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Casarrubios AM, Pérez-Atencio LF, Martín C, Ibarz JM, Mañas E, Paul DL, Barrio LC. Neural bases for the genesis and CO 2 therapy of periodic Cheyne-Stokes breathing in neonatal male connexin-36 knockout mice. Front Neurosci 2023; 17:1045269. [PMID: 36845442 PMCID: PMC9944137 DOI: 10.3389/fnins.2023.1045269] [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: 09/15/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
Periodic Cheyne-Stokes breathing (CSB) oscillating between apnea and crescendo-decrescendo hyperpnea is the most common central apnea. Currently, there is no proven therapy for CSB, probably because the fundamental pathophysiological question of how the respiratory center generates this form of breathing instability is still unresolved. Therefore, we aimed to determine the respiratory motor pattern of CSB resulting from the interaction of inspiratory and expiratory oscillators and identify the neural mechanism responsible for breathing regularization induced by the supplemental CO2 administration. Analysis of the inspiratory and expiratory motor pattern in a transgenic mouse model lacking connexin-36 electrical synapses, the neonatal (P14) Cx36 knockout male mouse, with a persistent CSB, revealed that the reconfigurations recurrent between apnea and hyperpnea and vice versa result from cyclical turn on/off of active expiration driven by the expiratory oscillator, which acts as a master pacemaker of respiration and entrains the inspiratory oscillator to restore ventilation. The results also showed that the suppression of CSB by supplemental 12% CO2 in inhaled air is due to the stabilization of coupling between expiratory and inspiratory oscillators, which causes the regularization of respiration. CSB rebooted after washout of CO2 excess when the inspiratory activity depressed again profoundly, indicating that the disability of the inspiratory oscillator to sustain ventilation is the triggering factor of CSB. Under these circumstances, the expiratory oscillator activated by the cyclic increase of CO2 behaves as an "anti-apnea" center generating the crescendo-decrescendo hyperpnea and periodic breathing. The neurogenic mechanism of CSB identified highlights the plasticity of the two-oscillator system in the neural control of respiration and provides a rationale base for CO2 therapy.
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Affiliation(s)
- Ana M. Casarrubios
- Units of Experimental Neurology and Sleep Apnea, Hospital “Ramón y Cajal” (IRYCIS), Madrid, Spain,Ph.D. Program in Neuroscience, Autonoma de Madrid University-Cajal Institute, Madrid, Spain
| | - Leonel F. Pérez-Atencio
- Units of Experimental Neurology and Sleep Apnea, Hospital “Ramón y Cajal” (IRYCIS), Madrid, Spain
| | - Cristina Martín
- Units of Experimental Neurology and Sleep Apnea, Hospital “Ramón y Cajal” (IRYCIS), Madrid, Spain
| | - José M. Ibarz
- Units of Experimental Neurology and Sleep Apnea, Hospital “Ramón y Cajal” (IRYCIS), Madrid, Spain
| | - Eva Mañas
- Sleep Apnea Unit, Respiratory Department, Hospital “Ramón y Cajal” (IRYCIS), Madrid, Spain
| | - David L. Paul
- Department of Neurobiology, Medical School, Harvard University, Boston, MA, United States
| | - Luis C. Barrio
- Units of Experimental Neurology and Sleep Apnea, Hospital “Ramón y Cajal” (IRYCIS), Madrid, Spain,Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain,*Correspondence: Luis C. Barrio, ; orcid.org/0000-0002-9016-3510
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Abstract
Es hat sich viel getan in der Welt der Schlafmedizin in der Kardiologie, weshalb eine vollwertige Überarbeitung des Positionspapiers „Schlafmedizin in der Kardiologie“ erforderlich wurde. In der aktuellen neuartigen Version finden sich nicht nur alle verfügbaren Studien, Literaturstellen und Updates zu Pathophysiologie, Diagnostik- und Therapieempfehlungen, sondern auch Ausblicke auf neue Entwicklungen und zukünftige Forschungserkenntnisse. Dieses überarbeitete Positionspapier gibt Empfehlungen für Diagnostik und Therapie von Patienten mit kardiovaskulären Erkrankungen mit schlafassoziierten Atmungsstörungen und erteilt darüber hinaus einen fundierten Überblick über verfügbare Therapien und Evidenzen, gibt aber ebenso Ratschläge wie mit Komorbiditäten umzugehen ist. Insbesondere enthält dieses überarbeitete Positionspapier aktualisierte Stellungnahmen zu schlafassoziierten Atmungsstörungen bei Patienten mit koronarer Herzerkrankung, Herzinsuffizienz, arterieller Hypertonie, aber auch für Patienten mit Vorhofflimmern. Darüber hinaus finden sich erstmals Empfehlungen zur Telemedizin als eigenes, neues Kapitel. Dieses Positionspapier bietet Kardiologen sowie Ärzten in der Behandlung von kardiovaskulären Patienten die Möglichkeit einer evidenzbasierten Behandlung der wachsend bedeutsamen und mit zunehmender Aufmerksamkeit behafteten Komorbidität schlafassoziierter Atmungsstörungen. Und nicht zuletzt besteht mit diesem neuen Positionspapier eine enge Verknüpfung mit dem neuen Curriculum Schlafmedizin der Deutschen Gesellschaft für Kardiologie, weshalb dieses Positionspapier eine Orientierung für die erworbenen Fähigkeiten des Curriculums im Umgang von kardiovaskulären Patienten mit schlafassoziierten Atmungsstörungen darstellt.
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Pre-Treatment with Ten-Minute Carbon Dioxide Inhalation Prevents Lipopolysaccharide-Induced Lung Injury in Mice via Down-Regulation of Toll-Like Receptor 4 Expression. Int J Mol Sci 2019; 20:ijms20246293. [PMID: 31847115 PMCID: PMC6940754 DOI: 10.3390/ijms20246293] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/07/2019] [Accepted: 12/11/2019] [Indexed: 12/29/2022] Open
Abstract
Various animal studies have shown beneficial effects of hypercapnia in lung injury. However, in patients with acute respiratory distress syndrome (ARDS), there is controversial information regarding the effect of hypercapnia on outcomes. The duration of carbon dioxide inhalation may be the key to the protective effect of hypercapnia. We investigated the effect of pre-treatment with inhaled carbon dioxide on lipopolysaccharide (LPS)-induced lung injury in mice. C57BL/6 mice were randomly divided into a control group or an LPS group. Each LPS group received intratracheal LPS (2 mg/kg); the LPS groups were exposed to hypercapnia (5% carbon dioxide) for 10 min or 60 min before LPS. Bronchoalveolar lavage fluid (BALF) and lung tissues were collected to evaluate the degree of lung injury. LPS significantly increased the ratio of lung weight to body weight; concentrations of BALF protein, tumor necrosis factor-α, and CXCL2; protein carbonyls; neutrophil infiltration; and lung injury score. LPS induced the degradation of the inhibitor of nuclear factor-κB-α (IκB-α) and nuclear translocation of NF-κB. LPS increased the surface protein expression of toll-like receptor 4 (TLR4). Pre-treatment with inhaled carbon dioxide for 10 min, but not for 60 min, inhibited LPS-induced pulmonary edema, inflammation, oxidative stress, lung injury, and TLR4 surface expression, and, accordingly, reduced NF-κB signaling. In summary, our data demonstrated that pre-treatment with 10-min carbon dioxide inhalation can ameliorate LPS-induced lung injury. The protective effect may be associated with down-regulation of the surface expression of TLR4 in the lungs.
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Hermand E, Lhuissier FJ, Richalet JP. Effect of dead space on breathing stability at exercise in hypoxia. Respir Physiol Neurobiol 2017; 246:26-32. [PMID: 28760461 DOI: 10.1016/j.resp.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 01/08/2023]
Abstract
Recent studies have shown that normal subjects exhibit periodic breathing when submitted to concomitant environmental (hypoxia) and physiological (exercise) stresses. A mathematical model including mass balance equations confirmed the short period of ventilatory oscillations and pointed out an important role of dead space in the genesis of these phenomena. Ten healthy subjects performed mild exercise on a cycloergometer in different conditions: rest/exercise, normoxia/hypoxia and no added dead space/added dead space (aDS). Ventilatory oscillations (V˙E peak power) were augmented by exercise, hypoxia and aDS (P<0.001, P<0.001 and P<0.01, respectively) whereas V˙E period was only shortened by exercise (P<0.001), with an 11-s period. aDS also increased V˙E (P<0.001), tidal volume (VT, P<0.001), and slightly augmented PETCO2 (P<0.05) and the respiratory frequency (P<0.05). These results confirmed our previous model, showing an exacerbation of breathing instability by increasing dead space. This underlines opposite effects observed in heart failure patients and normal subjects, in which added dead space drastically reduced periodic breathing and sleep apneas. It also points out that alveolar ventilation remains very close to metabolic needs and is not affected by an added dead space. Clinical Trial reg. n°: NCT02201875.
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Affiliation(s)
- Eric Hermand
- Université Paris 13, Sorbonne Paris Cité, Laboratoire "Hypoxie et poumon", EA2363, Bobigny, France.
| | - François J Lhuissier
- Université Paris 13, Sorbonne Paris Cité, Laboratoire "Hypoxie et poumon", EA2363, Bobigny, France; Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service de Physiologie, explorations fonctionnelles et médecine du sport, 93009 Bobigny, France
| | - Jean-Paul Richalet
- Université Paris 13, Sorbonne Paris Cité, Laboratoire "Hypoxie et poumon", EA2363, Bobigny, France.
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Wang M, Ding H, Kang J, Hu K, Lu W, Zhou X, Xu L. Association between polymorphisms of the HSPB7 gene and Cheyne-Stokes respiration with central sleep apnea in patients with dilated cardiomyopathy and congestive heart failure. Int J Cardiol 2016; 221:926-31. [PMID: 27441470 DOI: 10.1016/j.ijcard.2016.07.107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND CSR-CSA is frequent in patients with CHF. Dilated cardiomyopathy (DCM) is a structural heart disease with strong genetic background, yet one of the leading etiological causes of CHF. Studies have showed that the HSPB7 gene is associated with DCM. OBJECTIVES We aimed to explore the prevalence of polymorphisms of the HSPB7 gene in the Chinese Han population with CSR-CSA and CHF caused by DCM. METHODS A total of 503 unrelated subjects of the Chinese Han population, including 283 CHF patients caused by DCM and 220 healthy controls, were involved in the study. The CHF patients were classified as the CSA-CHF group and the non-CSA-CHF group according to the PSG parameters. The rs1739843 polymorphisms of the HSPB7 gene were identified by real-time quantitative polymerase chain reaction. RESULTS In the present study, 35.8% of CHF patients caused by DCM had CSR-CSA. Comparison demonstrated that the CSA-CHF group had significantly higher TT genotype and T allele frequencies in the rs1739843 single nucleotide polymorphism (SNP) of the HSPB7 gene. There were no significant differences among the CC genotype distribution of the CSA-CHF group and the non-CSA-CHF group or the control group. CONCLUSIONS The rs1739843 polymorphism of the HSPB7 gene might be involved in the pathogenesis of CSR-CSA and CHF subjects caused by DCM in the Chinese Han population. This finding was from a genetic search for the role of the HSPB7 gene in CSR-CSA of CHF patients caused by DCM.
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Affiliation(s)
- Mengmei Wang
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, Zhangzhidong Road No. 99, Wuhan 430060, China.
| | - Hao Ding
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, Zhangzhidong Road No. 99, Wuhan 430060, China.
| | - Jing Kang
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, Zhangzhidong Road No. 99, Wuhan 430060, China.
| | - Ke Hu
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, Zhangzhidong Road No. 99, Wuhan 430060, China.
| | - Wen Lu
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, Zhangzhidong Road No. 99, Wuhan 430060, China.
| | - Xiufang Zhou
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, Zhangzhidong Road No. 99, Wuhan 430060, China.
| | - Lifang Xu
- Division of Respiratory Disease, Renmin Hospital of Wuhan University, Zhangzhidong Road No. 99, Wuhan 430060, China.
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Wang Y, Cao J, Feng J, Chen BY. Cheyne-Stokes respiration during sleep: mechanisms and potential interventions. Br J Hosp Med (Lond) 2015; 76:390-6. [PMID: 26140557 DOI: 10.12968/hmed.2015.76.7.390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cheyne-Stokes respiration is characterized by a typical waxing and waning pattern in breathing amplitude, interspersed with central apnoeas or hypopnoeas. This article reviews current knowledge regarding Cheyne-Stokes respiration with a particular emphasis on the mechanisms and latest methods of intervention.
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Affiliation(s)
| | | | | | - Bao-Yuan Chen
- Chief Physician in the Department of Respiratory Diseases, Tianjin Medical University General Hospital, Tianjin, 300052, China
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Affiliation(s)
- Tomasz J Kuźniar
- Division of Pulmonary and Critical Care Medicine, NorthShore University HealthSystem, Evanston, IL
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