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Lazurova Z, Mitro P, Popovnakova M. The Role of Adenosine and Its Degradation Enzymes - Adenosinedeaminase and Adenosinekinase in Pathogenesis of Vasovagal Syncope. Eur J Intern Med 2022; 105:77-81. [PMID: 36075846 DOI: 10.1016/j.ejim.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Adenosine is mediator regulating physiological and pathological processes in organism. It probably plays a role in pathogenesis of vasovagal syncopes (VVS), too. Adenosine, its receptors and degradation enzymes- adenosinedeaminase (ADA) and adenosinekinase (ADK), are called the adenosinergic system. AIM We aimed to evaluate serum levels of adenosine, ADA and ADK in patients with tilt-induced VVS and compare them to tlit-negative controls. Secondary aim was to compare the levels between the types of VVS and correlate them with hemodynamic parameters. SUBJECTS AND METHODS Altogether 132 individuals were involved in this study (age 39,88±15,64 years, 51 males). All patients underwent head up tilt test (HUTT) in differential diagnosis of syncope. Blood sampling was performed before and after HUTT. Baseline and stimulated serum levels of adenosine, ADA and ADK were evaluated by ELISA method. RESULTS HUTT was positive in 91 patients (HUTT+), 41 individuals were negative (HUTT-). HUTT+ patients had higher baseline and stimulated adenosine levels, when compared to HUTT- population. The rise in adenosine was higher in HUTT+ group. On the other hand, the increase of ADA was significantly higher in HUTT- subjects. Among HUTT+ group, the highest adenosine was found during vasodepressoric VVS. CONCLUSION Adenosinergic system may play role in pathogenesis of VVS. Patients with VVS have higher adenosine levels, that may be caused by attenuated degradation. Adenosine seems to be involved predominantly in vasodepressoric type of VVS. Further research evaluating complex function of adenosinergic system in these patients is needed.
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Affiliation(s)
- Zora Lazurova
- 4th Department of Internal medicine, University of PJ Safarik, Medical Faculty, Košice, Slovakia; 1st Department of Cardiology, Institute of Cardiovascular Diseases of Eastern Slovakia, Košice, Slovakia.
| | - Peter Mitro
- 1st Department of Cardiology, Institute of Cardiovascular Diseases of Eastern Slovakia, Košice, Slovakia
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Advance in the understanding of vasovagal syncope in children and adolescents. World J Pediatr 2021; 17:58-62. [PMID: 32405708 DOI: 10.1007/s12519-020-00367-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Vasovagal syncope (VVS) accounts for 60-80% of cases of neurally mediated syncope. VVS results from acute orthostatic intolerance and recurrent syncopal attacks, which can seriously affect an individual's quality of life. In addition, some children even experience trauma during attacks. Therefore, it is particularly important to clarify the pathogenesis of VVS. The aim of our study is to reveal the latest research progress of VVS. DATA SOURCES Literature that involved the pathogenesis of VVS were selected from Cochrane Library (1990-2019), EMBASE (1991-2019) and PubMed (1968-2019) databases. RESULTS Hypovolemia, autonomic dysfunction, vasomotor dysfunction, baroreceptor reflex abnormalities, endothelial dysfunction, serotonin surges, and gut microbiota were involved in the underlying mechanism of VVS. CONCLUSIONS VVS is not always a benign prognosis. Various aspects were involved in its pathogenesis. Bezold-Jarish reflex, dysfunction of the autonomic nervous system, genetic factors and so on played important roles in VVS; however, the mechanism remains unclear.
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Liao Y, Du J. Pathophysiology and Individualized Management of Vasovagal Syncope and Postural Tachycardia Syndrome in Children and Adolescents: An Update. Neurosci Bull 2020; 36:667-681. [PMID: 32367250 PMCID: PMC7271077 DOI: 10.1007/s12264-020-00497-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
Vasovagal syncope (VVS) and postural tachycardia syndrome (POTS) are the main forms of orthostatic intolerance in pediatrics and both are underlying causes of neurally-mediated syncope. In recent years, increasing attention has been paid to the management of VVS and POTS in children and adolescents. A number of potential mechanisms are involved in their pathophysiology, but the leading cause of symptoms varies among patients. A few studies thus have focused on the individualized treatment of VVS or POTS based on selected hemodynamic parameters or biomarkers that can predict the therapeutic effect of certain therapies and improve their effectiveness. This review summarizes the latest developments in individualized treatment of VVS and POTS in children and indicates directions for further research in this field.
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Affiliation(s)
- Ying Liao
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China.
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Benditt DG, van Dijk JG, Krishnappa D, Adkisson WO, Sakaguchi S. Neurohormones in the Pathophysiology of Vasovagal Syncope in Adults. Front Cardiovasc Med 2020; 7:76. [PMID: 32478097 PMCID: PMC7232538 DOI: 10.3389/fcvm.2020.00076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/14/2020] [Indexed: 02/02/2023] Open
Abstract
Vasovagal syncope (VVS) is the most common cause of syncope across all age groups. Nonetheless, despite its clinical importance and considerable research effort over many years, the pathophysiology of VVS remains incompletely understood. In this regard, numerous studies have been undertaken in an attempt to improve insight into the evolution of VVS episodes and many of these studies have examined neurohormonal changes that occur during the progression of VVS events primarily using the head-up tilt table testing model. In this regard, the most consistent finding is a marked increase in epinephrine (Epi) spillover into the circulation beginning at an early stage as VVS evolves. Reported alterations of circulating norepinephrine (NE), on the other hand, have been more variable. Plasma concentrations of other vasoactive agents have been reported to exhibit more variable changes during a VVS event, and for the most part change somewhat later, but in some instances the changes are quite marked. The neurohormones that have drawn the most attention include arginine vasopressin [AVP], adrenomedullin, to a lesser extent brain and atrial natriuretic peptides (BNP, ANP), opioids, endothelin-1 (ET-1) and serotonin. However, whether some or all of these diverse agents contribute directly to VVS pathophysiology or are principally a compensatory response to an evolving hemodynamic crisis is as yet uncertain. The goal of this communication is to summarize key reported neurohumoral findings in VVS, and endeavor to ascertain how they may contribute to observed hemodynamic alterations during VVS.
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Affiliation(s)
- David G Benditt
- Cardiovascular Division, Department of Medicine, Cardiac Arrhythmia and Syncope Center, University of Minnesota Medical School, Minneapolis, MN, United States
| | - J Gert van Dijk
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Darshan Krishnappa
- Cardiovascular Division, Department of Medicine, Cardiac Arrhythmia and Syncope Center, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Wayne O Adkisson
- Cardiovascular Division, Department of Medicine, Cardiac Arrhythmia and Syncope Center, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Scott Sakaguchi
- Cardiovascular Division, Department of Medicine, Cardiac Arrhythmia and Syncope Center, University of Minnesota Medical School, Minneapolis, MN, United States
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Brunner SM, Koller A, Stockinger J, Sternberg F, Leis S, Ernst F, Strasser P, Brodowicz B, Ebner S, Holub BS, Rauch I, Graf K, Lang R, Kofler B. Validation of antibody-based tools for galanin research. Peptides 2019; 120:170009. [PMID: 30196126 DOI: 10.1016/j.peptides.2018.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/02/2018] [Accepted: 08/22/2018] [Indexed: 12/17/2022]
Abstract
Antibodies are an integral biomedical tool, not only for research but also as therapeutic agents. However, progress can only be made with sensitive and specific antibodies. The regulatory (neuro)peptide galanin and its three endogenous receptors (GAL1-3-R) are widely distributed in the central and peripheral nervous systems, and in peripheral non-neuronal tissues. The galanin system has multiple biological functions, including feeding behavior, pain processing, nerve regeneration and inflammation, to name only a few. Galanin could serve as biomarker in these processes, and therefore its receptors are potential drug targets for various diseases. For that reason, it is of paramount interest to precisely measure galanin peptide levels in tissues and to determine the cellular and subcellular localization of galanin receptors. A plethora of antibodies and antibody-based tools, including radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA) kits, are commercially available to detect galanin and its receptors. However, many of them lack rigorous validation which casts doubt on their specificity. A goal of the present study was to raise awareness of the importance of validation of antibodies and antibody-based tools, with a specific focus on the galanin system. To that end, we tested and report here about commercially available antibodies against galanin and galanin receptors that appear specific to us. Furthermore, we investigated the validity of commercially available galanin ELISA kits. As the tested ELISAs failed to meet the validation requirements, we developed and validated a specific sandwich ELISA which can be used to detect full-length galanin in human plasma.
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Affiliation(s)
- Susanne M Brunner
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Andreas Koller
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Julia Stockinger
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Felix Sternberg
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Stefan Leis
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, University Hospital of the Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria.
| | - Florian Ernst
- Department of Neurology, Christian Doppler Medical Centre and Centre for Cognitive Neuroscience, University Hospital of the Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria.
| | - Peter Strasser
- University Institute for Medical & Chemical Laboratory Diagnostic, University Hospital of the Paracelsus Medical University, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria.
| | - Bernhard Brodowicz
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Sabine Ebner
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Barbara S Holub
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Isabella Rauch
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Kerstin Graf
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Roland Lang
- Department of Dermatology, University Hospital of the Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Barbara Kofler
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Muellner Hauptstraße 48, 5020, Salzburg, Austria.
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Winter J, Laing C, Johannes B, Mulder E, Brix B, Roessler A, Reichmuth J, Rittweger J, Goswami N. Galanin and Adrenomedullin Plasma Responses During Artificial Gravity on a Human Short-Arm Centrifuge. Front Physiol 2019; 9:1956. [PMID: 30774604 PMCID: PMC6367687 DOI: 10.3389/fphys.2018.01956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/22/2018] [Indexed: 12/21/2022] Open
Abstract
Galanin and adrenomedullin plasma responses to head-up tilt and lower body negative pressure have been studied previously. However, to what extent short-arm human centrifugation (SAHC) affects these responses is not known. In this study, we assessed how the application of variable gradients of accelerations (ΔGz ) via shifting of the rotation axis during centrifugation affects selected hormonal responses. Specifically, we tested the hypothesis, that cardiovascular modulating hormones such as galanin and adrenomedullin will be higher in non-finishers (participants in whom at least one of the pre-defined criteria for presyncope was fulfilled) when compared to finishers (participants who completed the entire protocol in both sessions) during SAHC exposure. Twenty healthy subjects (10 women and 10 men) were exposed to two g-levels [1 Gz and 2.4 Gz at the feet (Gz_Feet)] in two positions (axis of rotation placed above the head and axis of rotation placed at the heart level). Elevated baseline levels of galanin appeared to predict orthostatic tolerance (p = 0.054) and seemed to support good orthostatic tolerance during 1 Gz_Feet SAHC (p = 0.034). In finishers, 2.4 Gz_Feet SAHC was associated with increased galanin levels after centrifugation (p = 0.007). For adrenomedullin, the hypothesized increases were observed after centrifugation at 1 Gz_Feet (p = 0.031), but not at 2.4 Gz_Feet, suggesting that other central mechanisms than local distribution of adrenomedullin predominate when coping with central hypovolemia induced by SAHC (p > 0.14). In conclusion, baseline galanin levels could potentially be used to predict development of presyncope in subjects. Furthermore, galanin levels increase during elevated levels of central hypovolemia and galanin responses appear to be important for coping with such challenges. Adrenomedullin release depends on degree of central hypovolemia induced fluid shifts and a subject's ability to cope with such challenges. Our results suggest that the gradient of acceleration (ΔGz ) is an innovative approach to quantify the grade of central hypovolemia and to assess neurohormonal responses in those that can tolerate (finishers) or not tolerate (non-finishers) artificial gravity (AG). As AG is being considered as a preventing tool for spaceflight induced deconditioning in future missions, understanding effects of AG on hormonal responses in subjects who develop presyncope is important.
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Affiliation(s)
- Julia Winter
- Department of Aerospace Physiology, Institute for Aerospace Medicine, German Aerospace Center e.V. (DLR), Cologne, Germany
| | - Charles Laing
- Department of Aerospace Physiology, Institute for Aerospace Medicine, German Aerospace Center e.V. (DLR), Cologne, Germany
- Centre for Human and Aerospace Physiological Sciences, King’s College London, London, United Kingdom
| | - Bernd Johannes
- Department of Aerospace Physiology, Institute for Aerospace Medicine, German Aerospace Center e.V. (DLR), Cologne, Germany
| | - Edwin Mulder
- Department of Aerospace Physiology, Institute for Aerospace Medicine, German Aerospace Center e.V. (DLR), Cologne, Germany
| | - Bianca Brix
- Gravitational Physiology and Medical Research Unit, Physiology Division, Otto Loewi Center for Research in Vascular Biology, Immunity, and Inflammation, Medical University of Graz, Graz, Austria
| | - Andreas Roessler
- Gravitational Physiology and Medical Research Unit, Physiology Division, Otto Loewi Center for Research in Vascular Biology, Immunity, and Inflammation, Medical University of Graz, Graz, Austria
| | - Johannes Reichmuth
- Gravitational Physiology and Medical Research Unit, Physiology Division, Otto Loewi Center for Research in Vascular Biology, Immunity, and Inflammation, Medical University of Graz, Graz, Austria
| | - Joern Rittweger
- Department of Aerospace Physiology, Institute for Aerospace Medicine, German Aerospace Center e.V. (DLR), Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| | - Nandu Goswami
- Gravitational Physiology and Medical Research Unit, Physiology Division, Otto Loewi Center for Research in Vascular Biology, Immunity, and Inflammation, Medical University of Graz, Graz, Austria
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Li H, Liao Y, Han Z, Wang Y, Liu P, Zhang C, Tang C, Du J, Jin H. Head-up tilt test provokes dynamic alterations in total peripheral resistance and cardiac output in children with vasovagal syncope. Acta Paediatr 2018; 107:1786-1791. [PMID: 29603793 DOI: 10.1111/apa.14342] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/26/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Abstract
AIM This study examined the total peripheral vascular resistance (TPVR) and cardiac output changes due to the head-up tilt test (HUTT) in children with vasovagal syncope (VVS). METHODS From December 2013 to January 2016, we recruited 77 children diagnosed with VVS group at Peking University First Hospital, China, and 28 children without VVS provided the control group. Heart rate, blood pressure, TPVR, cardiac output and baroreflex sensitivity were monitored during the HUTT. RESULTS In the supine position, TPVR and baroreflex sensitivity were higher in the patients with VVS than the controls, but cardiac output did not differ between the two groups. There were obvious increases in the VVS patients from TPVR in the supine position to the prepositive response period (p < 0.05), then the positive response period (p < 0.01). However, we noted the opposite trend in cardiac output, from the supine position to the prepositive response period (p < 0.01) then the positive response period (p < 0.01). CONCLUSION During HUTT, children with VVS demonstrated increases in TPVR but decreases in cardiac output, during the transition from the supine position to the positive response. This response might be involved in the pathogenesis of VVS.
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Affiliation(s)
- Hongxia Li
- Department of Pediatrics; Peking University First Hospital; Beijing China
| | - Ying Liao
- Department of Pediatrics; Peking University First Hospital; Beijing China
| | | | - Yuli Wang
- Department of Pediatrics; Peking University First Hospital; Beijing China
| | - Ping Liu
- Department of Pediatrics; Peking University First Hospital; Beijing China
| | - Chunyu Zhang
- Department of Pediatrics; Peking University First Hospital; Beijing China
| | - Chaoshu Tang
- Department of Physiology and Pathophysiology; Peking University Health Sciences Centre; Beijing China
| | - Junbao Du
- Department of Pediatrics; Peking University First Hospital; Beijing China
| | - Hongfang Jin
- Department of Pediatrics; Peking University First Hospital; Beijing China
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Left Ventricular Ejection Fraction and Fractional Shortening are Useful for the Prediction of the Therapeutic Response to Metoprolol in Children with Vasovagal Syncope. Pediatr Cardiol 2018; 39:1366-1372. [PMID: 29767293 DOI: 10.1007/s00246-018-1904-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 05/08/2018] [Indexed: 01/11/2023]
Abstract
The objective of this manuscript was to explore if left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) could predict the efficacy of metoprolol therapy on vasovagal syncope (VVS) in children. Forty-nine children, including 30 with VVS and 19 gender- and age-matched healthy controls, were included in the study. Metoprolol was prescribed to the VVS subjects. The clinical data were obtained during follow-up at 2 and 6 months. The results showed that LVEF and LVFS of responders were significantly higher than those of non-responders both at the 2-month follow-up (LVEF: 72.5 ± 3.2% vs. 64.6 ± 3.4%; LVFS: 40.9 ± 2.3% vs. 34.9 ± 2.9%), and at the 6-month follow-up (LVEF: 72.8 ± 2.8% vs. 65.5 ± 4.6%; LVFS: 41.1 ± 1.9% vs. 35.8 ± 3.6%). The receiver operating characteristic curve (ROC) analysis demonstrated that 70.5% as a cutoff value of baseline LVEF yielded a sensitivity of 80% and a specificity of 100% in predicting the therapeutic effectiveness of metoprolol at 2 months. For baseline LVFS, 38.5% as a cutoff value yielded a sensitivity of 90% and a specificity of 90%. At the 6-month follow-up, the ROC analysis demonstrated that 70.5% as a cutoff value of baseline LVEF yielded a sensitivity of 81.3% and a specificity of 88.9% in the prediction of metoprolol efficacy. For baseline LVFS, 37.5% as a cutoff value yielded a sensitivity of 93.8% and a specificity of 66.7%. In conclusion, baseline LVEF and LVFS might be useful predictors of the efficacy of β-blocker therapy on VVS in children.
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Bai W, Chen SY, Jin HF, Du JB. Vascular dysfunction of postural tachycardia syndrome in children. World J Pediatr 2018; 14:13-17. [PMID: 29411325 DOI: 10.1007/s12519-017-0104-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/26/2016] [Indexed: 10/18/2022]
Abstract
BACKGROUND Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance, and its incidence in children is approximately 6.8% [1]. The pathogenesis of POTS is complex with multiple, overlapping, interacting pathophysiological mechanisms. Although the specific pathogenic mechanism has remained perplexing, with the discovery of various gasotransmitters and biological peptides, the vascular dysfunction has aroused overwhelming attention. DATA SOURCES On the basis of searching in a wide range of recent original literatures, we reviewed the pathogenesis of vascular dysfunction in children with POTS. RESULTS The flow-mediated vasodilation of POTS patients was greater than that of healthy controls, and the vasodilator factors were increased in patients with POTS under basal condition or under a standing position, while the vasoconstriction factors were reduced. CONCLUSIONS Vascular dysfunction, as one of pathogenesis in pediatric POTS patients, affects the occurrence and development of diseases through a variety of factors.
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Affiliation(s)
- Wei Bai
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Si-Yao Chen
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong-Fang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Jun-Bao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China.
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O'Shea D, Lackner HK, Rössler A, Green DA, Gauger P, Mulder E, Tamma G, Hinghofer-Szalkay H, Valenti G, Goswami N. Influence of bed rest on plasma galanin and adrenomedullin at presyncope. Eur J Clin Invest 2015; 45:679-85. [PMID: 25912957 DOI: 10.1111/eci.12455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/22/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND The role of hormones in reduced orthostatic tolerance following long-term immobilization remains uncertain. We have previously shown that plasma concentrations of adrenomedullin and galanin, two peptides with vasodepressor properties, rise significantly during orthostatic challenge. We tested the hypothesis that bedrest immobilization increases the rise in adrenomedullin and galanin during orthostatic challenge leading to presyncope. MATERIALS AND METHODS We measured baseline (supine), presyncope and recovery (10 min postpresyncope, supine) levels of adrenomedullin and galanin in 8 healthy men, before and after 21 days of -6° head-down bed rest (HDBR). Presyncope was elicited using a combined head-up tilt and graded lower body negative pressure protocol. Orthostatic tolerance was defined as the time taken from the commencement of head-up tilt to the development of presyncope. RESULTS Orthostatic tolerance time after HDBR reduced by 8·36 ± 5·39 min (P = 0·0032). HDBR increased plasma adrenomedullin concentration to orthostatic challenge (P = 0·0367). Compared to pre-HDBR, a significant rise in post-HDBR presyncopal (P < 0·001) and recovery adrenomedullin concentration (P < 0·01) was demonstrated. In contrast, we observed no change in pre- and post-HDBR galanin levels to orthostatic challenge. CONCLUSIONS Bedrest immobilization appears to affect adrenomedullin levels in that greater increases in adrenomedullin occur at presyncope following bedrest immobilization. Due to its peripheral vasculature hypotensive effect, the greater levels of adrenomedullin at presyncope following bedrest immobilization may have contributed to the reduced orthostatic capacity postbedrest.
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Affiliation(s)
- Daniel O'Shea
- Gravitational Physiology and Medicine research unit, Institute of Physiology, Medical University of Graz, Graz, Austria.,Centre of Human & Aerospace Physiological Sciences, King's College London, London, UK
| | - Helmut K Lackner
- Gravitational Physiology and Medicine research unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Andreas Rössler
- Gravitational Physiology and Medicine research unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - David A Green
- Centre of Human & Aerospace Physiological Sciences, King's College London, London, UK
| | - Peter Gauger
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Edwin Mulder
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany
| | - Grazia Tamma
- Department of Biosciences, Biotechnologies and Biopharmaceutics University of Bari, Bari, Italy
| | - Helmut Hinghofer-Szalkay
- Gravitational Physiology and Medicine research unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Giovanna Valenti
- Department of Biosciences, Biotechnologies and Biopharmaceutics University of Bari, Bari, Italy
| | - Nandu Goswami
- Gravitational Physiology and Medicine research unit, Institute of Physiology, Medical University of Graz, Graz, Austria
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Plasek J, Doupal V, Furstova J, Furst T, Safarcik K, Krnacova A, Petejova N, Hrabovska Z, Martinek A, Taborsky M. The role of adrenomedullin and galanin in recurrent vasovagal syncope: a case control study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 157:162-7. [PMID: 22660210 DOI: 10.5507/bp.2011.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/10/2011] [Indexed: 11/23/2022] Open
Abstract
AIMS Orthostatic stimuli are known to elicit changes in vasoactive peptide levels. The hypothesis of no difference in adrenomedullin and/or galanin levels in patients with recurrent vasovagal syncope and healthy controls was tested in a passive 35-min head-up tilt test (HUTT). METHODS Twenty eight persons (14 patients and 14 healthy controls) were tested in a 35-min/60° head-up tilt test with telemetry monitoring. Three blood samples were evaluated for each person during the HUTT. Plasma levels of adrenomedullin and galanin were analysed by the Kruskal-Wallis test for all sampling periods. Vagal influence was indirectly assessed by the break index. RESULTS There were no significant differences between groups in median values for either adrenomedullin or galanin plasma levels (all 6 p-values were greater than 0.4). For adrenomedullin, no significant difference between groups was found. For galanin, the rate of change between the 1st and 2nd measurement was significantly greater for patients (P=0.04), regardless of HUTT result but between the 2(nd) and 3(rd) measurement it was insignificant (P=0.36). In the group of positive cases, the break index increased significantly (P=0.02). CONCLUSION We confirmed that there is a different galanin secretion pattern during orthostatic provocation in patients with recurrent vasovagal syncope than healthy individuals. For adrenomedullin, no significant difference was found. A significant increment of the break index confirmed increased vagal influence in the subgroup of positive cases.
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Affiliation(s)
- Jiri Plasek
- Clinic of Internal Medicine, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Czech Republic
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Abstract
Vavovagal syncope (VVS) is not generally associated with cardiovascular, neurological or other diseases, and, therefore, represents an isolated manifestation. Isolated VVS cannot be regarded as a disease for several reasons: spontaneous syncope occurs in about half of individuals during their lives, and the unidentified neural pathways involved in the vasovagal response are probably present in all healthy humans, with individual differences in susceptibility; VVS is induced during tilt testing in several subjects with no history of syncope; during haemorrhagic shock, the vasovagal reaction can be observed in subjects with no history of syncope; about 20% of astronauts, who are selected on the basis of their great resistance to orthostatic stress, experience syncope or presyncope on landing after a short-duration space flight; to date, no genetic basis of VVS has been demonstrated; subjects with VVS are generally normotensive and, importantly, have normal blood pressure regulation apart from the episodes of syncope; hormonal disorders or a generalized state of autonomic involvement, although frequently investigated, have never been clearly demonstrated. Isolated VVS should be distinguished from those forms that start in old age and which are often associated with cardiovascular or neurological disorders, and other dysautonomic disturbances such as carotid sinus hypersensitivity, post-prandial hypotension, and symptoms of autonomic dysfunction. In these subjects, VVS appears as an expression of a pathological process, i.e. a disease, mainly related to a generalized involvement of the autonomic nervous system, which is not yet well-defined from a nosological point of view.
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Affiliation(s)
- Paolo Alboni
- Division of Cardiology and Arrhythmologic Center, Ospedale Civile, Via Vicini 2, 44042 Cento (FE), Italy.
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Hinghofer-Szalkay HG, Rössler A, Evans JM, Stenger MB, Moore FB, Knapp CF. Circulatory galanin levels increase severalfold with intense orthostatic challenge in healthy humans. J Appl Physiol (1985) 2006; 100:844-9. [PMID: 16322373 DOI: 10.1152/japplphysiol.01039.2005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to test the hypothesis that plasma galanin concentration (pGal) is regularly increased in healthy humans with extensive orthostatic stress. Twenty-six test persons (14 men, 12 women) were brought to an orthostatic end point via a progressive cardiovascular stress (PCS) protocol consisting of 70° head-up tilt plus increasing levels of lower body negative pressure until either hemodynamically defined presyncope or other signs of orthostatic intolerance occurred (nausea, clammy skin, excessive sweating, pallor of the skin). We further tested for possible gender, gravitational, and muscular training influences on plasma pGal responses: PCS was applied before and after 3 wk of daily vertical acceleration exposure training on a Human Powered Centrifuge. Test persons were randomly assigned to active (with bicycle work) or passive (without work) groups (seven men, six women in each group). Resting pGal was 26 ± 3 pg/ml in men and 39 ± 15 pg/ml in women (not significant); women had higher galanin responses (4.9-fold increase) than men (3.5-fold, P = 0.017) to PCS exposure. Overall, PCS increased pGal to 186 ± 5 pg/ml ( P = 0.0003), without significant differences between presyncope vs. orthostatic intolerance, pre- vs. postcentrifuge, or active vs. passive gravitational training. Increases in pGal were poorly related to synchronous elevations in plasma vasopressin. We conclude that galanin is regularly increased in healthy humans under conditions of presyncopal orthostatic stress, the response being independent of gravity training but larger in women than in men.
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Affiliation(s)
- Helmut G Hinghofer-Szalkay
- Institute for Adaptive and Spaceflight Physiology, Medical Univ., Harrachgasse 21, A-8010 Graz, Austria.
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