu W, Cai X, Zheng C, Qiu S, Ke H, Huang Y. Update on the Relationship Between Depression and Neuroendocrine Metabolism. Front Neurosci 2021; 15:728810. [PMID: 34531719 PMCID: PMC8438205 DOI: 10.3389/fnins.2021.728810] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/11/2021] [Indexed: 12/27/2022] Open
Abstract
Through the past decade of research, the correlation between depression and metabolic diseases has been noticed. More and more studies have confirmed that depression is comorbid with a variety of metabolic diseases, such as obesity, diabetes, metabolic syndrome and so on. Studies showed that the underlying mechanisms of both depression and metabolic diseases include chronic inflammatory state, which is significantly related to the severity. In addition, they also involve endocrine, immune systems. At present, the effects of clinical treatments of depression is limited. Therefore, exploring the co-disease mechanism of depression and metabolic diseases is helpful to find a new clinical therapeutic intervention strategy. Herein, focusing on the relationship between depression and metabolic diseases, this manuscript aims to provide an overview of the comorbidity of depression and metabolic.
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Affiliation(s)
- Wenxin Qiu
- Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaodan Cai
- Fujian Medical University, Fuzhou, Fujian, China
| | | | - Shumin Qiu
- Fujian Medical University, Fuzhou, Fujian, China
| | - Hanyang Ke
- Fujian Medical University, Fuzhou, Fujian, China
| | - Yinqiong Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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6
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Huang Y, Lin X, Lin S. Neuropeptide Y and Metabolism Syndrome: An Update on Perspectives of Clinical Therapeutic Intervention Strategies. Front Cell Dev Biol 2021; 9:695623. [PMID: 34307371 PMCID: PMC8299562 DOI: 10.3389/fcell.2021.695623] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Through the past decade of research, the pathogenic mechanisms underlying metabolic syndrome have been suggested to involve not only the peripheral tissues, but also central metabolic regulation imbalances. The hypothalamus, and the arcuate nucleus in particular, is the control center for metabolic homeostasis and energy balance. Neuropeptide Y neurons are particularly abundantly expressed in the arcuate of the hypothalamus, where the blood-brain barrier is weak, such as to critically integrate peripheral metabolic signals with the brain center. Herein, focusing on metabolic syndrome, this manuscript aims to provide an overview of the regulatory effects of Neuropeptide Y on metabolic syndrome and discuss clinical intervention strategy perspectives for neurometabolic disease.
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Affiliation(s)
- Yinqiong Huang
- Department of Endocrinology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xiahong Lin
- Department of Endocrinology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Diabetes and Metabolism Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
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7
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Lauder L, Moon LB, Pipenhagen CA, Ewen S, Fish JM, Virmani R, Jensen JA, Böhm M, Mahfoud F. A drug-induced hypotensive challenge to verify catheter-based radiofrequency renal denervation in an obese hypertensive swine model. Clin Res Cardiol 2020; 111:595-603. [PMID: 33136224 PMCID: PMC9151536 DOI: 10.1007/s00392-020-01764-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
Abstract
Objective
Sham-controlled trials provided proof-of-principle for the blood pressure-lowering effect of catheter-based renal denervation (RDN). However, indicators for the immediate assessment of treatment success are lacking. This study sought to investigate the impact of RDN on renal renin arteriovenous difference (renal renin AV-Δ) following a hypotensive challenge (HC).
Methods
Twelve hypertensive Ossabaw swine underwent either combined surgical and chemical (n = 3) or catheter-based RDN (n = 9). A telemetry monitor was implanted to acquire hemodynamic data continuously. Before and after RDN, a sodium nitroprusside-induced HC was performed. Renal renin AV-Δ was calculated as the difference of plasma renin concentrations drawn from the renal artery and vein.
Results
In total, complete renal renin AV data were obtained in eight animals at baseline and six animals at baseline and 3 months of follow-up. Baseline renal renin AV-Δ correlated inversely with change in 24-h minimum systolic (− 0.764, p = 0.02), diastolic (r = − 0.679, p = 0.04), and mean (r = − 0.663, p = 0.05) blood pressure. In the animals with complete renin secretion data at baseline and follow-up, the HC increased renal renin AV-Δ at baseline, while this effect was attenuated following RDN (0.55 ± 0.34 pg/ml versus − 0.10 ± 0.16 pg/ml, p = 0.003). Renin urinary excretion remained unchanged throughout the study (baseline 0.286 ± 0.187 pg/ml versus termination 0.305 ± 0.072 pg/ml, p = 0.789).
Conclusion
Renin secretion induced by HC was attenuated following RDN and may serve as an indicator for patient selection and guide successful RDN procedures.
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8
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Zaldivia MTK, Hering D, Marusic P, Sata Y, Lee R, Esler MD, Htun NM, Duval J, Hammond L, Flierl U, Wang X, Drummond GR, Walton A, Gardiner EE, Andrews RK, Schlaich MP, Peter K. Successful renal denervation decreases the platelet activation status in hypertensive patients. Cardiovasc Res 2020; 116:202-210. [PMID: 30715163 DOI: 10.1093/cvr/cvz033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/18/2018] [Accepted: 01/31/2019] [Indexed: 12/23/2022] Open
Abstract
AIMS To determine whether renal denervation (RDN) in hypertensive patients affects the platelet activation status. METHODS AND RESULTS We investigated the effect of RDN on the platelet activation status in 41 hypertensive patients undergoing RDN. Ambulatory blood pressure (BP), plasma sympathetic neurotransmitter Neuropeptide Y, and platelet activation markers were measured at baseline, at 3 months, and 6 months after RDN. RDN significantly decreased BP at 3 months (150.6 ± 11.3/80.9 ± 11.4 mmHg to 144.7 ± 12.0/77.1 ± 11.1 mmHg; P < 0.01) and at 6 months (144.3 ± 13.8/78.3 ± 11.1 mmHg; P < 0.01). Plasma levels of the sympathetic neurotransmitter Neuropeptide Y, an indicator of sympathetic nerve activity, were significantly decreased at 3 months (0.29 ± 0.11 ng/mL to 0.23 ± 0.11 ng/mL; P < 0.0001) and at 6 months (0.22 ± 0.12 ng/mL; P < 0.001) after RDN. This was associated with a reduction in platelet membrane P-selectin expression (3 months, P < 0.05; 6 months, P < 0.05), soluble P-selectin (6 months, P < 0.05), circulating numbers of platelet-derived extracellular vesicles (EVs) (3 months, P < 0.001; 6 months, P < 0.01), and phosphatidylserine expressing EVs (3 months, P < 0.001; 6 months, P < 0.0001), indicative of a reduction in platelet activation status and procoagulant activity. Only patients who responded to RDN with a BP reduction showed inhibition of P-selectin expression at 3 months (P < 0.05) and 6 months (P < 0.05) as well as reduction of glycoprotein IIb/IIIa activation at 3 months (P < 0.05). Notably, 13 patients who took aspirin did not show significant reduction in platelet P-selectin expression following RDN. CONCLUSION Our results imply a connection between the sympathetic nervous system and the platelet activation status and provide a potential mechanistic explanation by which RDN can have favourable effects towards reducing cardiovascular complications.
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Affiliation(s)
- Maria T K Zaldivia
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Dagmara Hering
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Petra Marusic
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Yusuke Sata
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Rebecca Lee
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Murray D Esler
- Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Nay M Htun
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Jacqueline Duval
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Louise Hammond
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Ulrike Flierl
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Xiaowei Wang
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Grant R Drummond
- Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, Australia
| | - Antony Walton
- Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Elizabeth E Gardiner
- ACRF Department of Cancer Biology and Therapeutics, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Robert K Andrews
- Department of Medicine, Monash University, Melbourne, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Markus P Schlaich
- Department of Medicine, Monash University, Melbourne, Australia.,Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
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9
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Neuropeptide Y predicts cardiovascular events in chronic kidney disease patients: a cohort study. J Hypertens 2020; 37:1359-1365. [PMID: 30633126 DOI: 10.1097/hjh.0000000000002030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neuropeptide Y (NPY) is a multifaceted sympathetic neurotransmitter regulating reflex cardiovascular control, myocardial cell growth, inflammation and innate immunity. Circulating NPY levels predict cardiovascular mortality in patients with end stage kidney disease on dialysis but this relationship has never been tested in predialysis chronic kidney disease (CKD) patients. METHODS We investigated the relationship between circulating NPY and the risk for cardiovascular events (Fine & Gray competing risks model) in a cohort of 753 stages 2-5 CKD patients over a median follow-up of 36 months. RESULTS Independently of other risk factors, plasma NPY was directly related with the glomerular filtration rate (β = -0.19, P < 0.001) but was independent of systemic inflammation as quantified by serum IL6 and C reactive protein. Over follow-up 112 patients had cardiovascular events and 12 died. In analyses fully adjusted for traditional risk factors and a large series of CKD-specific risk factors and considering death as a competing event (Fine and Gray model) a 0.25 μmol/l increase in NPY robustly predicted the incident risk for cardiovascular events (subdistribution hazard ratio: 1.25; 95% confidence interval: 1.09-1.44; P = 0.002). Furthermore, the fully adjusted NPY - cardiovascular outcomes relationship was modified by age (P = 0.012) being quite strong in young patients but weaker in the old ones. CONCLUSION NPY is an independent, robust predictor of cardiovascular events in predialysis CKD patients and the risk for such events is age-dependent being maximal in young patients. These findings suggest that NPY may play a role in the high risk of cardiovascular disease in this population.
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10
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Scherschel K, Hedenus K, Jungen C, Lemoine MD, Rübsamen N, Veldkamp MW, Klatt N, Lindner D, Westermann D, Casini S, Kuklik P, Eickholt C, Klöcker N, Shivkumar K, Christ T, Zeller T, Willems S, Meyer C. Cardiac glial cells release neurotrophic S100B upon catheter-based treatment of atrial fibrillation. Sci Transl Med 2020; 11:11/493/eaav7770. [PMID: 31118294 DOI: 10.1126/scitranslmed.aav7770] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/12/2019] [Indexed: 01/02/2023]
Abstract
Atrial fibrillation (AF), the most common sustained heart rhythm disorder worldwide, is linked to dysfunction of the intrinsic cardiac autonomic nervous system (ICNS). The role of ICNS damage occurring during catheter-based treatment of AF, which is the therapy of choice for many patients, remains controversial. We show here that the neuronal injury marker S100B is expressed in cardiac glia throughout the ICNS and is released specifically upon catheter ablation of AF. Patients with higher S100B release were more likely to be AF free during follow-up. Subsequent in vitro studies revealed that murine intracardiac neurons react to S100B with diminished action potential firing and increased neurite growth. This suggests that release of S100B from cardiac glia upon catheter-based treatment of AF is a hallmark of acute neural damage that contributes to nerve sprouting and can be used to assess ICNS damage.
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Affiliation(s)
- Katharina Scherschel
- Department of Cardiology-Electrophysiology, cNEP (cardiac Neuro- and Electrophysiology research group), University Heart Centre, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
| | - Katja Hedenus
- Department of Cardiology-Electrophysiology, cNEP (cardiac Neuro- and Electrophysiology research group), University Heart Centre, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
| | - Christiane Jungen
- Department of Cardiology-Electrophysiology, cNEP (cardiac Neuro- and Electrophysiology research group), University Heart Centre, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
| | - Marc D Lemoine
- Department of Cardiology-Electrophysiology, cNEP (cardiac Neuro- and Electrophysiology research group), University Heart Centre, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany.,Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Nicole Rübsamen
- Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Marieke W Veldkamp
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, 1105 AZ, Amsterdam, Netherlands
| | - Niklas Klatt
- Department of Cardiology-Electrophysiology, cNEP (cardiac Neuro- and Electrophysiology research group), University Heart Centre, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
| | - Diana Lindner
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany.,Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Dirk Westermann
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany.,Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Simona Casini
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, 1105 AZ, Amsterdam, Netherlands
| | - Pawel Kuklik
- Department of Cardiology-Electrophysiology, cNEP (cardiac Neuro- and Electrophysiology research group), University Heart Centre, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
| | - Christian Eickholt
- Department of Cardiology-Electrophysiology, cNEP (cardiac Neuro- and Electrophysiology research group), University Heart Centre, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
| | - Nikolaj Klöcker
- Institute of Neural and Sensory Physiology, Medical Faculty, University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Kalyanam Shivkumar
- Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, Molecular, Cellular and Integrative Physiology Interdepartmental Program, UCLA, Los Angeles, CA 90095, USA
| | - Torsten Christ
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany.,Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Tanja Zeller
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany.,Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology-Electrophysiology, cNEP (cardiac Neuro- and Electrophysiology research group), University Heart Centre, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, cNEP (cardiac Neuro- and Electrophysiology research group), University Heart Centre, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, 13347 Berlin, Germany
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11
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Abstract
Neuropeptide Y (NPY) is implicated in many pathological conditions including obesity, diabetes, and insulin resistance. However, a pathogenic role of NPY in kidney disease has not been described. We found that NPY is produced by the podocyte in the glomerulus, and this production decreases in renal disease, in contrast to an increase in circulating NPY levels. In the glomerulus, NPY signals via the NPY receptor 2 (NPY2R) and modulates PI3K, MAPK, and NFAT signaling, along with RNA processing and cell migration and, if prolonged, predicted nephrotoxicity. The pharmacological inhibition of NPY-NPY2R signaling also protected against albuminuria and kidney disease in a mouse model of glomerulosclerosis, suggesting that inhibiting this pathway may be therapeutically beneficial in the prevention of kidney disease. Albuminuria is an independent risk factor for the progression to end-stage kidney failure, cardiovascular morbidity, and premature death. As such, discovering signaling pathways that modulate albuminuria is desirable. Here, we studied the transcriptomes of podocytes, key cells in the prevention of albuminuria, under diabetic conditions. We found that Neuropeptide Y (NPY) was significantly down-regulated in insulin-resistant vs. insulin-sensitive mouse podocytes and in human glomeruli of patients with early and late-stage diabetic nephropathy, as well as other nondiabetic glomerular diseases. This contrasts with the increased plasma and urinary levels of NPY that are observed in such conditions. Studying NPY-knockout mice, we found that NPY deficiency in vivo surprisingly reduced the level of albuminuria and podocyte injury in models of both diabetic and nondiabetic kidney disease. In vitro, podocyte NPY signaling occurred via the NPY2 receptor (NPY2R), stimulating PI3K, MAPK, and NFAT activation. Additional unbiased proteomic analysis revealed that glomerular NPY-NPY2R signaling predicted nephrotoxicity, modulated RNA processing, and inhibited cell migration. Furthermore, pharmacologically inhibiting the NPY2R in vivo significantly reduced albuminuria in adriamycin-treated glomerulosclerotic mice. Our findings suggest a pathogenic role of excessive NPY-NPY2R signaling in the glomerulus and that inhibiting NPY-NPY2R signaling in albuminuric kidney disease has therapeutic potential.
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12
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Abstract
PURPOSE OF REVIEW Interventional cardiology and in particular the field of renal denervation is subject to constant change. This review provides an up to date overview of renal denervation trials and an outlook on what to expect in the future. RECENT FINDINGS After the sham-controlled SYMPLICITY HTN-3 trial dampened the euphoria following early renal denervation trials, the recently published results of the sham-controlled SPYRAL HTN and RADIANCE HTN trials provided proof-of-principle for the blood pressure-lowering efficacy of renal denervation. However, these studies underline the major issue of patients' non-adherence to antihypertensive medication as well as the need for reliable patient- and procedure-related predictors of response. The second generation of sham-controlled renal denervation trials provided proof of principle for the blood pressure-lowering efficacy of RDN. However, larger trials have to assess long-term safety and efficacy.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany.
| | - Milan A Wolf
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
| | - Sean S Scholz
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
| | - Mathias Hohl
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Medical Center and Saarland University, 66421, Homburg, Saar, Germany
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13
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Vonend O, Martin O, Rump LC, Kroepil P, Stegbauer J. Erythrocyte Salt Sedimentation Assay Does Not Predict Response to Renal Denervation. Front Med (Lausanne) 2018; 5:51. [PMID: 29594117 PMCID: PMC5854684 DOI: 10.3389/fmed.2018.00051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/13/2018] [Indexed: 12/23/2022] Open
Abstract
Renal denervation (RDN) has recently been shown to be effective in patients without antihypertensive medication. However, about 30% of patients do not respond to RDN, and therefore, there exists a need to find predictors of response. Individuals are either salt-sensitive (SS) or non-salt-sensitive (NSS) in terms of their blood pressure (BP) regulation. The sympathetic nervous system can influence water and salt handling. RDN reduces sympathetic drive and has an impact on salt excretion. The present study was conducted to test the influence of salt sensitivity in terms of the BP reducing effect after RDN procedure. Salt sensitivity was estimated using the in vitro Erythrocyte Salt Sedimentation Assay (ESS). In 88 patients with resistant hypertension, RDN was performed. Office BP and lab testing were performed at baseline and at month 1, 3, 6, 12, 18, and 24 after RDN. A responder rate of 64.7% has been observed. Salt sensitivity measurements (ESS-Test) were completed in a subgroup of 37 patients with resistant hypertension. In this group, 15 were SS and 17 were salt-resistant according to the in vitro assay, respectively. The responder rate was 60% in SS patients and 59.1% in NSS patients, respectively. Electrolytes as well as aldosterone and renin levels did not differ between the two groups at baseline and in the follow-up measurements. The present study showed that salt sensitivity, estimated using the ESS in vitro test, did not affect the outcome of RDN and, therefore, does not help to identify patients suitable for RDN.
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Affiliation(s)
- Oliver Vonend
- Nierenzentrum, DKD Helios Klinik Wiesbaden, Wiesbaden, Germany.,Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Ole Martin
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Lars C Rump
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Patrick Kroepil
- Departement of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Johannes Stegbauer
- Department of Nephrology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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14
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Linz D, Hohl M, Elliott AD, Lau DH, Mahfoud F, Esler MD, Sanders P, Böhm M. Modulation of renal sympathetic innervation: recent insights beyond blood pressure control. Clin Auton Res 2018; 28:375-384. [PMID: 29429026 DOI: 10.1007/s10286-018-0508-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/29/2018] [Indexed: 02/06/2023]
Abstract
Renal afferent and efferent sympathetic nerves are involved in the regulation of blood pressure and have a pathophysiological role in hypertension. Additionally, several conditions that frequently coexist with hypertension, such as heart failure, obstructive sleep apnea, atrial fibrillation, renal dysfunction, and metabolic syndrome, demonstrate enhanced sympathetic activity. Renal denervation (RDN) is an approach to reduce renal and whole body sympathetic activation. Experimental models indicate that RDN has the potential to lower blood pressure and prevent cardio-renal remodeling in chronic diseases associated with enhanced sympathetic activation. Studies have shown that RDN can reduce blood pressure in drug-naïve hypertensive patients and in hypertensive patients under drug treatment. Beyond its effects on blood pressure, sympathetic modulation by RDN has been shown to have profound effects on cardiac electrophysiology and cardiac arrhythmogenesis. RDN can display anti-arrhythmic effects in a variety of animal models for atrial fibrillation and ventricular arrhythmias. The first non-randomized studies demonstrate that RDN may promote the maintenance of sinus rhythm following catheter ablation in patients with atrial fibrillation. Registry data point towards a beneficial effect of RDN to prevent ventricular arrhythmias in patients with heart failure and electrical storm. Further large randomized placebo-controlled trials are needed to confirm the antihypertensive and anti-arrhythmic effects of RDN. Here, we will review the current literature on anti-arrhythmic effects of RDN with the focus on atrial fibrillation and ventricular arrhythmias. We will discuss new insights from preclinical and clinical mechanistic studies and possible clinical implications of RDN.
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Affiliation(s)
- Dominik Linz
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. .,Centre for Heart Rhythm Disorders, Department of Cardiology, New Royal Adelaide Hospital, Adelaide, 5000, Australia.
| | - Mathias Hohl
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Saarbrücken, Germany
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Felix Mahfoud
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Saarbrücken, Germany.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Murray D Esler
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Saarbrücken, Germany
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15
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Jackson N, Gizurarson S, Azam MA, King B, Ramadeen A, Zamiri N, Porta-Sánchez A, Al-Hesayen A, Graham J, Kusha M, Massé S, Lai PFH, Parker J, John R, Kiehl TR, Nair GKK, Dorian P, Nanthakumar K. Effects of Renal Artery Denervation on Ventricular Arrhythmias in a Postinfarct Model. Circ Cardiovasc Interv 2017; 10:e004172. [PMID: 28258128 DOI: 10.1161/circinterventions.116.004172] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 01/13/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND The therapeutic potential of renal denervation (RDN) for arrhythmias has not been fully explored. Detailed mechanistic evaluation is in order. The objective of the present study was to determine the antiarrhythmic potential of RDN in a postinfarct animal model and to determine whether any benefits relate to RDN-induced reduction of sympathetic effectors on the myocardium. METHODS AND RESULTS Pigs implanted with single-chamber implantable cardioverter defibrillators to record ventricular arrhythmias (VAs) were subjected to percutaneous coronary occlusion to induce myocardial infarction. Two weeks later, a sham or real RDN treatment was performed bilaterally using the St Jude EnligHTN basket catheter. Parameters of ventricular remodeling and modulation of cardio-renal sympathetic axis were monitored for 3 weeks after myocardial infarction. Histological analysis of renal arteries yielded a mean neurofilament score of healthy nerves that was significantly lower in the real RDN group than in sham controls; damaged nerves were found only in the real RDN group. There was a 100% reduction in the rate of spontaneous VAs after real RDN and a 75% increase in the rate of spontaneous VAs after sham RDN (P=0.03). In the infarcted myocardium, presence of sympathetic nerves and tissue abundance of neuropeptide-Y, an indicator of sympathetic nerve activities, were significantly lower in the RDN group. Peak and mean sinus tachycardia rates were significantly reduced after RDN. CONCLUSIONS RDN in the infarcted pig model leads to reduction of postinfarction VAs and myocardial sympathetic effectors. This may form the basis for a potential therapeutic role of RDN in postinfarct VAs.
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Affiliation(s)
- Nicholas Jackson
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Sigfús Gizurarson
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Mohammed Ali Azam
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Benjamin King
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Andrew Ramadeen
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Nima Zamiri
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Andreu Porta-Sánchez
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Abdul Al-Hesayen
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - John Graham
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Marjan Kusha
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Stéphane Massé
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Patrick F H Lai
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - John Parker
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Rohan John
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Tim-Rasmus Kiehl
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Govind Krishna Kumar Nair
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Paul Dorian
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.)
| | - Kumaraswamy Nanthakumar
- From the Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology (N.J., S.G., M.A.A., B.K., N.Z., A.P.-S., M.K., S.M., P.F.H.L., G.K.K.N., K.N.) and Department of Pathology (R.J., T.-R.K.), University Health Network, Toronto, Ontario, Canada; St Michael's Hospital, Toronto, Ontario, Canada (A.R., A.A.-H., J.G., P.D.); University of Newcastle, Australia (N.J.); and Mount Sinai Hospital, Toronto, Ontario, Canada (J.P.).
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16
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Sanders MF, Reitsma JB, Morpey M, Gremmels H, Bots ML, Pisano A, Bolignano D, Zoccali C, Blankestijn PJ. Renal safety of catheter-based renal denervation: systematic review and meta-analysis. Nephrol Dial Transplant 2017; 32:1440-1447. [DOI: 10.1093/ndt/gfx088] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/05/2017] [Indexed: 12/29/2022] Open
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17
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Fengler K, Rommel KP, Okon T, Schuler G, Lurz P. Renal sympathetic denervation in therapy resistant hypertension - pathophysiological aspects and predictors for treatment success. World J Cardiol 2016; 8:436-446. [PMID: 27621771 PMCID: PMC4997524 DOI: 10.4330/wjc.v8.i8.436] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023] Open
Abstract
Many forms of human hypertension are associated with an increased systemic sympathetic activity. Especially the renal sympathetic nervous system has been found to play a prominent role in this context. Therefore, catheter-interventional renal sympathetic denervation (RDN) has been established as a treatment for patients suffering from therapy resistant hypertension in the past decade. The initial enthusiasm for this treatment was markedly dampened by the results of the Symplicity-HTN-3 trial, although the transferability of the results into clinical practice to date appears to be questionable. In contrast to the extensive use of RDN in treating hypertensive patients within or without clinical trial settings over the past years, its effects on the complex pathophysiological mechanisms underlying therapy resistant hypertension are only partly understood and are part of ongoing research. Effects of RDN have been described on many levels in human trials: From altered systemic sympathetic activity across cardiac and metabolic alterations down to changes in renal function. Most of these changes could sustainably change long-term morbidity and mortality of the treated patients, even if blood pressure remains unchanged. Furthermore, a number of promising predictors for a successful treatment with RDN have been identified recently and further trials are ongoing. This will certainly help to improve the preselection of potential candidates for RDN and thereby optimize treatment outcomes. This review summarizes important pathophysiologic effects of renal denervation and illustrates the currently known predictors for therapy success.
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Neumann JT, Ewen S, Mortensen K, Nef H, Zeller T, Ojeda F, Sydow K, Mahfoud F, Böhm M, Hamm C, Dörr O, Blankenberg S. Effects of renal denervation on heart failure biomarkers and blood pressure in patients with resistant hypertension. Biomark Med 2016; 10:841-51. [DOI: 10.2217/bmm-2016-0098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This multicenter study investigated the effect of renal denervation therapy (RDN) on the heart failure related biomarkers NT-proBNP, ST-2, galectin-3 and hs-TnI. Patients & methods: We included 157 patients with resistant hypertension undergoing RDN. Blood sampling was performed before and 6 months after RDN. Results: Six months after RDN systolic blood pressure (BP) was reduced by 24 mmHg. Biomarker concentrations were not changed after RDN, except a small increase of hs-TnI by 0.3 pg/ml. In individuals with high baseline BP, we observed a BP reduction of 45 mmHg and a decrease of hs-TnI concentrations by 1.2 pg/ml. Conclusion: In this multicenter analysis RDN did significantly reduce systolic BP. However, NT-proBNP, ST-2, galectin-3 and hs-TnI did not correspond to BP reduction 6 months after RDN.
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Affiliation(s)
- Johannes Tobias Neumann
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung e.V. (DZHK), Partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Homburg/Saar, Germany
| | - Kai Mortensen
- Klinik für Innere Medizin II, Kardiologie, Universität Lübeck, Lübeck, Germany
| | - Holger Nef
- Klinik für Innere Medizin I, Kardiologie/Angiologie, Universität Giessen, Giessen, Germany
| | - Tanja Zeller
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung e.V. (DZHK), Partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - Francisco Ojeda
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - Karsten Sydow
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Homburg/Saar, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universität des Saarlandes, Homburg/Saar, Germany
| | - Christian Hamm
- Klinik für Innere Medizin I, Kardiologie/Angiologie, Universität Giessen, Giessen, Germany
| | - Oliver Dörr
- Klinik für Innere Medizin I, Kardiologie/Angiologie, Universität Giessen, Giessen, Germany
| | - Stefan Blankenberg
- Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung e.V. (DZHK), Partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
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Second denervation in a patient with resistant hypertension. Clin Res Cardiol 2016; 105:880-3. [PMID: 27278635 DOI: 10.1007/s00392-016-0997-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
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Renal denervation improves exercise blood pressure: insights from a randomized, sham-controlled trial. Clin Res Cardiol 2016; 105:592-600. [PMID: 26728060 DOI: 10.1007/s00392-015-0955-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 12/18/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Despite the ongoing debate on the role of renal sympathetic denervation (RSD) in the management of therapy-resistant hypertension, little is known about its possible effects on exercise blood pressure (BP), a known predictor for future cardiovascular events. We sought to evaluate the effect of RSD on exercise BP in a randomized, sham-controlled trial in patients with mild hypertension. METHODS AND RESULTS Patients with therapy-resistant mild hypertension (defined by mean daytime systolic BP between 135 and 149 mmHg or mean daytime diastolic BP between 90 and 94 mmHg on 24-h ambulatory BP measurement) were randomized to either radiofrequency-based RSD or a sham procedure. Patients underwent cardiopulmonary exercise testing at baseline and after 6 months. Of the 71 patients randomized, data from cardiopulmonary exercise testing were available for 48 patients (22 in the RSD group, 26 in the sham group). After 6 months, patients undergoing RSD had a significantly lower systolic BP at maximum exercise workload compared to baseline (-14.2 ± 26.1 mmHg, p = 0.009). In contrast, no change was observed in the sham group (0.6 ± 22.9 mmHg, p = 0.45, p = 0.04 for between-group comparison). When analyzing patients with exaggerated baseline exercise BP only, the effect was even more pronounced (RSD vs. sham -29.5 ± 23.4 vs. 0.1 ± 25.3 mmHg, p = 0.008). CONCLUSION Exercise systolic BP values in patients with mild therapy-resistant hypertension are reduced after RSD as compared to a sham-procedure.
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