Cardiac and sympathetic effects of middle cerebral artery occlusion in the spontaneously hypertensive rat

Stroke-heart syndrome: current progress and future outlook

Stroke can lead to cardiac complications such as arrhythmia, myocardial injury, and cardiac dysfunction, collectively termed stroke-heart syndrome (SHS). These cardiac alterations typically peak within 72 h of stroke onset and can have long-term effects on cardiac function. Post-stroke cardiac complications seriously affect prognosis and are the second most frequent cause of death in patients with stroke. Although traditional vascular risk factors contribute to SHS, other potential mechanisms indirectly induced by stroke have also been recognized. Accumulating clinical and experimental evidence has emphasized the role of central autonomic network disorders and inflammation as key pathophysiological mechanisms of SHS. Therefore, an assessment of post-stroke cardiac dysautonomia is necessary. Currently, the development of treatment strategies for SHS is a vital but challenging task. Identifying potential key mediators and signaling pathways of SHS is essential for developing therapeutic targets. Therapies targeting pathophysiological mechanisms may be promising. Remote ischemic conditioning exerts protective effects through humoral, nerve, and immune-inflammatory regulatory mechanisms, potentially preventing the development of SHS. In the future, well-designed trials are required to verify its clinical efficacy. This comprehensive review provides valuable insights for future research.

Elevated Vascular Sympathetic Neurotransmission and Remodelling Is a Common Feature in a Rat Model of Foetal Programming of Hypertension and SHR

Hypertension is of unknown aetiology, with sympathetic nervous system hyperactivation being one of the possible contributors. Hypertension may have a developmental origin, owing to the exposure to adverse factors during the intrauterine period. Our hypothesis is that sympathetic hyperinnervation may be implicated in hypertension of developmental origins, being this is a common feature with essential hypertension. Two-animal models were used: spontaneously hypertensive rats (SHR-model of essential hypertension) and offspring from dams exposed to undernutrition (MUN-model of developmental hypertension), with their respective controls. In adult males, we assessed systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), sympathetic nerve function (3H-tritium release), sympathetic innervation (immunohistochemistry) and vascular remodelling (histology). MUN showed higher SBP/DBP, but not HR, while SHR exhibited higher SBP/DBP/HR. Regarding the mesenteric arteries, MUN and SHR showed reduced lumen, increased media and adventitial thickness and increased wall/lumen and connective tissue compared to respective controls. Regarding sympathetic nerve activation, MUN and SHR showed higher tritium release compared to controls. Total tritium tissue/tyrosine hydroxylase detection was higher in SHR and MUN adventitia arteries compared to respective controls. In conclusion, sympathetic hyperinnervation may be one of the contributors to vascular remodelling and hypertension in rats exposed to undernutrition during intrauterine life, which is a common feature with spontaneous hypertension.

Cerebral-Cardiac Syndrome and Diabetes: Cardiac Damage After Ischemic Stroke in Diabetic State

Cerebral-cardiac syndrome (CCS) refers to cardiac dysfunction following varying brain injuries. Ischemic stroke is strongly evidenced to induce CCS characterizing as arrhythmia, myocardial damage, and heart failure. CCS is attributed to be the second leading cause of death in the post-stroke stage; however, the responsible mechanisms are obscure. Studies indicated the possible mechanisms including insular cortex injury, autonomic imbalance, catecholamine surge, immune response, and systemic inflammation. Of note, the characteristics of the stroke population reveal a common comorbidity with diabetes. The close and causative correlation of diabetes and stroke directs the involvement of diabetes in CCS. Nevertheless, the role of diabetes and its corresponding molecular mechanisms in CCS have not been clarified. Here we conclude the features of CCS and the potential role of diabetes in CCS. Diabetes drives establish a “primed” inflammatory microenvironment and further induces severe systemic inflammation after stroke. The boosted inflammation is suspected to provoke cardiac pathological changes and hence exacerbate CCS. Importantly, as the key element of inflammation, NOD-like receptor pyrin domain containing 3 (NLRP3) inflammasome is indicated to play an important role in diabetes, stroke, and the sequential CCS. Overall, we characterize the corresponding role of diabetes in CCS and speculate a link of NLRP3 inflammasome between them.

Forebrain neurocircuitry associated with human reflex cardiovascular control

Physiological homeostasis depends upon adequate integration and responsiveness of sensory information with the autonomic nervous system to affect rapid and effective adjustments in end organ control. Dysregulation of the autonomic nervous system leads to cardiovascular disability with consequences as severe as sudden death. The neural pathways involved in reflexive autonomic control are dependent upon brainstem nuclei but these receive modulatory inputs from higher centers in the midbrain and cortex. Neuroimaging technologies have allowed closer study of the cortical circuitry related to autonomic cardiovascular adjustments to many stressors in awake humans and have exposed many forebrain sites that associate strongly with cardiovascular arousal during stress including the medial prefrontal cortex, insula cortex, anterior cingulate, amygdala and hippocampus. Using a comparative approach, this review will consider the cortical autonomic circuitry in rodents and primates with a major emphasis on more recent neuroimaging studies in awake humans. A challenge with neuroimaging studies is their interpretation in view of multiple sensory, perceptual, emotive and/or reflexive components of autonomic responses. This review will focus on those responses related to non-volitional baroreflex control of blood pressure and also on the coordinated responses to non-fatiguing, non-painful volitional exercise with particular emphasis on the medial prefrontal cortex and the insula cortex.

Cortical circuitry associated with reflex cardiovascular control in humans: does the cortical autonomic network "speak" or "listen" during cardiovascular arousal

Beginning with clinical evidence of fatal cardiac arrhythmias in response to severe stress, in epileptic patients, and following stroke, the role of the cerebral cortex in autonomic control of the cardiovascular system has gained both academic and clinical interest. Studies in anesthetized rodents have exposed the role of several forebrain regions involved in cardiovascular control. The introduction of functional neuroimaging techniques has enabled investigations into the conscious human brain to illuminate the temporal and spatial activation patterns of cortical regions that are involved with cardiovascular control through the autonomic nervous system. This symposia report emphasizes the research performed by the authors to understand the functional organization of the human forebrain in cardiovascular control during physical stressors of baroreceptor unloading and handgrip exercise. The studies have exposed important associations between activation patterns of the insula cortex, dorsal anterior cingulate, and the medial prefrontal cortex and cardiovascular adjustments to physical stressors. Furthermore, these studies provide functional anatomic evidence that sensory signals arising from baroreceptors and skeletal muscle are represented within the insula cortex and the medial prefrontal cortex, in addition to the sensory cortex. Thus, the cortical pathways subserving reflex cardiovascular control integrate viscerosensory inputs with outgoing traffic that modulates the autonomic nervous system.

Autonomic reactions and peri-interventional alterations in body weight as potential supplementary outcome parameters for thromboembolic stroke in rats

Background

Since several neuroprotectives failed to reproduce promising preclinical results under clinical conditions, efforts emerged to implement clinically relevant endpoints in animal stroke studies. Thereby, insufficient attention was given on autonomic reactions due to experimental stroke, although clinical trials reported on high functional and prognostic impact. This study focused on autonomic consequences and body weight changes in a translational relevant stroke model and investigated interrelations to different outcome measurements.

Methods

Forty-eight rats underwent thromboembolic middle cerebral artery occlusion (MCAO) while recording heart rate (HR) and mean arterial pressure (MAP). After assessing early functional impairment (Menzies score), animals were assigned to control procedure or potentially neuroprotective treatment with normobaric (NBO) or hyperbaric oxygen (HBO). Four or 24 hours after ischemia onset, functional impairment was re-assessed and FITC-albumin administered intravenously obtaining leakage-related blood–brain barrier (BBB) impairment. Body weight was documented prior to MCAO and 4 or 24 hours after ischemia onset.

Results

During MCAO, HR was found to increase significantly while MAP decreased. The amount of changes in HR was positively correlated with early functional impairment (P = 0.001): Severely affected animals provided an increase of 15.2 compared to 0.8 beats/minute in rats with low impairment (P = 0.048). Regarding body weight, a decrease of 9.4% within 24 hours after MCAO occurred, but treatment-specific alterations showed no significant correlations with respective functional or BBB impairment.

Conclusions

Future studies should routinely include autonomic parameters to allow inter-group comparisons and better understanding of autonomic reactions due to experimental stroke. Prospectively, autonomic consequences might represent a useful outcome parameter enhancing the methodological spectrum of preclinical stroke studies.

Transient middle cerebral artery occlusion and reperfusion alters inducible NOS expression within the ventrolateral medulla and modulates cardiovascular function during static exercise

A major cause of stroke is cerebral ischemia in regions supplied by the middle cerebral artery (MCA). In this study, we hypothesized that compromised cardiovascular function during static exercise may involve altered expression of inducible NOS (iNOS) protein within the rostral ventrolateral medulla (RVLM) and caudal ventrolateral medulla (CVLM). We compared cardiovascular responses and iNOS protein expression within the left and right sides of both RVLM and CVLM in sham-operated rats and in rats with a 90 min left-sided MCA occlusion (MCAO) followed by 24 h of reperfusion. Increases in blood pressure during a static muscle contraction were attenuated in MCAO rats compared with sham-operated rats. Also, iNOS expression within the left RVLM was augmented compared with the right RVLM in MCAO rats and compared with both RVLM quadrants in sham-operated rats. In contrast, compared with sham-operated rats and the right CVLM of MCAO rats, iNOS expression was attenuated in the left CVLM in left-sided MCAO rats. These data suggest that the attenuation of pressor responses during static exercise in MCAO rats involves overexpression of iNOS within the ipsilateral RVLM and attenuation in iNOS within the ipsilateral CVLM. Differential expression of iNOS within the medulla plays a role in mediating cardiovascular responses during static exercise following stroke.

A modified suture technique produces consistent cerebral infarction in rats

Intraluminal occlusion of the middle cerebral artery (MCA) is used extensively in cerebral ischemia research. We tested a modified nylon suture in a rat model of middle cerebral artery occlusion (MCAO) under two anesthesia regimens. Sprague-Dawley rats were divided into six groups (Group 1, Poly-L-lysine-coated suture under ketamine/xylazine anesthesia; Group 2, modified suture under ketamine/xylazine anesthesia; Group 3, Poly-L-lysine-coated suture under ketamine/xylazine anesthesia with mechanical ventilation; Group 4, modified suture under ketamine/xylazine anesthesia with mechanical ventilation; Group 5, Poly-L-lysine-coated suture under isoflurane anesthesia; Group 6, modified suture under isoflurane anesthesia) and subjected to 2-hour MCAO. Regional cerebral blood flow (rCBF) was monitored by Laser-Doppler flowmetry. Neurological evaluation and ischemic lesion (TTC stain) were assessed at 24 hours of reperfusion. The total ischemic lesion (sum of areas with lacking and intermediate TTC staining) was similar among all six groups. Compared with a Poly-L-lysine-coated suture technique, the modified suture technique produced a lower rCBF, larger infarct size, smaller variance of infarct size, and greater neurological deficit. In addition, isoflurane significantly reduced infarct size. We conclude that the use of this modified suture technique with ketamine/xylazine anesthesia and mechanical ventilation produces a more consistent change in cerebral ischemic damage following MCAO in rats.

Endothelial NOS expression within the ventrolateral medulla can affect cardiovascular function during static exercise in stroked rats

Temporary occlusion of the middle cerebral artery (MCA) causing damage to brain tissue occurs in the majority of human stroke victims. Reflex cardiovascular responses during static exercise were attenuated following transient MCA occlusion (MCAO) and reperfusion, mediated via alteration of the neuronal nitric oxide synthase (nNOS) protein isoform within the rostral (RVLM) and caudal (CVLM) ventrolateral medulla (Ally, A., Nauli, S.M., Maher, T.J. 2005. Molecular changes in nNOS protein expression within the ventrolateral medulla following transient focal ischemia affect cardiovascular functions. Brain Res. [1055, 73-82]. We hypothesized that the endothelial NOS (eNOS) isoform within the RVLM and CVLM might also play a role in integrating cardiovascular function. Thus, we compared cardiovascular responses to static muscle contraction and eNOS expression within the four quadrants, i.e., left and right sides of both RVLM and CVLM in sham operated rats and in rats with a temporary 90-minute one-sided MCAO followed by 24 hour reperfusion. Increases in arterial pressure during a muscle contraction were attenuated in MCAO rats when compared to sham rats. Left-sided MCAO significantly decreased the expression of eNOS in the ipsilateral side but not contralateral RVLM, and to both RVLM quadrants in sham-operated rats. In contrast, compared to sham rats and the right CVLM quadrant of MCAO rats, eNOS expression was significantly increased in the left ipsilateral CVLM quadrant in left-sided MCAO rats. These data suggest that attenuation of cardiovascular responses during muscle contraction in MCAO rats may be partly due to a reduction in eNOS expression within the ipsilateral RVLM and an overexpression of eNOS within the ipsilateral CVLM. Results demonstrate that the eNOS protein within the medulla may play a significant role in mediating cardiovascular responses during static exercise in pathophysiological conditions, such as stroke.

Functional magnetic resonance signal changes in neural structures to baroreceptor reflex activation

The sequence of neural responses to exogenous arterial pressure manipulation remains unclear, especially for extramedullary sites. We used functional magnetic resonance imaging procedures to visualize neural responses during pressor (phenylephrine) and depressor (sodium nitroprusside) challenges in seven isoflurane-anesthetized adult cats. Depressor challenges produced signal-intensity declines in multiple cardiovascular-related sites in the medulla, including the nucleus tractus solitarius, and caudal and rostral ventrolateral medulla. Signal decreases also emerged in the cerebellar vermis, inferior olive, dorsolateral pons, and right insula. Rostral sites, such as the amygdala and hypothalamus, increased signal intensity as arterial pressure declined. In contrast, arterial pressure elevation elicited smaller signal increases in medullary regions, the dorsolateral pons, and the right insula and signal declines in regions of the hypothalamus, with no change in deep cerebellar areas. Responses to both pressor and depressor challenges were typically lateralized. In a subset of animals, barodenervation resulted in rises and falls of blood pressure that were comparable to these resulting from the pharmacological challenges but different regional neural responses, indicating that the regional signal intensity responses did not derive from global perfusion effects but from baroreceptor mediation of central mechanisms. The findings demonstrate widespread lateralized distribution of neural sites responsive to blood pressure manipulation. The distribution and time course of neural responses follow patterns associated with early and late compensatory reactions.

Cardiovascular responses and neurotransmission in the ventrolateral medulla during skeletal muscle contraction following transient middle cerebral artery occlusion and reperfusion

We hypothesized that static skeletal muscle contraction-induced systemic cardiovascular responses, and central glutamate/GABA release in rostral (RVLM) and caudal ventrolateral medulla (CVLM), would be modulated by cerebral ischemia. In sham-operated rats, a 2-min tibial nerve stimulation induced static contraction of the triceps surae, evoked pressor responses, increased glutamate in both the RVLM and CVLM, decreased GABA in the CVLM, and increased GABA in the RVLM. In rats with a temporary 90-min left middle cerebral artery occlusion (MCAO) followed by 24 h reperfusion, pressor responses during muscle contractions were attenuated, as were glutamate within the left RVLM and left CVLM. Glutamate within the right RVLM and right CVLM were unaltered and similar to those in sham rats. In contrast, GABA increases during muscle contractions were enhanced in the left RVLM and CVLM but changes within the right CVLM and RVLM were similar to those in sham rats. These results indicate that unilateral ischemia increases ipsilateral GABA/glutamate ratios during muscle contraction in the RVLM. In contrast, opposite changes in ipsilateral glutamate and GABA release within the RVLM and CVLM were observed following a 90-min right-sided MCAO followed by 24 h reperfusion. However, cardiovascular responses during muscle contraction were depressed following such an ischemic brain injury. These data suggest that transient ischemic brain injury attenuates cardiovascular responses to static exercise via modulating neurotransmission within the ventrolateral medulla.

Circadian variation of blood pressure and neurohumoral factors during the acute phase of stroke

This study was to investigate the relationship between circadian blood pressure (BP) variation and circadian variation of neurohumoral factors during the acute phase of stroke. We studied 17 patients with cerebral infarction in 16 and cerebral hemorrhage in one. We performed 24-hour ambulatory BP monitoring and examined plasma renin activity (PRA), catecholamine, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), endothelin 1 (ET1) and prothrombin fragment 1+2 (PT F1+2) and urinary catecholamine. Our result showed that the circadian variation of BP, neurohumoral and coagulation factors were diminished. There were significant relationships between BP levels and plasma BNP levels, nocturnal urinary adrenalines and ET1s. There were also significant relationships between night/day ratio of BP and plasma ET1 level. In conclusion the abnormal patterns of circadian BP rhythm were frequently observed during the acute phase of stroke. The cause of this abnormality may result from the diminished circadian rhythms of neurohumoral factors.

Why are strokes related to hypertension? Classic studies and hypotheses revisited

Although it seems obvious that excessive intravascular pressure is the cause of spontaneous intracerebral haemorrhage, the available evidence instead suggests that haemorrhage arises from previous ischaemic damage to the walls of small blood vessels. This interpretation unifies the aetiology of cerebral infarction and intracerebral haemorrhage. It is supported by much pathological evidence and also fits with observations on spontaneous stroke-prone hypertensive rats, which have smaller cerebral arteries than Wistar-Kyoto rats. Ischaemic damage to the brain probably occurs during spontaneous dips in aortic pressure in the presence of atheromatous arterial lesions and arteriolar narrowing by lipohyaline deposits. It may also follow long-lasting arterial spasm provoked by sudden pressure elevations. Local factors, especially unevenness of cerebral perfusion, probably determine the site of an infarct and whether it becomes haemorrhagic or not. In the long term, hypotensive drugs will lessen atheroma deposition. In the short term, they may act by reducing or preventing damaging arteriolar spasm.

Neuropeptide Y-Y1 receptor antisense oligodeoxynucleotide increases the infarct volume after middle cerebral artery occlusion in rats

An antisense oligodeoxynucleotide selective for the rat neuropeptide Y1 receptor gene was given into the left lateral ventricle in the experimental group of rats, whereas a missense oligodeoxynucleotide or saline was given in the control groups. Some rats were decapitated at 1-2h after the last injection of the oligodeoxynucleotides to examine their effects on the Y1 receptor density in the insular cortex. When compared to the Y1 and Y2 binding density of the untreated rats, the antisense-treated rats had reduced Y1 binding in the insular cortex but the Y2 binding was unaffected; treatment with missense oligodeoxynucleotide had no effect. Other rats underwent a right-sided middle cerebral artery occlusion at 1-2h after the last injection of the oligodeoxynucleotides or saline to examine the effect on the infarction volume at three days following stroke. The antisense treatment resulted in a doubling of the mean infarction volume when compared to the missense or saline treatment.Thus, reducing the Y1 receptor density prior to middle cerebral artery occlusion is harmful. Neuropeptide Y may mediate neuroprotection against focal ischemia via the cortical Y1 receptor, since the immunoreactivity for neuropeptide Y has been shown to increase within the peri-infarct cortex after middle cerebral artery occlusion.

Which parameters of beat-to-beat blood pressure and variability best predict early outcome after acute ischemic stroke?

BACKGROUND AND PURPOSE

In hypertensive populations, increasing blood pressure (BP) levels and BP variability (BPV) are associated with a greater incidence of target organ damage. After stroke, elevated 24-hour BP levels predict a poor outcome, although it is uncertain whether shorter-length BP recordings assessing mean BP levels and BPV have a similar predictive role. The objectives of this study were to compare the different measures of beat-to-beat BP and BPV on outcome after acute ischemic stroke and assess whether these parameters were affected by stroke subtype.

METHODS

Ninety-two consecutive admissions with a CT-confirmed diagnosis of acute ischemic stroke were recruited, of whom 54 had cortical infarction, 29 subcortical, and 9 posterior circulation infarction. Casual and two 5-minute recordings of beat-to-beat BP (Finapres, Ohmeda) were made under standardized conditions within 72 hours of ictus, with mean BP levels taken as the average of this 10-minute recording and BPV as the standard deviation. Outcome was assessed at 30 days as dead/dependent or independent (Rankin </=2). The effects of BP, BPV, and stroke subtype on outcome were studied with the use of logistic regression. Stroke subjects were subsequently divided by BP quartiles and within each quartile into low- and high-variability groups; the influence of high BPV on outcome was also assessed.

RESULTS

The odds ratio for death/dependency was significantly higher in cortical strokes compared with subcortical and posterior circulation strokes even after controlling for differences in BP and BPV (OR 4.19, P=0.002). Beat-to-beat systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP +/- SD) levels were higher in the dead/dependent group compared with the independent group (MAP 106+/-20.4 mm Hg vs 97+/-19.1 mm Hg, P<0.02), as was MAP variability: 6.1 (interquartile range 4.5 to 7.4 mm Hg) versus 4.9 (3.8 to 6.4 mm Hg, P=0.02). The odds ratio for a poor outcome was 1. 38 (P=0.014) for every 10-mm Hg increase in MAP and 1.32 (P=0.02) for every 1-mm Hg increase in MAP variability. Casual BP measurements had no prognostic significance. For the group as a whole when separated into BP quartiles, those with a high MAP and DBP but not SBP variability within each quartile had a worse prognosis compared with those with a low BPV.

CONCLUSIONS

A poor outcome at 30 days after ischemic stroke was dependent on stroke subtype, beat-to-beat DBP, and MAP levels and variability. Important prognostic information can be readily obtained from a short period of noninvasive BP monitoring in the acute stroke patient. These findings have important implications, particularly regarding the use of hypotensive agents in the acute stroke period.

Diurnal blood pressure change varies with stroke subtype in the acute phase

BACKGROUND AND PURPOSE

It is unclear whether acute stroke is associated with a loss of the normal diurnal blood pressure (BP) change and whether stroke type influences this. Some of this confusion results from the use of fixed time definitions of day and night, which can be overcome by the use of cumulative sums analysis (cusums).

METHODS

Ninety-eight stroke patients had 24-hour BP monitoring (Spacelabs 90207) performed within 48 hours of ictus. Three subgroups were identified: cortical infarct, n=50; subcortical infarct, n=29; and primary intracerebral hemorrhage [PICH], n= 19. An age-matched control group of 74 subjects was also studied. Diurnal change was assessed by both day-night differences (absolute and percentage) and cusums (cusums plot height [CPH] and circadian alteration magnitude [CDCAM]); ANCOVA was used to compare groups.

RESULTS

Compared with control subjects, cortical infarct and PICH subgroups had significantly reduced mean diurnal systolic changes using day-night differences (absolute, -12 and -17 mm Hg; percentage, -10 and -12, respectively; P < 0.0001) and cusums (CDCAM, -6.96 and -8.6 mm Hg; CPH, -32.05 and -46.04 mm Hg, respectively; P < 0.005), only the subcortical infarct subgroup demonstrated reduced percentage differences (-4.4%, P < 0.02). Mean diastolic differences were significantly reduced in all stroke subgroups(CPH, -24.84, -17.31, and -36.92 mm Hg; absolute, -8.26, -4.04, and -11.44 mm Hg; percentage, -10.65, -5.81, and -15.23%, for cortical infarct, subcortical infarct, and PICH subgroups, respectively; P < 0.05), except for CDCAM, which was not reduced in subcortical infarcts (-4.78 and -7.70 mm Hg for cortical infarct and PICH subgroups, respectively; P < 0.001).

CONCLUSIONS

Diurnal BP change was reduced in the 3 stroke subgroups studied, especially in patients with cortical infarcts and PICH. This may reflect damage to the central modulation of autonomic BP control. The implications in terms of prognosis and therapy in the acute period require further study.

Influence of neonatal focal cerebral hypoxia-ischemia on cardiovascular and neurobehavioral functions in adult Wistar rats

No experimental studies looked at the disturbances appearing after a neonatal focal cerebral hypoxia-ischemia (HI) when animals become adults. Using radiotelemetry, we examined the effects of neonatal focal cerebral HI on blood pressure (BP), heart rate (HR), locomotor activity (LA), body temperature (BT) levels and circadian rhythm parameters of unrestrained adult Wistar rats. At 15 weeks of age, we continuously recorded the cardiovascular and neurobehavioral parameters of HI (n = 6) and sham-operated (n = 6) rats. In adult rats, HI induced persistent hypertensive effects associated with alteration in BP circadian rhythms and pronounced decreases in mesor and percent rhythm of LA. HR and BT parameters were not significantly modified. Therefore, our results suggest that the rat cardiovascular and behavioural circadian control systems may involve several structures which present selective vulnerability to early cerebral HI.

Role of the insular cortex in the modulation of baroreflex sensitivity

Cervical vagal stimulation for 2 h results in a depressed baroreflex sensitivity produced by an enhanced sympathetic output, as indicated by increased plasma norepinephrine levels. The current study examined the role of the insular cortex in modulating the vagal stimulation-induced changes in baroreflex sensitivity. Male Sprague-Dawley rats were anesthetized with thiobutabarbitol sodium and instrumented for recording blood pressure, heart rate, intravenous drug administration, and vagal afferent nerve stimulation. Stereotaxic microinjections (300 nl) of either 5% lidocaine or 0.9% saline were made bilaterally into the insula. Thirty minutes after 2 h of vagal stimulation, the baroreflex was significantly depressed and plasma norepinephrine levels were significantly elevated in both groups. The baroreflex was also significantly depressed after bilateral lidocaine injections into the insula, independent of vagal stimulation. However, no significant change in plasma norepinephrine was observed, suggesting that an attenuated parasympathetic output contributed to the altered baroreflex. Taken together, the results suggest that the insular cortex modulates the cardiac baroreflex through a modulation of parasympathetic output.

Characterization, distribution and lateralization of baroreceptor-related neurons in the rat insular cortex

The insular cortex contains a site of cardiovascular representation. Stimulation experiments suggest a discrete localization within the rostral posterior insula. In 34 urethane-anesthetized male Sprague-Dawley rats, we investigated whether cells responsive to baroreceptor stimulation with phenylephrine and sodium nitroprusside were selectively clustered within the insula compared with the surrounding frontoparietal cortex, the extent of distribution of these responsive cells within the insula, and whether there was any lateralization of response. In addition, we characterized the cells as SE (sympathoexcitatory), SI (sympathoinhibitory) or null cells using the criteria of Barman. Of the 128 insular cells investigated with extracellular recording techniques, 70% responded to baroreceptor manipulations compared to 32% of the 57 cells investigated outside the insula (P < 0.0001). The majority of the responsive cells were SE units and were distributed widely throughout the insular cortex including anterior areas not previously thought to be involved in cardiovascular control. Within the rostral posterior insula from which cardiovascular effects are mainly obtained in stimulation experiments, lateralization was identified, with significantly more cells responding to blood pressure changes being found within the right posterior insula than the left (P < 0.003). These data confirm the importance of the right posterior insula in the rat as a site of cardiovascular representation; identify a more extensive distribution of cells responsive to blood pressure changes within the insula than previous studies and imply more widespread convergence of visceral afferent information within the insula.

Cardiovascular response to stress after middle cerebral artery occlusion in rats

Previously, we have shown cardiovascular and autonomic disturbances in male Wistar rats following middle cerebral artery occlusion (MCAO). Using this model, neurochemical changes, that were maximal at 3-5 days and subsiding by day 10, were observed unilaterally in the insular cortex and amygdala. The amygdalar neurochemical changes may be related to the stroke-induced cardiovascular disturbances, since the amygdala is critical in mediating the cardiovascular responses to stress. We examined the cardiovascular responses to intermittent and continuous noise and air-jet stimulation in male Wistar rats on days 2-10 after right-sided MCAO or sham MCAO. Compared to the sham MCAO rats, intermittent noise elicited significant tachycardiac responses on days 5 and 7 after stroke. Air-jet stimulation also elicited a significant tachycardic response on day 5, whereas continuous noise produced significant tachycardiac and pressor responses at days 5 and 7, respectively, in the MCAO rats compared to the control rats. Analyses on the heart rate variability using fast Fourier transformation revealed significant increases in the normalized mid-frequency spectral power on day 7 for intermittent noise and air-jet stimulation, suggesting increases in the sympathetic activity. These results indicate a time-course of exaggerated cardiovascular responses to stress and suggest a state of susceptibility to cardiac perturbations in rats following stroke.

Neuropeptide changes following excitotoxic lesion of the insular cortex in rats

Following middle cerebral artery occlusion in Wistar rats, the immunoreactivity of neuropeptide Y increased ipsilaterally in the insular cortex and basolateral nucleus of the amygdala. In addition, the immunoreactivity of leucine-enkephalin, dynorphin, and neurotensin increased in the ipsilateral central nucleus of the amygdala. The amygdalar neurochemical changes are likely the result of damage to the insular cortex, although other cortical areas were also affected by the ischemia. To investigate whether damage to the insular cortex is essential in eliciting these changes, a localized lesion of the right or left insular cortex was produced by microinjection of D,L-homocysteic acid. Control animals received injections of vehicle into the right or left insular cortex or D,L-homocysteic acid into the right primary somatosensory cortex. Neurochemical changes were examined immunohistochemically with the peroxidase-antiperoxidase reaction 5 days after the injection. The immunoreactivity of neuropeptide Y increased locally after excitotoxic damage to the insular cortex or primary somatosensory cortex. The amygdalar neurochemical changes, including neuropeptide Y increase in the basolateral nucleus and leucine-enkephalin, dynorphin, and neurotensin increase in the central nucleus, were seen only when the ipsilateral insular cortex was lesioned. These neurochemical changes were similar to those seen 5 days after middle cerebral artery occlusion. Our findings indicate that damage to the insular cortex is essential in eliciting the neurochemical changes in the ipsilateral amygdala. In addition, the change in neuropeptide Y in the cortex appears to be a local reaction occurring irrespective of location of the lesion and glutamate receptor activation may be involved.

Time-course of neuropeptide changes in peri-ischemic zone and amygdala following focal ischemia in rats

Previously, using a middle cerebral artery occlusion model in Wistar rat, we showed autonomic disturbances similar to those seen clinically and observed striking neurochemical changes in cortical and subcortical sites at 5 days following stroke. The neurochemical changes may account for functional recovery and/or autonomic disturbances after focal ischemia. To understand the possible mechanisms and to facilitate future studies, it is necessary to define the time-courses of these changes. Using immunohistochemical staining with the peroxidase-antiperoxidase reaction, the changes in several neuropeptides over the peri-ischemic region and the ipsilateral central and basolateral nucleus of the amygdala were investigated at different times after middle cerebral artery occlusion. In the experimental group, neuropeptide Y immunoreactivity appeared to increase by 6 hours in the peri-ischemic region. Using image analysis to quantify the staining intensity, the change became statistically significant at 1 day, peaked around 3 days, and subsided at 10 days. There was a delayed increase in neuropeptide Y in the ipsilateral basolateral nucleus of the amygdala with a peak around 3 days. Immunoreactive staining for leucine-enkephalin, dynorphin, and neurotensin demonstrated an increase that was localized to the ipsilateral central nucleus of the amygdala with a peak around 3 days and a return to baseline levels by 10 days. The results support a specific time-course for each of the neuropeptides studied and indicate that a survival time of 3 days after focal ischemia is the critical period for examining the relationship between neuropeptide responses and neuronal or functional recovery.

Insular lesion evokes autonomic effects of stroke in normotensive and hypertensive rats

BACKGROUND AND PURPOSE

Increases in sympathetic activity and frequency of myocardial damage occur after middle cerebral artery occlusion (MCAO) in Wistar rats, while MCAO in the spontaneously hypertensive rat (SHR) decreases sympathoadrenal activity. Autonomic changes have been suggested to result from damage to the insular cortex (IC).

METHODS

A lesion of the IC was made using the excitotoxin D,L-homocysteic acid (DLH; 1 mol/L), in urethane-anesthetized Wistar rats and SHRs. Mean arterial pressure (MAP), heart rate, renal sympathetic nerve discharge (SND), ECG, and plasma catecholamines were measured in 14 SHRs and 14 Wistar male rats after a 500-nL injection of DLH or phosphate-buffered saline (PBS) into the IC.

RESULTS

Histological examination showed that DLH resulted in neuronal damage throughout the IC. DLH injection initially elevated MAP (at approximately 10 minutes after injection) in Wistar rats but not in SHRs. At 4 hours after the DLH injection, there was a secondary, longer-term increase in MAP in the Wistar rats. MAP decreased in the SHRs after IC lesion such that at 6 hours, lesioned SHRs had a MAP that was significantly lower than that of sham-lesioned SHRs. SND initially increased (at 10 minutes) after DLH injection in Wistar rats. In the SHRs, SND decreased significantly from the initial values, by 3 hours after DLH injection. Plasma catecholamine levels were not significantly changed as a result of IC lesion in the Wistar rats or the SHRs. Heart rates increased in all animals, with no differences between groups. There were no changes in the ECG or in the frequency of cardiac myocytolysis in either strain (sham or lesioned animals).

CONCLUSIONS

IC lesion in the SHR and Wistar rat therefore appears to result in autonomic changes similar to that seen after MCAO. Unlike MCAO, however, the autonomic changes do not appear to be sufficient to produce myocardial damage.

Identification of a cortical site for stress-induced cardiovascular dysfunction

The evidence indicating that the insular cortex is a likely candidate to mediate stress-induced cardiovascular responses is reviewed. Both neuroanatomical and electrophysiological investigations demonstrate that the insular cortex receives an organized representation of visceral information. In addition, the insular cortex also receives highly processed association cortex information. The insular cortex is also highly interconnected with many subcortical limbic and autonomic regions. This combination of sensory input and limbic/autonomic connectivity would be necessary to permit the insular cortex to be a critical site for the integration of emotional and autonomic responses. Stimulation of the insular cortex elicits specific cardiovascular and autonomic responses from discrete sites. Phasic stimulation entrained to the cardiac cycle is even capable of causing severe arrhythmias. The efferent pathways and some of the neurotransmitter mechanisms have determined. It appears that the lateral hypothalamic area is the primary site of synapse for responses originating in the insular cortex and this information is relayed by NMDA glutamatergic receptors and modulated by neuropeptides including neuropeptide Y, neurotensin, leu-enkephalin and dynorphin. Finally, a rat stroke model, which includes the insular cortex in the infarct region indicates that disruption of the insula can produce substantial cardiac and autonomic abnormalities, which might be similar to those produced by stress. Some of the chronic neurochemical changes, including increases in opioids, neuropeptide Y and neurotensin in the central nucleus of the amygdala, which might be mediating these cardiovascular disturbances, have been determined.