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El-Naggar AE, Helmy MM, El-Gowilly SM, El-Mas MM. Suppression by central adenosine A3 receptors of the cholinergic defense against cardiovascular aberrations of sepsis: role of PI3K/MAPKs/NFκB signaling. Front Pharmacol 2024; 15:1418981. [PMID: 38966542 PMCID: PMC11222418 DOI: 10.3389/fphar.2024.1418981] [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: 04/17/2024] [Accepted: 06/06/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction: Despite the established role of peripheral adenosine receptors in sepsis-induced organ dysfunction, little or no data is available on the interaction of central adenosine receptors with sepsis. The current study tested the hypothesis that central adenosine A3 receptors (A3ARs) modulate the cardiovascular aberrations and neuroinflammation triggered by sepsis and their counteraction by the cholinergic antiinflammatory pathway. Methods: Sepsis was induced by cecal ligation and puncture (CLP) in rats pre-instrumented with femoral and intracisternal (i.c.) catheters for hemodynamic monitoring and central drug administration, respectively. Results: The CLP-induced hypotension, reduction in overall heart rate variability (HRV) and sympathovagal imbalance towards parasympathetic predominance were abolished by i.v. nicotine (100 μg/kg) or i.c. VUF5574 (A3AR antagonist, 2 µg/rat). In addition, the selective A3AR agonist, 3-iodobenzyl-5'-N-methylcarboxamidoadenosine IB-MECA, 4 µg/rat, i.c.) exaggerated the hypotension and cardiac autonomic dysfunction induced by sepsis and opposed the favorable nicotine actions against these septic manifestations. Immunohistochemically, IB-MECA abolished the nicotine-mediated downregulation of NFκB and NOX2 expression in rostral ventrolateral medullary areas (RVLM) of brainstem of septic rats. The inhibitory actions of IB-MECA on nicotine responses disappeared after i.c. administration of PD98059 (MAPK-ERK inhibitor), SP600125 (MAPK-JNK inhibitor) or wortmannin (PI3K inhibitor). Moreover, infliximab (TNFα inhibitor) eliminated the IB-MECA-induced rises in RVLM-NFκB expression and falls in HRV, but not blood pressure. Conclusion: Central PI3K/MAPKs pathway mediates the A3AR counteraction of cholinergic defenses against cardiovascular and neuroinflammatory aberrations in sepsis.
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Affiliation(s)
- Amany E. El-Naggar
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Mai M. Helmy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Sahar M. El-Gowilly
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Mahmoud M. El-Mas
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
- Department of Pharmacology and Toxicology, College of Medicine, Kuwait University, Kuwait City, Kuwait
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Azam MA, Weinrib AZ, Slepian PM, Rosenbloom BN, Waisman A, Clarke H, Katz J. Effects of perioperative clinical hypnosis on heart rate variability in patients undergoing oncologic surgery: secondary outcomes of a randomized controlled trial. FRONTIERS IN PAIN RESEARCH 2024; 5:1354015. [PMID: 38524266 PMCID: PMC10957530 DOI: 10.3389/fpain.2024.1354015] [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: 12/11/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Clinical hypnosis has been proposed for post-surgical pain management for its potential vagal-mediated anti-inflammatory properties. Evidence is needed to understand its effectiveness for post-surgical recovery. Iin this secondary outcome study, it was hypothesized that surgical oncology patients randomized to receive perioperative clinical hypnosis (CH) would demonstrate greater heart-rate variability (HRV) during rest and relaxation at a 1-month post-surgery assessment compared to a treatment-as-usual group (TAU). Methods After REB approval, trial registration and informed consent, 92 participants were randomized to receive CH (n = 45) or TAU (n = 47). CH participants received a CH session before surgery and during post-surgical in-hospital stay HRV was assessed during rest (5 min) and relaxation (10 min) before and 1-month after surgery. Pain intensity was obtained using a 0-10 numeric rating scale pre and post 1-week and 1-month post surgery. Results One month after surgery, HRV was significantly higher in CH group (n = 29) during rest and relaxation (both p < 0.05, d = 0.73) than TAU group (n = 28). By contrast, rest and relaxation HRV decreased from pre- to 1-month post-surgery for the TAU (both p < 0.001, d > 0.48) but not the CH group. Pain intensity increased from pre-surgery to 1-week post-surgery (p < 0.001, d = 0.50), and decreased from 1-week to 1-month post-surgery (p = 0.005, d = 0.21) for all participants. Discussion The results suggest that hypnosis prevents the deleterious effects of surgery on HRV by preserving pre-operative vagal activity. These findings underscore the potential of clinical hypnosis in mitigating the adverse effects of surgery on autonomic function and may have significant implications for enhancing post-surgical recovery and pain management strategies. Clinical Trial Registration ClinicalTrials.gov, identifier (NCT03730350).
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Affiliation(s)
- Muhammad Abid Azam
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Aliza Z. Weinrib
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - P. Maxwell Slepian
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto ON, Canada
| | | | - Anna Waisman
- Department of Psychology, York University, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto ON, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto ON, Canada
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Zila I, Kolomaznik M, Mikolka P, Kosutova P, Czippelova B, Javorka M, Calkovska A. Vagal cardiac control in rats with LPS-induced lung injury. Respir Physiol Neurobiol 2023; 316:104120. [PMID: 37473790 DOI: 10.1016/j.resp.2023.104120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023]
Abstract
Heart rate variability (HRV) as an index of cardiac autonomic control in acute lung injury (ALI) has been evaluated in anaesthetized rats intratracheally instilled with bacterial lipopolysaccharide (LPS) and ventilated with breathing frequency of 60/min, 40% oxygen, inspiratory time 40%, tidal volume of 6 mL/kg. ECG was recorded before and 30, 60, 120, 180 and 240 min after LPS or saline (control) administration. HRV was quantified by time and frequency-domain analysis (mean RR interval, SDRR, RMSSD and spectral power in high frequency (HF) band. Lactate in plasma, and oxidative stress, IL-1β, IL-5, IL-12p70 and IL-13 and galectin-3 in heart tissue raised in LPS-injured rats. Overall HRV magnitude (SDRR) and marker of vagal heart rate control (RMSSD), as well as frequency domain parameter, spectral power HF was increased 120 and 180 min since ALI onset. In conclusion, LPS-induced ALI is accompanied by altered vagal cardiac control mediated by autonomic nervous system, likely based on the close relationship between immune response and vagally mediated autonomic nervous activity.
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Affiliation(s)
- I Zila
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - M Kolomaznik
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - P Mikolka
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia; Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - P Kosutova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - B Czippelova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - M Javorka
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - A Calkovska
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
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Silva RBD, Neves VR, Barros MC, Gambassi BB, Schwingel PA, Sobral Filho DC. Autonomic dysfunction in COVID-19 patients receiving mechanical ventilation: A cross-sectional study. SAO PAULO MED J 2023; 141:e2022513. [PMID: 37075456 PMCID: PMC10109544 DOI: 10.1590/1516-3180.2022.0513.r1.09022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/09/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) can damage cardiac tissue by increasing troponin levels and inducing arrhythmias, myocarditis, and acute coronary syndrome. OBJECTIVES To analyze the impact of COVID-19 on cardiac autonomic control in mechanically ventilated intensive care unit (ICU) patients. DESIGN AND SETTING This cross-sectional analytical study of ICU patients of both sexes receiving mechanical ventilation was conducted in a tertiary hospital. METHODS Patients were divided into COVID-19-positive (COVID(+)) and COVID-19-negative (COVID(-)) groups. Clinical data were collected and heart rate variability (HRV) records obtained using a heart rate monitor. RESULTS The study sample comprised 82 subjects: 36 (44%) in the COVID(-) group (58.3% female; median age, 64.5 years) and 46 (56%) in the COVID(+) group (39.1% females; median age, 57.5 years). The HRV indices were lower than the reference values. An intergroup comparison identified no statistically significant differences in the mean normal-to-normal (NN) interval, standard deviation of the NN interval, or root mean square of successive differences in NN intervals. The COVID(+) group had an increased low frequency (P = 0.05), reduced high frequency (P = 0.045), and increased low frequency/high frequency (LF/HF) ratio (P = 0.048). There was a weak positive correlation between LF/HF and length of stay in the COVID(+) group. CONCLUSION Patients who received mechanical ventilation had lower overall HRV indices. COVID(+) patients who received mechanical ventilation had lower vagal HRV components. These findings likely indicate clinical applicability, as autonomic control impairments are associated with a greater risk of cardiac death.
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Affiliation(s)
- Renata Baltar da Silva
- PT, MSc. Physiotherapist and Doctoral Student, Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade de Pernambuco (UPE), Recife (PE), Brazil. Physiotherapist, Hospital das Clínicas of the Universidade Federal de Pernambuco (HC-UFPE), Empresa Brasileira de Serviços Hospitalares (EBSERH), Recife (PE), Brazil. Physiotherapist, Agamenon Magalhães Hospital (HAM), UPE, Recife (PE), Brazil
| | - Victor Ribeiro Neves
- PT, PhD. Physiotherapist and Adjunct Professor, Programa de Pós-Graduação em Reabilitação e Desempenho Funcional (PPGRDF), Universidade de Pernambuco (UPE), Petrolina (PE), Brazil
| | - Mayara Costa Barros
- PT. Physiotherapist and Master's Student, Programa de Pós-Graduação em Saúde Translacional (PPGST), Universidade Federal de Pernambuco (UFPE), Recife (PE), Brazil
| | - Bruno Bavaresco Gambassi
- PhD. Physical Educator and Adjunct Professor, Programa de Pós-Graduação em Gestão de Programas e Serviços de Saúde (MGPSS), Universidade Ceuma (UniCEUMA), São Luís (MA), Brazil
| | - Paulo Adriano Schwingel
- PhD. Sports Physiologist and Associate Professor, Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade de Pernambuco (UPE), Recife (PE), Brazil
| | - Dário Celestino Sobral Filho
- MD, PhD. Physician and Associate Professor, Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade de Pernambuco (UPE), Recife (PE), Brazil
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Rojas GA, Saavedra N, Saavedra K, Hevia M, Morales C, Lanas F, Salazar LA. Polycyclic Aromatic Hydrocarbons (PAHs) Exposure Triggers Inflammation and Endothelial Dysfunction in BALB/c Mice: A Pilot Study. TOXICS 2022; 10:toxics10090497. [PMID: 36136462 PMCID: PMC9504903 DOI: 10.3390/toxics10090497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 05/19/2023]
Abstract
The particulate matter present in air pollution is a complex mixture of solid and liquid particles that vary in size, origin, and composition, among which are polycyclic aromatic hydrocarbons (PAHs). Although exposure to PAHs has become an important risk factor for cardiovascular disease, the mechanisms by which these compounds contribute to increased cardiovascular risk have not been fully explored. The aim of the present study was to evaluate the effects of PAH exposure on systemic pro-inflammatory cytokines and markers of endothelial dysfunction. An intervention was designed using a murine model composed of twenty BALB/c male mice separated into controls and three groups exposed to a mixture of phenanthrene, fluoranthene, and pyrene using three different concentrations. The serum levels of the inflammatory cytokines and gene expression of adhesion molecules located on endothelial cells along with inflammatory markers related to PAH exposure in aortic tissue were determined. Furthermore, the expression of the ICAM-1 and VCAM-1 proteins was evaluated. The data showed significant differences in IL-6 and IFN-γ in the serum. In the gene expression, significant differences for ICAM-1, VCAM-1, and E-Selectin were observed. The results suggest that phenanthrene, fluoranthene, and pyrene, present in air pollution, stimulate the increase in serum inflammatory cytokines and the expression of markers of endothelial dysfunction in the murine model studied, both relevant characteristics associated with the onset of disease atherosclerosis and cardiovascular disease.
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Affiliation(s)
- Gabriel A. Rojas
- Center of Molecular Biology & Pharmacogenetics, Department of Basic Sciences, Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco 4811230, Chile
- Faculty of Health, School of Kinesiology, Universidad Santo Tomás, Valdivia 5090000, Chile
| | - Nicolás Saavedra
- Center of Molecular Biology & Pharmacogenetics, Department of Basic Sciences, Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco 4811230, Chile
| | - Kathleen Saavedra
- Center of Molecular Biology & Pharmacogenetics, Department of Basic Sciences, Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco 4811230, Chile
| | - Montserrat Hevia
- Center of Molecular Biology & Pharmacogenetics, Department of Basic Sciences, Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco 4811230, Chile
| | - Cristian Morales
- Center of Molecular Biology & Pharmacogenetics, Department of Basic Sciences, Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco 4811230, Chile
| | - Fernando Lanas
- Department of Internal Medicine, Faculty of Medicine, Universidad de La Frontera, Temuco 4811230, Chile
| | - Luis A. Salazar
- Center of Molecular Biology & Pharmacogenetics, Department of Basic Sciences, Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco 4811230, Chile
- Correspondence:
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Badke CM, Carroll MS, Weese-Mayer DE, Sanchez-Pinto LN. Association Between Heart Rate Variability and Inflammatory Biomarkers in Critically Ill Children. Pediatr Crit Care Med 2022; 23:e289-e294. [PMID: 35293369 DOI: 10.1097/pcc.0000000000002936] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The autonomic nervous system (ANS) can both modulate and be modulated by the inflammatory response during critical illness. We aimed to determine whether heart rate variability (HRV), a measure of ANS function, is associated with proinflammatory biomarker levels in critically ill children. DESIGN Two cohorts were analyzed. The first was a prospective observational cohort from August 2018 to August 2020 who had plasma proinflammatory cytokine measurements within 72 hours of admission, including tumor necrosis factor-α, interleukin (IL)-1β, IL-6, and IL-8. The second was a retrospective cohort from June 2012 to August 2020 who had at least one C-reactive protein (CRP) measurement within 72 hours of admission. SETTING Forty-six-bed PICU. PATIENTS Critically ill children in either cohort who had continuous heart rate data available from the bedside monitors. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Sixty-two patients were included in the prospective cohort and 599 patients in the retrospective cohort. HRV was measured using the age-adjusted integer heart rate variability (HRVi), which is the sd of the heart rate sampled every 1 second over 5 consecutive minutes. The median HRVi was measured in the 12-hour period ending 30 minutes prior to inflammatory biomarker collection. HRVi was inversely correlated with IL-6, IL-8, and CRP levels (p ≤ 0.02); correlation with IL-8 and CRP persisted after adjusting for Pediatric Risk of Mortality III and age, and median HR and age (p < 0.001). CONCLUSIONS HRVi is inversely correlated with IL-6, IL-8, and CRP. Further studies are needed to validate this measure as a proxy for a proinflammatory state.
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Affiliation(s)
- Colleen M Badke
- Division of Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michael S Carroll
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Debra E Weese-Mayer
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Pediatrics, Stanley Manne Children's Research Institute, Chicago, IL
- Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - L Nelson Sanchez-Pinto
- Division of Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Ghiasi S, Zhu T, Lu P, Hagenah J, Khanh PNQ, Hao NV, Thwaites L, Clifton DA. Sepsis Mortality Prediction Using Wearable Monitoring in Low-Middle Income Countries. SENSORS 2022; 22:s22103866. [PMID: 35632275 PMCID: PMC9145695 DOI: 10.3390/s22103866] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 02/05/2023]
Abstract
Sepsis is associated with high mortality—particularly in low–middle income countries (LMICs). Critical care management of sepsis is challenging in LMICs due to the lack of care providers and the high cost of bedside monitors. Recent advances in wearable sensor technology and machine learning (ML) models in healthcare promise to deliver new ways of digital monitoring integrated with automated decision systems to reduce the mortality risk in sepsis. In this study, firstly, we aim to assess the feasibility of using wearable sensors instead of traditional bedside monitors in the sepsis care management of hospital admitted patients, and secondly, to introduce automated prediction models for the mortality prediction of sepsis patients. To this end, we continuously monitored 50 sepsis patients for nearly 24 h after their admission to the Hospital for Tropical Diseases in Vietnam. We then compared the performance and interpretability of state-of-the-art ML models for the task of mortality prediction of sepsis using the heart rate variability (HRV) signal from wearable sensors and vital signs from bedside monitors. Our results show that all ML models trained on wearable data outperformed ML models trained on data gathered from the bedside monitors for the task of mortality prediction with the highest performance (area under the precision recall curve = 0.83) achieved using time-varying features of HRV and recurrent neural networks. Our results demonstrate that the integration of automated ML prediction models with wearable technology is well suited for helping clinicians who manage sepsis patients in LMICs to reduce the mortality risk of sepsis.
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Affiliation(s)
- Shadi Ghiasi
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
- Correspondence:
| | - Tingting Zhu
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
| | - Ping Lu
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
| | - Jannis Hagenah
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
| | - Phan Nguyen Quoc Khanh
- Oxford University Clinical Research Unit, Ho Chi Minh City 710400, Vietnam; (P.N.Q.K.); (L.T.)
| | - Nguyen Van Hao
- Hospital of Tropical Diseases, Ho Chi Minh City 700000, Vietnam;
| | | | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City 710400, Vietnam; (P.N.Q.K.); (L.T.)
| | - David A. Clifton
- Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK; (T.Z.); (P.L.); (J.H.); (D.A.C.)
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The Association between Inflammatory Biomarkers and Cardiovascular Autonomic Dysfunction after Bacterial Infection. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Heart rate variability (HRV) is a known measure of cardiac autonomic function. A cardiovascular autonomic dysfunction (CAD), measured as changes in HRV, is usually presented after an infectious process. The aim of the present study is to assess the association between serum inflammatory markers and CAD. For this purpose, 50 volunteers (13 of them recovering from an infection) were recruited and followed-up for 6 weeks. Their serum inflammatory biomarkers (CRP, IL1, IL4, IL6, IL10, and TNFalpha) were quantified throughout those weeks, along with their HRV resting, in response to the Valsalva maneuver, metronome breathing, standing and sustained handgrip. The correlation of within-subject changes in both HRV and inflammatory biomarkers was assessed to evaluate the concurrent changes. An inverse within-subject correlation was found between CRP and HRV in response to the Valsalva maneuver (rho (95% CI): −0.517 (−0.877 to −0.001); p = 0.032) and HRV standing (rho (95% CI): −0.490 (−0.943 to −0.036); p = 0.034). At the beginning, increased values of CRP are found along with reduced levels of HRV. Then, the CRP was reduced, accompanied by an improvement (increase) in HRV. These results suggest that CRP is a potential marker of CAD. Whether it is the cause, the consequence or a risk indicator non-causally associated is still to be determined.
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9
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Nakashima R, Inagaki N, Kasaoka S. Exploration of autonomic regulation reflecting on pathophysiological change of sepsis: a prospective observational study. Acute Med Surg 2022; 9:e776. [PMID: 35949315 PMCID: PMC9353857 DOI: 10.1002/ams2.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Abstract
Aim It remains unclear how autonomic regulation modulates pathophysiological changes of sepsis. This study aims to analyze and clarify those in patients with suspected sepsis. Methods In this single‐centered, prospective, observational study, adult patients who had an infection, a quick Sequential Organ Failure Assessment score of 2 or more at the emergency department, and underwent intensive care were screened. Heart rate variability (HRV) and serum adrenaline were measured immediately after arrival. The primary outcome was defined as vasopressor dependence during 48 h after arrival. Results A total of 63 patients were included. All the patients had SOFA score of 2 or more on admission. Vasopressor dependence, renal replacement therapy, and in‐hospital mortality were associated with higher adrenaline (which reflects sympathetic adrenergic system activity). Bacteremia was associated with lower high‐frequency components of HRV (parasympathetic nerve activity). The HRV parameter of sympathetic nerve activity had no significant association with the outcomes. In the multivariate logistic regression model adjusted for age and sex, vasopressor dependence remained associated with higher adrenaline (cut‐off 0.11 ng/mL, odds ratio 9.71, 95% confidence interval 2.55–37; P = 0.000874), and lower high‐frequency components with bacteremia (17.2 ms2, odds ratio 4.86, 95% confidence interval 1.36–17.4; P = 0.0152). There were no significant correlations between parameters of HRV and serum adrenaline. Conclusion Hypoperfusion, organ dysfunction, and in‐hospital mortality were associated with an increased sympathetic adrenergic activity. Bacteremia was associated with decreased parasympathetic nerve activity. The autonomic regulator may involve a multilayered and differentiated modulating process for sepsis.
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Affiliation(s)
- Ryuta Nakashima
- Graduate School of Medical Sciences Kumamoto University Kumamoto City Kumamoto Japan
- Department of Emergency and Intensive Care Medicine Oita City Medical Association's Almeida Memorial Hospital Oita City Oita Japan
- Department of Emergency Medicine Oita Prefecture Saiseikai Hita Hospital Hita City Oita Japan
| | - Nobuhiro Inagaki
- Department of Emergency and Intensive Care Medicine Oita City Medical Association's Almeida Memorial Hospital Oita City Oita Japan
| | - Shunji Kasaoka
- Disaster Medical Education and Research Center Kumamoto University Hospital Kumamoto City Kumamoto Japan
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Mollura M, Lehman LW, Barbieri R. Assessment of Sepsis in the ICU by Linear and Complex Characterization of Cardiovascular Dynamics. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:862-865. [PMID: 34891426 DOI: 10.1109/embc46164.2021.9630521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Sepsis is one of the pathological conditions with the highest incidence in intensive care units. Sepsis-induced cardiac and autonomic dysfunction are well-known effects, among others, caused by a dysregulated host response to infection. In this context, we investigate the role of complex cardiovascular dynamics quantified through sample entropy indices from the inter-beat interval, systolic and diastolic blood pressure time series as well as the cross-entropy between heartbeat and systolic blood pressure in patients with sepsis in the first hour of intensive care when compared with non-septic subjects. Results show a significant (p<0.05) reduction in the probability of being septic for a unitary increase in entropy for systolic and diastolic time series (odds equal to 0.038 and 0.264, respectively) when adjusting for confounding factors. A significant (p<0.001) odds ratio (0.248) is observed also in cross-entropy, showing a reduced probability of being septic for an increase in heartbeat and systolic pressure asynchrony. The inclusion of our measures of complexity also determines an increase in the predictive ability (+0.03) of a logistic regression model reaching an area under the receiving operating and precision recall curves both equal to 0.95.Clinical relevance The study demonstrates the ability of information theory in catching a reduction of complex cardiovascular dynamics from vital signs commonly recorded in ICU. The considered complexity measures contribute to characterize sepsis development by showing a general loss of the interaction between heartbeat and pressure regulation. The extracted measures also improve the ability to identify sepsis in the first hour of intensive care.
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Sinha M, Behera AK, Sinha R, Parganiha A, Pande B, Sharma R, Pati AK. Circadian rhythmicity of heart rate variability and its impact on cardiac autonomic modulation in asthma. Chronobiol Int 2021; 38:1631-1639. [PMID: 34121548 DOI: 10.1080/07420528.2021.1938595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The commonly observed nocturnal attack of asthma is accompanied by circadian variations in airway inflammation and other physiological variables. It is also documented to present with a significantly higher risk of adverse cardiovascular events that are associated with lower heart rate variability (HRV) and depressed sympathetic and enhanced parasympathetic modulations. However, available literature is scarce with regard to the impact of alteration in circadian rhythmicity of long-term HRV and its day-night variation in asthmatic patients. Thus, 72-h continuous recording of RR interval and oxygen saturation was done to study the circadian variability of HRV (in terms of time and frequency domain indices) and also to assess the pattern of alterations in sympathetic and parasympathetic tones at different times of the day in asthmatic patients (n = 32) and healthy control subjects (n = 31). Repeated-measure analysis of variance and independent-samples t-test revealed significantly increased parasympathetic tone [in terms of increased square root of the mean squared differences of successive NN intervals (RMSSD), percentage of number of pairs of adjacent RR interval differing by more than 50 ms (pNN50), standard deviation of NN intervals (SDNN), and high frequency (HF)] with reduced sympathetic activity [decreased low frequency (LF) and LF/HF ratio] at early morning hours (between 04:00 and 10:00 h) in the asthma patients in contrast to the healthy subjects who had opposite response. Also, significant phase delay (p<0.05) of all the HRV indices and SpO2, was evident by cosinor analysis. Therefore, disturbed circadian rhythm of HRV indices and early morning increased parasympathetic tone points toward the possible pathophysiological basis of exacerbated asthmatic symptoms at late night/early morning hours and susceptibility of future cardiovascular pathologies. This also necessitates the assessment of HRV rhythm while dealing with the therapeutic management of asthma patients.
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Affiliation(s)
- Meenakshi Sinha
- Department of Physiology, All India Institute of Medical Sciences, Raipur, India
| | - Ajoy K Behera
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Raipur, India
| | - Ramanjan Sinha
- Department of Physiology, All India Institute of Medical Sciences, Raipur, India
| | - Arti Parganiha
- School of Studies in Life Sciences, Pt. Ravishankar Shukla University, Raipur, India
| | - Babita Pande
- Department of Physiology, All India Institute of Medical Sciences, Raipur, India
| | - Richa Sharma
- Department of Physiology, All India Institute of Medical Sciences, Raipur, India
| | - Atanu K Pati
- Department of Zoology, Gangadhar Meher University, Odisha, India
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De Paula DCC, Leite EA, Araujo CM, Branquinho RT, Guimarães HN, Grabe-Guimarães A. Caspofungin Effects on Electrocardiogram of Mice: An Evaluation of Cardiac Safety. Cardiovasc Toxicol 2020; 21:93-105. [PMID: 32845461 DOI: 10.1007/s12012-020-09599-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/11/2020] [Indexed: 01/02/2023]
Abstract
Caspofungin is an echinocandin, exhibiting efficacy against most Candida species invasive infection. Its cardiotoxicity was reported in isolated rat heart and ventricular myocytes, but in vivo and clinical studies are insufficient. Our objective was to evaluate caspofungin in vivo cardiac effects using an efficacious dose against Candida albicans. Female Swiss mice were infected with C. albicans, and treated with caspofungin, 5 or 10 mg/kg, intraperitoneal along 5 days. Survival rate and colony-forming units (CFU) into vital organs were determined. For cardiac effects study, mice were treated with caspofungin 10 mg/kg, and electrocardiogram (ECG) signal was obtained on C. albicans-infected mice, single dose-treated, and uninfected mice treated along 5 days, both groups to measure ECG intervals. Besides, ECG was also obtained by telemetry on uninfected mice to evaluate heart rate variability (HRV) parameters. The MIC for caspofungin on the wild-type C. albicans SC5314 strain was 0.3 μg/ml, indicating the susceptible. Survival rate increased significantly in infected mice treated with caspofungin compared to mice treated with vehicle. None of the survived infected mice presented positive CFU after treatment with 10 mg/kg. C. albicans infection induced prolongation of QRS, QT, and QTc intervals; caspofungin did not alter this effect. Caspofungin induced increase of PR and an additional increase of QRS after 24 h of a single dose in infected mice. No significant alterations occurred in ECG intervals and HRV parameters of uninfected mice, after caspofungin treatment. Caspofungin showed in vivo cardiac relative safety maintaining its antifungal efficacy against C. albicans.
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Affiliation(s)
- Danielle Cristiane Correa De Paula
- Pharmaceutical Science Program (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Campus Morro do Cruzeiro, s/n, Ouro Preto, Minas Gerais, 35400-000, Brazil
| | - Elaine Amaral Leite
- Department of Pharmaceutical Products, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carolina Morais Araujo
- Pharmaceutical Science Program (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Campus Morro do Cruzeiro, s/n, Ouro Preto, Minas Gerais, 35400-000, Brazil
| | - Renata Tupinambá Branquinho
- Pharmaceutical Science Program (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Campus Morro do Cruzeiro, s/n, Ouro Preto, Minas Gerais, 35400-000, Brazil
| | - Homero Nogueira Guimarães
- Department of Electrical Engineering, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andrea Grabe-Guimarães
- Pharmaceutical Science Program (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Campus Morro do Cruzeiro, s/n, Ouro Preto, Minas Gerais, 35400-000, Brazil.
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13
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Robinson-Papp J, Astha V, Nmashie A, Sharma SK, Kim-Schulze S, Murray J, George MC, Morgello S, Mueller BR, Lawrence SA, Benn EK. Sympathetic function and markers of inflammation in well-controlled HIV. Brain Behav Immun Health 2020; 7:100112. [PMID: 34589872 PMCID: PMC8474355 DOI: 10.1016/j.bbih.2020.100112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 01/14/2023] Open
Abstract
PURPOSE HIV-associated autonomic neuropathy (HIV-AN) is common and may be associated with both sympathetic and parasympathetic dysfunction. Sympathetic nervous system (SNS) dysfunction occurs on a continuum of hyper-to hypo-adrenergic function, and may be a mediator between psychological stress and chronic inflammation. We sought to describe patterns of SNS dysfunction in people living with HIV, and to determine whether SNS dysfunction is associated with markers of systemic inflammation (focusing on IL-6 and TNF-α) and pain and anxiety. METHODS Forty-seven people with well-controlled HIV and without confounding medical conditions or medications completed the Medical Outcomes Survey (MOS-HIV), quantification of a panel of 41 plasma cytokines/chemokines, and a standardized, non-invasive autonomic reflex screen (ARS). Adrenergic baroreflex sensitivity (BRSA) was calculated from the ARS as a measure of SNS function. RESULTS Pain (46%) and anxiety (52%) were commonly reported on the MOS-HIV. BRSA was reduced in 30% of participants and elevated in 9% with the latter occurring only in participants with normal to mild HIV-AN. BRSA was significantly associated with IL-6, but not with TNF-α, pain or anxiety. Exploratory analyses also revealed positive associations of BRSA with numerous other cytokines with no significant inverse associations. CONCLUSION Higher BRSA, indicative of a more hyperadrenergic state, can be part of the spectrum of early HIV-AN, and may be associated with elevations in multiple cytokines including IL-6. These associations do not appear to be driven by stressors such as pain or anxiety.
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Affiliation(s)
| | - Varuna Astha
- Icahn School of Medicine at Mount Sinai, Center for Scientific Diversity, Center for Biostatistics & Department of Population Health Science and Policy, United States
| | - Alexandra Nmashie
- Icahn School of Medicine at Mount Sinai, Department of Neurology, United States
| | - Sandeep K. Sharma
- Icahn School of Medicine at Mount Sinai, Department of Neurology, United States
- Icahn School of Medicine at Mount Sinai, Center for Scientific Diversity, Center for Biostatistics & Department of Population Health Science and Policy, United States
| | - Seunghee Kim-Schulze
- Icahn School of Medicine at Mount Sinai, Human Immune Monitoring Center, United States
| | - Jacinta Murray
- Icahn School of Medicine at Mount Sinai, Department of Neurology, United States
| | | | - Susan Morgello
- Icahn School of Medicine at Mount Sinai, Department of Neurology, United States
| | - Bridget R. Mueller
- Icahn School of Medicine at Mount Sinai, Department of Neurology, United States
| | - Steven A. Lawrence
- Icahn School of Medicine at Mount Sinai, Center for Scientific Diversity, Center for Biostatistics & Department of Population Health Science and Policy, United States
- Columbia University Mailman School of Public Health, Department of Biostatistics, United States
| | - Emma K.T. Benn
- Icahn School of Medicine at Mount Sinai, Center for Scientific Diversity, Center for Biostatistics & Department of Population Health Science and Policy, United States
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Johnston BW, Barrett-Jolley R, Krige A, Welters ID. Heart rate variability: Measurement and emerging use in critical care medicine. J Intensive Care Soc 2020; 21:148-157. [PMID: 32489411 PMCID: PMC7238479 DOI: 10.1177/1751143719853744] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Variation in the time interval between consecutive R wave peaks of the QRS complex has long been recognised. Measurement of this RR interval is used to derive heart rate variability. Heart rate variability is thought to reflect modulation of automaticity of the sinus node by the sympathetic and parasympathetic components of the autonomic nervous system. The clinical application of heart rate variability in determining prognosis post myocardial infarction and the risk of sudden cardiac death is well recognised. More recently, analysis of heart rate variability has found utility in predicting foetal deterioration, deterioration due to sepsis and impending multiorgan dysfunction syndrome in critically unwell adults. Moreover, reductions in heart rate variability have been associated with increased mortality in patients admitted to the intensive care unit. It is hypothesised that heart rate variability reflects and quantifies the neural regulation of organ systems such as the cardiovascular and respiratory systems. In disease states, it is thought that there is an 'uncoupling' of organ systems, leading to alterations in 'inter-organ communication' and a clinically detectable reduction in heart rate variability. Despite the increasing evidence of the utility of measuring heart rate variability, there remains debate as to the methodology that best represents clinically relevant outcomes. With continuing advances in technology, our understanding of the physiology responsible for heart rate variability evolves. In this article, we review the current understanding of the physiological basis of heart rate variability and the methods available for its measurement. Finally, we review the emerging use of heart rate variability analysis in intensive care medicine and conditions in which heart rate variability has shown promise as a potential physiomarker of disease.
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Affiliation(s)
- Brian W Johnston
- University of Liverpool and The Royal Liverpool University Hospital, Liverpool Healthcare Partners, Liverpool, UK
| | - Richard Barrett-Jolley
- University of Liverpool and The Royal Liverpool University Hospital, Liverpool Healthcare Partners, Liverpool, UK
| | - Anton Krige
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Ingeborg D Welters
- University of Liverpool and The Royal Liverpool University Hospital, Liverpool Healthcare Partners, Liverpool, UK
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15
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Heart rate variability as an independent predictor for 8-year mortality among chronic hemodialysis patients. Sci Rep 2020; 10:881. [PMID: 31964940 PMCID: PMC6972735 DOI: 10.1038/s41598-020-57792-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/07/2020] [Indexed: 11/08/2022] Open
Abstract
The repeated measurements of heart rate variability (HRV) is more relevant than a single HRV measurement in predicting patient prognosis but is less addressed previously. This prospective study aimed to investigate the association between repeated measurements of HRV and long-term mortality in chronic hemodialysis patients. The 164 patients (65.0 ± 13.1 years; woman, 57.3%) were enrolled from June 1, 2010, to August 31, 2010, and received four HRV measurements (before and during the index hemodialysis session) after the enrollment. The baseline characteristic and clinical variables, including mortality, were documented. The joint modeling method and Cox regression were used for statistical analyses. After an 8-year follow-up, 79 patients expired, and 85 patients survived. We found that higher normalized high-frequency (nHF) (hazard ratio [HR] 1.033) as well as lower very-low-frequency (HR 0.990), Variance (HR 0.991), normalized low-frequency (HR 0.999, P = 0.006), and low-frequency/high-frequency ratio (HR 0.796) were independent predictors for cardiovascular mortality. Whereas the independent predictors for infection-associated mortality included higher nHF (HR 1.033) as well as higher age (HR 19.29) and lower serum albumin (HR 0.01, P = 0.001). (all P < 0.001 unless otherwise stated) In conclusion, HRV measurement predicts long-term mortality among hemodialysis patients.
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16
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Myalgic encephalomyelitis/chronic fatigue syndrome: From pathophysiological insights to novel therapeutic opportunities. Pharmacol Res 2019; 148:104450. [PMID: 31509764 DOI: 10.1016/j.phrs.2019.104450] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/26/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022]
Abstract
Myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS) is a common and disabling condition with a paucity of effective and evidence-based therapies, reflecting a major unmet need. Cognitive behavioural therapy and graded exercise are of modest benefit for only some ME/CFS patients, and many sufferers report aggravation of symptoms of fatigue with exercise. The presence of a multiplicity of pathophysiological abnormalities in at least the subgroup of people with ME/CFS diagnosed with the current international consensus "Fukuda" criteria, points to numerous potential therapeutic targets. Such abnormalities include extensive data showing that at least a subgroup has a pro-inflammatory state, increased oxidative and nitrosative stress, disruption of gut mucosal barriers and mitochondrial dysfunction together with dysregulated bioenergetics. In this paper, these pathways are summarised, and data regarding promising therapeutic options that target these pathways are highlighted; they include coenzyme Q10, melatonin, curcumin, molecular hydrogen and N-acetylcysteine. These data are promising yet preliminary, suggesting hopeful avenues to address this major unmet burden of illness.
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17
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Jansen C, Chatterjee DA, Thomsen KL, Al-Kassou B, Sawhney R, Jones H, Gallego-Leon A, Lehmann J, Pohlmann A, Nickenig G, Strassburg CP, Andrié R, Jalan R, Linhart M, Trebicka J, Mookerjee RP. Significant reduction in heart rate variability is a feature of acute decompensation of cirrhosis and predicts 90-day mortality. Aliment Pharmacol Ther 2019; 50:568-579. [PMID: 31286545 DOI: 10.1111/apt.15365] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/18/2019] [Accepted: 05/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Heart rate variability (HRV) is reduced in cirrhosis and in conditions of systemic inflammation. Whether HRV is associated with cirrhosis decompensation and development of acute-on-chronic liver failure (ACLF) is unknown. AIMS To (a) validate wireless remote HRV monitoring in cirrhosis decompensation; (b) determine if severely reduced HRV is a surrogate for inflammation and progression of cirrhosis decompensation; (c) assess if measuring HRV determines prognosis in cirrhosis decompensation. METHODS One hundred and eleven patients at risk of cirrhosis decompensation at two clinical sites were monitored for HRV. Standard deviation of all normal beat-beat intervals (SDNN) reflecting HRV was assessed using remote monitoring (Isansys Lifetouch) and/or Holter ECG recording. Clinical outcomes and major prognostic scores were recorded during 90-day follow-up. RESULTS Reduced HRV denoted by lower baseline SDNN, correlated with severity of decompensation (median 14 (IQR 11-23) vs 33 (25-42); P < 0.001, decompensated patients vs stable outpatient cirrhosis). Furthermore, SDNN was significantly lower in patients developing ACLF compared to those with only decompensation (median 10 (IQR9-12) vs 16 (11-24); P = 0.02), and correlated inversely with MELD and Child-Pugh scores, and C-reactive protein (all P < 0.0001) and white cell count (P < 0.001). SDNN predicted disease progression on repeat measures and appeared an independent predictor of 90-day mortality (12 patients). An SDNN cut-off of 13.25 ms had a 98% negative predictive value. CONCLUSIONS This study demonstrates that remote wireless HRV monitoring identifies cirrhosis patients at high risk of developing ACLF and death, and suggests such monitoring might guide the need for early intervention in such patients. Clinical Trial number: NIHR clinical research network CPMS ID 4949.
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Affiliation(s)
- Christian Jansen
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Devnandan Amor Chatterjee
- Institiute of Liver and Digestive Health, University College London Medical School Royal Free Hospital Campus, London, UK
| | - Karen Louise Thomsen
- Institiute of Liver and Digestive Health, University College London Medical School Royal Free Hospital Campus, London, UK.,Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Baravan Al-Kassou
- Department of Internal Medicine I, University of Bonn, Bonn, Germany.,Department of Internal Medicine II, University of Bonn, Bonn, Germany
| | - Rohit Sawhney
- Institiute of Liver and Digestive Health, University College London Medical School Royal Free Hospital Campus, London, UK
| | - Helen Jones
- Institiute of Liver and Digestive Health, University College London Medical School Royal Free Hospital Campus, London, UK
| | | | - Jennifer Lehmann
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | | | - Georg Nickenig
- Department of Internal Medicine II, University of Bonn, Bonn, Germany
| | | | - René Andrié
- Department of Internal Medicine II, University of Bonn, Bonn, Germany
| | - Rajiv Jalan
- Institiute of Liver and Digestive Health, University College London Medical School Royal Free Hospital Campus, London, UK
| | - Markus Linhart
- Department of Internal Medicine II, University of Bonn, Bonn, Germany
| | - Jonel Trebicka
- Department of Internal Medicine I, University of Bonn, Bonn, Germany.,European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain.,Department of Internal Medicine I, University of Frankfurt am Main, Frankfurt, Germany
| | - Rajeshwar P Mookerjee
- Institiute of Liver and Digestive Health, University College London Medical School Royal Free Hospital Campus, London, UK
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18
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Williams DP, Koenig J, Carnevali L, Sgoifo A, Jarczok MN, Sternberg EM, Thayer JF. Heart rate variability and inflammation: A meta-analysis of human studies. Brain Behav Immun 2019; 80:219-226. [PMID: 30872091 DOI: 10.1016/j.bbi.2019.03.009] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/23/2019] [Accepted: 03/09/2019] [Indexed: 12/16/2022] Open
Abstract
The inflammatory reflex is known as the body's primary defense against infection and has been implicated in a number of diseases. The magnitude of the inflammatory response is important, as an extreme or insufficient response can be differentially harmful to the individual. Converging evidence suggests that the autonomic nervous system (ANS) regulates the inflammatory reflex. Heart rate variability (HRV) can be separated into components that primarily reflect parasympathetic (PNS) or vagal activity (i.e., indices of vagally mediated HRV) and a combination of both sympathetic (SNS) and PNS influences. Given the physiological relation between the vagus and inflammatory processes, one would expect to find higher HRV, especially indices of vagally-mediated HRV, to be associated with decreased levels of inflammation via the cholinergic anti-inflammatory pathway. However, existing findings here are mixed, such that studies have also shown a positive association between indices of HRV and markers of inflammation. Therefore, the present meta-analysis aimed to synthesize existing studies, estimating the general direction and strength of the relationship between different indices of HRV and inflammatory markers. A systematic search of the literature yielded 2283 studies that were screened for inclusion eligibility (159 studies eligible for inclusion); in sum, 51 studies reported/provided adequate information for inclusion in meta-analyses. Results generally showed negative associations between indices of HRV and markers of inflammation. In this regard, the standard deviation of R-R intervals (SDNN) and power in the high frequency band of HRV (HF-HRV) showed the strongest and most robust associations with inflammatory markers compared to other time- and frequency-domain measures of HRV. Overall, we propose that indices of HRV can be used to index activity of the neurophysiological pathway responsible for adaptively regulating inflammatory processes in humans.
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Affiliation(s)
- DeWayne P Williams
- Department of Psychology, The Ohio State University, Columbus, OH, United States.
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Luca Carnevali
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Italy
| | - Andrea Sgoifo
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Italy
| | - Marc N Jarczok
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center Ulm, Germany
| | - Esther M Sternberg
- Center for Integrative Medicine, The University of Arizona, Tucson, AZ, United States
| | - Julian F Thayer
- Department of Psychology, The Ohio State University, Columbus, OH, United States
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Paccione CE, Jacobsen HB. Motivational Non-directive Resonance Breathing as a Treatment for Chronic Widespread Pain. Front Psychol 2019; 10:1207. [PMID: 31244707 PMCID: PMC6579813 DOI: 10.3389/fpsyg.2019.01207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 05/07/2019] [Indexed: 12/28/2022] Open
Abstract
Chronic widespread pain (CWP) is one of the most difficult pain conditions to treat due to an unknown etiology and a lack of innovative treatment design and effectiveness. Based upon preliminary findings within the fields of motivational psychology, integrative neuroscience, diaphragmatic breathing, and vagal nerve stimulation, we propose a new treatment intervention, motivational non-directive (ND) resonance breathing, as a means of reducing pain and suffering in patients with CWP. Motivational ND resonance breathing provides patients with a noninvasive means of potentially modulating five psychophysiological mechanisms imperative for endogenously treating pain and increasing overall quality of life.
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Affiliation(s)
- Charles Ethan Paccione
- Department of Pain Management and Research, Oslo University Hospital, University of Oslo, Oslo, Norway
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20
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Papaioannou V, Pnevmatikos I. Heart Rate Variability: A Potential Tool for Monitoring Immunomodulatory Effects of Parenteral Fish Oil Feeding in Patients With Sepsis. Nutr Metab Insights 2019; 12:1178638819847486. [PMID: 31105430 PMCID: PMC6506912 DOI: 10.1177/1178638819847486] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 12/13/2022] Open
Abstract
Fish oil, rich in the very-long chain omega (ω)-3 polyunsaturated fatty acids (PUFAs), has been found to have immunomodulatory effects in different groups of critically ill patients. In addition, its parenteral administration seems to attenuate the inflammatory response within 2 to 3 days. The activation of the cholinergic anti-inflammatory pathway has been suggested to mediate such immunoregulatory effects. As different experimental studies have convincingly illustrated that enhanced vagal tone can decrease pro-inflammatory cytokine secretion, novel monitoring tools of its activity at the bedside could be developed, to evaluate nutritional manipulation of immune response in the critically ill. Heart rate variability (HRV) is the variability of R-R series in the electrocardiogram and could be a promising surrogate marker of immune response and its modulation during fish oil feeding, rich in ω-3 PUFAs. Heart rate variability is an indirect measure of autonomic nervous system (ANS) output, reflecting mainly fluctuations in ANS activity. Through HRV analysis, different "physiomarkers" can be estimated that could be used as early and more accurate "smart alarms" because they are based on high-frequency measurements and are much more easy to get at the bedside. On the contrary, various "biomarkers" such as cytokines exhibit marked interdependence, pleiotropy, and their plasma concentrations fluctuate from day to day in patients with sepsis. In this respect, an inverse relation between different HRV components and inflammatory biomarkers has been observed in patients with severe sepsis and septic shock, whereas a beneficial effect of ω-3 PUFAs on HRV has been demonstrated in patients with cardiovascular diseases. Consequently, in this article, we suggest that a beneficial effect of ω-3 PUFAs on HRV and clinical outcome in patients with sepsis merits further investigation and could be tested in future clinical trials as a real-time monitoring tool of nutritional manipulation of the inflammatory response in the critically ill.
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Affiliation(s)
- Vasilios Papaioannou
- Intensive Care Unit, Alexandroupolis General Hospital, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioannis Pnevmatikos
- Intensive Care Unit, Alexandroupolis General Hospital, Democritus University of Thrace, Alexandroupolis, Greece
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21
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Bhogal AS, De Rui M, Pavanello D, El-Azizi I, Rowshan S, Amodio P, Montagnese S, Mani AR. Which heart rate variability index is an independent predictor of mortality in cirrhosis? Dig Liver Dis 2019; 51:695-702. [PMID: 30293892 DOI: 10.1016/j.dld.2018.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/29/2018] [Accepted: 09/11/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Liver cirrhosis is associated with reduced heart rate variability (HRV), which indicates impaired integrity of cardiovascular control in this patient population. There are several different indices for HRV quantification. The present study was designed to: 1) determine which of the HRV indices is best at predicting mortality in patients with cirrhosis; 2) verify if such ability to predict mortality is independent of the severity of hepatic failure. METHODS Ten minutes electrocardiogram was recorded in 74 patients with cirrhosis. Heart rate fluctuations were quantified using statistical, geometrical and non-linear analysis. The patients were followed-up for 18months and information was collected on the occurrence of death/liver transplantation. RESULTS During the follow-up period, 24 patients (32%) died or were transplanted for hepatic decompensation. Cox's regression analysis showed that SDNN (total HRV), cSDNN (corrected SDNN), SD1 (short-term HRV), SD2 (long-terms HRV) and spectral indices could predict survival in these patients. However, only SD2 and cSDNN were shown to be independent of MELD in predicting survival. The prognostic value of HRV indices was independent of age, gender, use of beta blockers, and the aetiology of liver disease. CONCLUSION Two HRV indices were identified that could predict mortality in patients with cirrhosis, independently of MELD. These indices are potentially useful tools for survival prediction.
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Affiliation(s)
- Amar S Bhogal
- Division of Medicine, University College London, London, UK
| | - Michele De Rui
- Department of Medicine, University of Padova, Padova, Italy
| | | | - Ilias El-Azizi
- Division of Medicine, University College London, London, UK
| | - Sadia Rowshan
- Division of Medicine, University College London, London, UK
| | - Piero Amodio
- Department of Medicine, University of Padova, Padova, Italy
| | - Sara Montagnese
- Department of Medicine, University of Padova, Padova, Italy.
| | - Ali R Mani
- Division of Medicine, University College London, London, UK.
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22
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Morris G, Maes M, Berk M, Puri BK. Myalgic encephalomyelitis or chronic fatigue syndrome: how could the illness develop? Metab Brain Dis 2019; 34:385-415. [PMID: 30758706 PMCID: PMC6428797 DOI: 10.1007/s11011-019-0388-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 01/23/2019] [Indexed: 12/19/2022]
Abstract
A model of the development and progression of chronic fatigue syndrome (myalgic encephalomyelitis), the aetiology of which is currently unknown, is put forward, starting with a consideration of the post-infection role of damage-associated molecular patterns and the development of chronic inflammatory, oxidative and nitrosative stress in genetically predisposed individuals. The consequences are detailed, including the role of increased intestinal permeability and the translocation of commensal antigens into the circulation, and the development of dysautonomia, neuroinflammation, and neurocognitive and neuroimaging abnormalities. Increasing levels of such stress and the switch to immune and metabolic downregulation are detailed next in relation to the advent of hypernitrosylation, impaired mitochondrial performance, immune suppression, cellular hibernation, endotoxin tolerance and sirtuin 1 activation. The role of chronic stress and the development of endotoxin tolerance via indoleamine 2,3-dioxygenase upregulation and the characteristics of neutrophils, monocytes, macrophages and T cells, including regulatory T cells, in endotoxin tolerance are detailed next. Finally, it is shown how the immune and metabolic abnormalities of chronic fatigue syndrome can be explained by endotoxin tolerance, thus completing the model.
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Affiliation(s)
- Gerwyn Morris
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Michael Maes
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Basant K Puri
- Department of Medicine, Imperial College London, Hammersmith Hospital, London, England, W12 0HS, UK.
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Very Low Frequency Heart Rate Variability Predicts the Development of Post-Stroke Infections. Transl Stroke Res 2019; 10:607-619. [DOI: 10.1007/s12975-018-0684-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/03/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
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Ahmadi N, Moss L, Hauser P, Nemeroff C, Atre-Vaidya N. Clinical outcome of maintenance electroconvulsive therapy in comorbid Posttraumatic Stress Disorder and major depressive disorder. J Psychiatr Res 2018; 105:132-136. [PMID: 30219562 DOI: 10.1016/j.jpsychires.2018.08.023] [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: 04/26/2018] [Revised: 07/11/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are prevalent and frequently comorbid. Approximately 42-48% of patients with PTSD also meet diagnostic criteria for MDD. Maintenance electroconvulsive therapy (mECT) has been found to be efficacious for the prevention of recurrence of MDD. This study investigated the efficacy of mECT in the treatment of MDD with and without comorbid syndromal PTSD. METHODS This retrospective study includes 36 patients, 26 with MDD and 10 with comorbid MDD & PTSD receiving monthly mECT for a mean of 1.5 years. The mean age was 52 ± 14 years and 25% were female. The change in PTSD and MDD symptoms in response to mECT was assessed using Clinical Global Impression - Severity Scale (CGI-S). Heart rate variability (HRV), 12-month hospitalization rate, suicide rate and all-cause mortality in response to mECT were assessed and compared between groups using repeated generalized linear regression (GLM) analysis. RESULTS At mECT baseline, there were no statistically significant differences in CGI-S scores, HRV between patients with MDD alone and those with comorbid MDD and PTSD (P > 0.05). After 12-months of mECT, a significant increase in HRV (mean difference: 10.9 95%CI 4.8-20.3, p = 0.001) and decrease in CGI-S overall (mean difference: 3.5, 95% CI 3.3-3.6, p = 0.001)], PTSD (mean difference: 3.4, 95% CI 3.2-3.6, p = 0.001)], and MDD (mean difference: 3.8, 95% CI 3.5-3.9, p = 0.001)] symptoms in both groups were noted (p < 0.05). No psychiatric hospitalization or suicide occurred in any of the patients. CONCLUSIONS Maintenance ECT is associated with improved HRV, reduction of both major depression and PTSD symptoms, and a favorable clinical outcome.
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Affiliation(s)
- Naser Ahmadi
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States.
| | - Lori Moss
- Captain James A Lovell Federal Healthcare Center, Chicago Medical School, North Chicago, IL, United States
| | - Peter Hauser
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Charles Nemeroff
- Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Nutan Atre-Vaidya
- Captain James A Lovell Federal Healthcare Center, Chicago Medical School, North Chicago, IL, United States
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de Castilho FM, Ribeiro ALP, Nobre V, Barros G, de Sousa MR. Heart rate variability as predictor of mortality in sepsis: A systematic review. PLoS One 2018; 13:e0203487. [PMID: 30204803 PMCID: PMC6133362 DOI: 10.1371/journal.pone.0203487] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Autonomic dysregulation is one of the recognized pathophysiological mechanisms in sepsis, generating the hypothesis that heart rate variability (HRV) can be used to predict mortality in sepsis. METHODS This was a systematic review of studies evaluating HRV as a predictor of death in patients with sepsis. The search was performed by independent researchers in PubMed, LILACS and Cochrane, including papers in English, Portuguese or Spanish, indexed until August 20th, 2017 with at least 10 patients. Study quality was assessed by Newcastle-Ottawa Scale. To analyze the results, we divided the articles between those who measured HRV for short-term recordings (≤ 1 hour), and those who did long-term recordings (≥ 24 hours). RESULTS Nine studies were included with a total of 536 patients. All of them were observational studies. Studies quality varied from 4 to 7 stars in Newcastle-Ottawa Scale. The mortality rate in the studies ranged from 8 to 61%. Seven studies performed HRV analysis in short-term recordings. With the exception of one study that did not explain which group had the lowest results, all other studies showed reduction of several HRV parameters in the non-survivors in relation to the surviving septic patients. SDNN (Standard deviation of the Normal to Normal interval), TP (Total Power), VLF (Very Low Frequency Power), LF (Low Frequency Power), LF/HF (Low Frequency Power / High Frequency Power), nLF (Normalized Low Frequency Power), α1/α2 (short-term and long-term fractal scaling coefficients from DFA) and r-MSSD (Square root of the squared mean of the difference of successive NN-intervals) of the non-survivor group were reduced in relation to the survivors in at least one study. Two studies found that SDNN is associated with mortality in sepsis, even after adjusting for possible confounding factors. Three studies performed HRV analysis using long-term recordings. Only one of these studies found difference between surviving and non-surviving groups, and even so, in only one HRV parameter: LogHF. CONCLUSIONS Several HRV parameters are reduced in nonsurviving septic patients in short-term recording. Two studies have found that SDNN is associated with mortality in sepsis, even after adjusting for possible confounding factors.
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Affiliation(s)
- Fábio M. de Castilho
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Antonio Luiz P. Ribeiro
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Vandack Nobre
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Núcleo Interdisciplinar de Investigação em Medicina Intensiva (NIIMI), UFMG, Belo Horizonte, Brazil
| | - Guilherme Barros
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Marcos R. de Sousa
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Sallam MY, El-Gowilly SM, El-Gowelli HM, El-Lakany MA, El-Mas MM. Additive counteraction by α7 and α4β2-nAChRs of the hypotension and cardiac sympathovagal imbalance evoked by endotoxemia in male rats. Eur J Pharmacol 2018; 834:36-44. [DOI: 10.1016/j.ejphar.2018.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/28/2018] [Accepted: 07/12/2018] [Indexed: 01/01/2023]
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Rudiger A, Jeger V, Arrigo M, Schaer CA, Hildenbrand FF, Arras M, Seifert B, Singer M, Schoedon G, Spahn DR, Bettex D. Heart rate elevations during early sepsis predict death in fluid-resuscitated rats with fecal peritonitis. Intensive Care Med Exp 2018; 6:28. [PMID: 30128907 PMCID: PMC6102166 DOI: 10.1186/s40635-018-0190-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/19/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In sepsis, early outcome prediction would allow investigation of both adaptive mechanisms underlying survival and maladaptive mechanisms resulting in death. The aim of this study was to test whether early changes in heart rate monitored by telemetry could predict outcome in a long-term rat model of fecal peritonitis. METHODS Male Wistar rats (n = 24) were instrumented with a central venous line for administration of fluids, antibiotics and analgesics. A telemetry transmitter continuously collected electrocardiogram signals. Sepsis was induced by intraperitoneal injection of fecal slurry, and the animals were observed for 48 h. Additional animals underwent arterial cannulation at baseline (n = 9), 4 h (n = 16), or 24 h (n = 6) for physiology and laboratory measurements. RESULTS 48-h mortality was 33% (8/24), with all deaths occurring between 4 and 22 h. Septic animals were characterized by lethargy, fever, tachycardia, positive blood cultures, and elevated cytokine (IL-1, IL-6, TNF alpha) levels. An increase in heart rate ≥ 50 bpm during the first 4 h of sepsis predicted death with sensitivity and specificity of 88% (p = 0.001). CONCLUSIONS In this long-term rat sepsis model, prognostication could be made early by telemetry-monitored changes in heart rate. This model enables the study of underlying mechanisms and the assessment of any differential effects of novel therapies in predicted survivors or non-survivors.
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Affiliation(s)
- Alain Rudiger
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Victor Jeger
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Inflammation Research Unit, Division of Internal Medicine, University and University Hospital Zurich, Raemistrasse 100, CH 8091 Zurich, Switzerland
| | - Mattia Arrigo
- Clinic for Cardiology, University Heart Centre, University and University Hospital Zurich, Raemistrasse 100, CH 8091 Zurich, Switzerland
| | - Christian A. Schaer
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Inflammation Research Unit, Division of Internal Medicine, University and University Hospital Zurich, Raemistrasse 100, CH 8091 Zurich, Switzerland
| | - Florian F. Hildenbrand
- Inflammation Research Unit, Division of Internal Medicine, University and University Hospital Zurich, Raemistrasse 100, CH 8091 Zurich, Switzerland
| | - Margarete Arras
- Department of Surgery, University and University Hospital Zurich, Raemistrasse 100, CH 8091 Zurich, Switzerland
| | - Burkhardt Seifert
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, Gower Street, London, WC1E 6BT UK
| | - Gabriele Schoedon
- Inflammation Research Unit, Division of Internal Medicine, University and University Hospital Zurich, Raemistrasse 100, CH 8091 Zurich, Switzerland
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Dominique Bettex
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Ye F, Winchester D, Stalvey C, Jansen M, Lee A, Khuddus M, Mazza J, Yale S. Proposed mechanisms of relative bradycardia. Med Hypotheses 2018; 119:63-67. [PMID: 30122494 DOI: 10.1016/j.mehy.2018.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/18/2018] [Accepted: 07/14/2018] [Indexed: 12/17/2022]
Abstract
Relative bradycardia is the term used to describe the mechanism where there is dissociation between pulse and temperature. This finding is important to recognize since it may provide further insights into the potential underlying causes of disease. There is no known proposed mechanism to explain this phenomenon. We hypothesize that relative bradycardia is the central mechanism reflecting and influenced potentially by the direct pathogenic effect on the sinoatrial node as well as cross-talk between the autonomic nervous system and immune system. Cardiac pacemaker cells may act as a target for inflammatory cytokines leading to alteration in heart rate dynamics or their responsiveness to neurotransmitters during systemic inflammation. These factors account for the important role of how the host response to infectious and non-infectious causes influences the appearance of relative bradycardia. We propose several methods that may be useful to confirm the proposed theoretical framework to further enhance our understanding of this paradoxical phenomenon. This includes measuring, during the episode of relative bradycardia, proinflammatory and anti-inflammatory cytokines, monitoring heart rate variability (HRV), and assessing underlying comorbidities and outcomes in patients with the same disease.
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Affiliation(s)
- Fan Ye
- Graduate Medical Education, University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, United States
| | - David Winchester
- Department of Cardiology, University of Florida, College of Medicine, Gainesville, FL 32610, United States
| | - Carolyn Stalvey
- Department of General Internal Medicine, University of Florida, College of Medicine, Gainesville, FL 32610, United States
| | - Michael Jansen
- The Cardiac and Vascular Institute, Gainesville, 4645 NW 8th Ave., Gainesville, FL 32605, United States
| | - Arthur Lee
- The Cardiac and Vascular Institute, Gainesville, 4645 NW 8th Ave., Gainesville, FL 32605, United States
| | - Matheen Khuddus
- The Cardiac and Vascular Institute, Gainesville, 4645 NW 8th Ave., Gainesville, FL 32605, United States
| | - Joseph Mazza
- Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI 54449, United States
| | - Steven Yale
- Department of Internal Medicine, University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, United States.
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Inata Y, Piraino G, Hake PW, O'Connor M, Lahni P, Wolfe V, Schulte C, Moore V, James JM, Zingarelli B. Age-dependent cardiac function during experimental sepsis: effect of pharmacological activation of AMP-activated protein kinase by AICAR. Am J Physiol Heart Circ Physiol 2018; 315:H826-H837. [PMID: 29979626 DOI: 10.1152/ajpheart.00052.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Age represents a major risk factor for multiple organ failure, including cardiac dysfunction, in patients with sepsis. AMP-activated protein kinase (AMPK) is a crucial regulator of energy homeostasis that controls mitochondrial biogenesis by activation of peroxisome proliferator-activated receptor-γ coactivator-1α and disposal of defective organelles by autophagy. We investigated whether AMPK dysregulation contributes to age-dependent cardiac injury in young (2-3 mo) and mature adult (11-13 mo) male mice subjected to sepsis by cecal ligation and puncture and whether AMPK activation by 5-amino-4-imidazole carboxamide riboside affords cardioprotective effects. Plasma proinflammatory cytokines and myokine follistatin were similarly elevated in vehicle-treated young and mature adult mice at 18 h after sepsis. However, despite equivalent troponin I and T levels compared with similarly treated young mice, vehicle-treated mature adult mice exhibited more severe cardiac damage by light and electron microscopy analyses with more marked intercellular edema, inflammatory cell infiltration, and mitochondrial derangement. Echocardiography revealed that vehicle-treated young mice exhibited left ventricular dysfunction after sepsis, whereas mature adult mice exhibited a reduction in stroke volume without apparent changes in load-dependent indexes of cardiac function. At molecular analysis, phosphorylation of the catalytic subunits AMPK-α1/α2 was associated with nuclear translocation of peroxisome proliferator-activated receptor-γ coactivator-1α in vehicle-treated young but not mature adult mice. Treatment with 5-amino-4-imidazole carboxamide riboside ameliorated cardiac architecture derangement in mice of both ages. These cardioprotective effects were associated with attenuation of the systemic inflammatory response and amelioration of cardiac dysfunction in young mice only, not in mature adult animals. NEW & NOTEWORTHY Our data suggest that sepsis-induced cardiac dysfunction manifests with age-dependent characteristics, which are associated with a distinct regulation of AMP-activated protein kinase-dependent metabolic pathways. Consistent with this age-related deterioration, pharmacological activation of AMP-activated protein kinase may afford cardioprotective effects allowing a partial recovery of cardiac function in young but not mature age.
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Affiliation(s)
- Yu Inata
- Division of Critical Care Medicine, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Giovanna Piraino
- Division of Critical Care Medicine, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Paul W Hake
- Division of Critical Care Medicine, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Michael O'Connor
- Division of Critical Care Medicine, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Patrick Lahni
- Division of Critical Care Medicine, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Vivian Wolfe
- Division of Critical Care Medicine, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Christine Schulte
- Cardiovascular Imaging Core of the Heart Institute Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Victoria Moore
- Cardiovascular Imaging Core of the Heart Institute Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati , Cincinnati, Ohio
| | - Jeanne M James
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Basilia Zingarelli
- Division of Critical Care Medicine, College of Medicine, University of Cincinnati , Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati , Cincinnati, Ohio
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Zila I, Mokra D, Kopincova J, Kolomaznik M, Javorka M, Calkovska A. Vagal-immune interactions involved in cholinergic anti-inflammatory pathway. Physiol Res 2018; 66:S139-S145. [PMID: 28937230 DOI: 10.33549/physiolres.933671] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Inflammation and other immune responses are involved in the variety of diseases and disorders. The acute response to endotoxemia includes activation of innate immune mechanisms as well as changes in autonomic nervous activity. The autonomic nervous system and the inflammatory response are intimately linked and sympathetic and vagal nerves are thought to have anti-inflammation functions. The basic functional circuit between vagus nerve and inflammatory response was identified and the neuroimmunomodulation loop was called cholinergic anti-inflammatory pathway. Unique function of vagus nerve in the anti-inflammatory reflex arc was found in many experimental and pre-clinical studies. They brought evidence on the cholinergic signaling interacting with systemic and local inflammation, particularly suppressing immune cells function. Pharmacological/electrical modulation of vagal activity suppressed TNF-alpha and other proinflammatory cytokines production and had beneficial therapeutic effects. Many questions related to mapping, linking and targeting of vagal-immune interactions have been elucidated and brought understanding of its basic physiology and provided the initial support for development of Tracey´s inflammatory reflex. This review summarizes and critically assesses the current knowledge defining cholinergic anti-inflammatory pathway with main focus on studies employing an experimental approach and emphasizes the potential of modulation of vagally-mediated anti-inflammatory pathway in the treatment strategies.
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Affiliation(s)
- I Zila
- Department of Physiology and Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
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Abstract
OBJECTIVE Autonomic nervous system (ANS) imbalance has been cross-sectionally associated with inflammatory processes. Longitudinal studies are needed to shed light on the nature of this relationship. We examined cross-sectional and bidirectional prospective associations between cardiac autonomic measures and inflammatory markers. METHODS Analyses were conducted with baseline (n = 2823), 2-year (n = 2099), and 6-year (n = 1774) data from the Netherlands Study of Depression and Anxiety. To compare the pattern of results, prospective analyses with ANS (during sleep, leisure time, and work) and inflammation were conducted in two data sets from the Netherlands Twin Register measured for 4.9 years (n = 356) and 5.4 years (n = 472). Autonomic nervous system measures were heart rate (HR) and respiratory sinus arrhythmia (RSA). Inflammatory markers were C-reactive protein (CRP) and interleukin (IL)-6. RESULTS The Netherlands Study of Depression and Anxiety results showed that higher HR and lower RSA were cross-sectionally significantly associated with higher inflammatory levels. Higher HR predicted higher levels of CRP (B = .065, p < .001) and IL-6 (B = .036, p = .014) at follow-up. Higher CRP levels predicted lower RSA (B = -.024, p = .048) at follow-up. The Netherlands Twin Register results confirmed that higher HR was associated with higher CRP and IL-6 levels 4.9 years later. Higher IL-6 levels predicted higher HR and lower RSA at follow-up. CONCLUSIONS Autonomic imbalance is associated with higher levels of inflammation. Independent data from two studies converge in evidence that higher HR predicts subsequent higher levels of CRP and IL-6. Inflammatory markers may also predict future ANS activity, but evidence for this was less consistent.
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Robinson-Papp J, Nmashie A, Pedowitz E, Benn EKT, George MC, Sharma S, Murray J, Machac J, Heiba S, Mehandru S, Kim-Schulze S, Navis A, Elicer I, Morgello S. Vagal dysfunction and small intestinal bacterial overgrowth: novel pathways to chronic inflammation in HIV. AIDS 2018; 32:1147-1156. [PMID: 29596112 PMCID: PMC5945300 DOI: 10.1097/qad.0000000000001802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Chronic inflammation in HIV-infected individuals drives disease progression and the development of comorbidities, despite viral suppression with combined antiretroviral therapy. Here, we sought evidence that vagal dysfunction, which occurs commonly as part of HIV-associated autonomic neuropathy, could exacerbate inflammation through gastrointestinal dysmotility, small intestinal bacterial overgrowth (SIBO), and alterations in patterns of soluble immune mediators. DESIGN This is a cross-sectional observational study. METHODS Forty participants on stable combined antiretroviral therapy with gastrointestinal symptoms, and no causes for vagal or gastrointestinal dysfunction other than HIV, underwent autonomic testing, hydrogen/methane breath testing for SIBO, and gastric emptying scintigraphy. A panel of 41 cytokines, high-mobility group box 1, and markers of bacterial translocation (lipopolysaccharide) and monocyte/macrophage activation (sCD14 and sCD163) were tested in plasma. RESULTS We found that participants with vagal dysfunction had delayed gastric emptying and higher prevalence of SIBO. SIBO was associated with IL-6, but not sCD14; lipopolysaccharide could not be detected in any participant. We also found alteration of cytokine networks in participants with vagal dysfunction, with stronger and more numerous positive correlations between cytokines. In the vagal dysfunction group, high mobility group box 1 was the only soluble mediator displaying strong negative correlations with other cytokines, especially those cytokines that had numerous other strong positive correlations. CONCLUSION The current study provides evidence that the vagal component of HIV-associated autonomic neuropathy is associated with changes in immune and gastrointestinal function in individuals with well treated HIV. Further study will be needed to understand whether therapies targeted at enhancing vagal function could be of benefit in HIV.
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Affiliation(s)
- Jessica Robinson-Papp
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Quinten VM, van Meurs M, Renes MH, Ligtenberg JJM, Ter Maaten JC. Protocol of the sepsivit study: a prospective observational study to determine whether continuous heart rate variability measurement during the first 48 hours of hospitalisation provides an early warning for deterioration in patients presenting with infection or sepsis to the emergency department of a Dutch academic teaching hospital. BMJ Open 2017; 7:e018259. [PMID: 29151053 PMCID: PMC5702015 DOI: 10.1136/bmjopen-2017-018259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/01/2017] [Accepted: 10/25/2017] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION One in five patients with sepsis deteriorates within 48 hours after hospital admission. Regrettably, a clear tool for the early detection of deterioration is still lacking. The SepsiVit study aims to determine whether continuous heart rate variability (HRV) measurement can provide an early warning for deterioration in patients presenting with suspected infection or sepsis to the emergency department (ED). METHODS AND ANALYSIS The protocol of a prospective observational study in the ED. We will include 171 adult medical patients presenting with suspected infection or sepsis and at least two systemic inflammatory response syndrome criteria. Patients with known pregnancy, cardiac transplantation or not admitted to our hospital are excluded.High sample frequency ECG signals (500 Hz), respiratory rate, blood pressure and peripheral oxygen saturation will be recorded continuously during the first 48 hours of hospitalisation using a bedside patient monitor (Philips IntelliVue MP70). Primary endpoint is patient deterioration, defined as the development of organ dysfunction, unplanned intensive care unit admission or in-hospital mortality. The ECG data will be used for offline HRV analysis. We will compare the HRV between two groups (deterioration/no deterioration) and analyse whether HRV provides an early warning for deterioration. Furthermore, we will create a multivariate predictive model for deterioration based on heart rate, respiratory rate and HRV. As planned secondary analyses, we (1) perform a subgroup analysis for patients with pneumosepsis and urosepsis and (2) determine whether HRV using lower sample frequencies (1 Hz or less) suffices to predict deterioration. ETHICS AND DISSEMINATION The Institutional Review Board of the University Medical Center Groningen granted a waiver for the study (METc 2015/164). Results will be disseminated through international peer-reviewed publications and conference presentations. A lay summary of the results will be provided to the study participants. TRIAL REGISTRATION NUMBER NTR6168; Pre-results.
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Affiliation(s)
- Vincent M Quinten
- Department of Emergency Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matijs van Meurs
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pathology and Medical Biology, Medical Biology Section, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maurits H Renes
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jack J M Ligtenberg
- Department of Emergency Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan C Ter Maaten
- Department of Emergency Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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de Castilho FM, Ribeiro ALP, da Silva JLP, Nobre V, de Sousa MR. Heart rate variability as predictor of mortality in sepsis: A prospective cohort study. PLoS One 2017; 12:e0180060. [PMID: 28654692 PMCID: PMC5487061 DOI: 10.1371/journal.pone.0180060] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 06/08/2017] [Indexed: 12/29/2022] Open
Abstract
Background Sepsis is a serious medical condition with increasing prevalence and high mortality. The role of the autonomic nervous system in pathophysiology of sepsis has been increasingly researched. The objective of this study is to evaluate the Heart rate variability (HRV) as a predictor of mortality in septic patients. Methods This was a prospective cohort of patients diagnosed with sepsis. Patient recruitment was carried out at ICU in tertiary university hospital between March 2012 and February 2014. Clinical data and laboratory exams were collected at admission. Each patient underwent a 20-minute Holter and a 24-hour Holter on the first day of enrollment. The primary outcome was the 28-day all-cause mortality. Results A total of 63 patients were included. Patients were categorized into nonsurvivor group (n = 16) or survivor group (n = 47) depending on this endpoint. Survivors were younger (48.6 years vs. 63.0 years), had better renal function and lower values in severity scores (APACHE II and SOFA) compared to nonsurvivors. In the 20-minute Holter, SDNN, Total Power, VLF Power, LF Power and LF/HF of nonsurvivors were significantly lower than those of survivors (p = <0.001, p = 0.003, p = 0.002, p = 0.006, p = 0.009 respectively). ROC curve of SDNN was built, showing area under the curve of 0.772 (0.638–0.906) for mortality. The value of 17ms was chosen as best SDNN cutoff to discriminate survivors and nonsurvivors. In the Cox proportional regression, adjusted for SOFA score and for APACHE II, a SDNN ≤ 17ms was associated with a greater risk of death, with hazard ratios of 6.3 (1.4–28.0; p = 0.015) and 5.5 (1,2–24,8; p = 0.027), respectively. The addition of the dichotomized SDNN to the SOFA model reduced AIC and increased the concordance statistic and the R2, indicating that predictive power of the SDNN + SOFA model is better than predictive power of SOFA only. Conclusions Several HRV parameters are reduced in nonsurviving septic patients. SDNN ≤17 is a risk factor for death in septic patients, even after adjusting for severity scores.
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Affiliation(s)
- Fábio M. de Castilho
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- * E-mail:
| | - Antonio Luiz P. Ribeiro
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - José Luiz P. da Silva
- Department of Statistics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Vandack Nobre
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Núcleo Interdisciplinar de Investigação em Medicina Intensiva (NIIMI), UFMG, Belo Horizonte, Brazil
| | - Marcos R. de Sousa
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Al-Shargabi T, Govindan RB, Dave R, Metzler M, Wang Y, du Plessis A, Massaro AN. Inflammatory cytokine response and reduced heart rate variability in newborns with hypoxic-ischemic encephalopathy. J Perinatol 2017; 37:668-672. [PMID: 28252659 PMCID: PMC5446303 DOI: 10.1038/jp.2017.15] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/04/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether systemic inflammation-modulating cytokine expression is related to heart rate variability (HRV) in newborns with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN The data from 30 newborns with HIE were analyzed. Cytokine levels (IL-2, IL-4, IL-6, IL-8, IL-10, IL-13, IL-1β, TNF-α, IFN-λ) were measured either at 24 h of cooling (n=5), 72 h of cooling (n=4) or at both timepoints (n=21). The following HRV metrics were quantified in the time domain: alpha_S, alpha_L, root mean square (RMS) at short time scales (RMS_S), RMS at long time scales (RMS_L), while low-frequency power (LF) and high-frequency power (HF) were quantified in the frequency domain. The relationships between HRV metrics and cytokines were evaluated using mixed-models. RESULT IL-6, IL-8, IL-10, and IL-13 levels were inversely related to selected HRV metrics. CONCLUSION Inflammation-modulating cytokines may be important mediators in the autonomic dysfunction observed in newborns with HIE.
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Affiliation(s)
- Tareq Al-Shargabi
- Division of Fetal and Transitional Medicine, Fetal Medicine Institute, Children’s National Health System, Washington, United States
| | - R. B. Govindan
- Division of Fetal and Transitional Medicine, Fetal Medicine Institute, Children’s National Health System, Washington, United States,The George Washington University, Washington, DC, United States
| | - Rhiya Dave
- The George Washington University, Washington, DC, United States
| | - Marina Metzler
- Division of Fetal and Transitional Medicine, Fetal Medicine Institute, Children’s National Health System, Washington, United States
| | - Yunfei Wang
- Division of Biostatistics and Study Methodology, Children’s National Health System, Washington, DC, United States
| | - Adre du Plessis
- Division of Fetal and Transitional Medicine, Fetal Medicine Institute, Children’s National Health System, Washington, United States,The George Washington University, Washington, DC, United States
| | - An N. Massaro
- Division of Fetal and Transitional Medicine, Fetal Medicine Institute, Children’s National Health System, Washington, United States,Division of Neonatology, Children’s National Health System, Washington, DC, United States,The George Washington University, Washington, DC, United States,Dr. An N. Massaro, MD, Division of Neonatology, Children’s National Health System, 111 Michigan Ave, NW, Washington, DC 20010, United States, Phone: +1-202-476-5448, Fax: +1-202-476-3459,
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Abstract
OBJECTIVE It has been proposed that the inflammatory cytokine system is regulated through the vagus nerve, where vagal activation inhibits release of inflammatory cytokines and, therefore, inflammation. Thus, loss of vagal activation (i.e., reduced high-frequency heart rate variability [HF-HRV]) should result in greater inflammation. Evidence to date for this relationship has relied on animal models and resting states in humans. The present study used a psychosocial stressor to test whether stress-induced decreases in HF-HRV predict increases in circulating inflammatory markers. METHODS Thirty healthy young women completed a speech stressor. HF-HRV was assessed before and during the stressor while circulating plasma interleukin 6, tumor necrosis factor α, and C-reactive protein were assessed before and 1 hour after the stressor. RESULTS Consistent with the neural reflex for immunity, greater reductions in HF-HRV during the stressor were associated with greater increases in tumor necrosis factor α (β = -0.29 to -0.47) and interleukin 6 (β = -0.40 to -0.68) but not C-reactive protein (β = 0.10 to 0.29) 1 hour after the stressor. CONCLUSIONS These findings expand on the current literature by showing that changes in HF-HRV predict and precede changes in circulating inflammatory cytokines in humans and may have implications for treatment of inflammatory diseases.
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Di Lullo L, Bellasi A, Barbera V, Russo D, Russo L, Di Iorio B, Cozzolino M, Ronco C. Pathophysiology of the cardio-renal syndromes types 1-5: An uptodate. Indian Heart J 2017; 69:255-265. [PMID: 28460776 PMCID: PMC5415026 DOI: 10.1016/j.ihj.2017.01.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/06/2016] [Accepted: 01/10/2017] [Indexed: 12/19/2022] Open
Abstract
According to the recent definition proposed by the Consensus conference on Acute Dialysis Quality Initiative Group, the term cardio-renal syndrome (CRS) has been used to define different clinical conditions in which heart and kidney dysfunction overlap. Type 1 CRS (acute cardio- renal syndrome) is characterized by acute worsening of cardiac function leading to AKI (5, 6) in the setting of active cardiac disease such as ADHF, while type - 2 CRS occurs in a setting of chronic heart disease. Type 3 CRS is closely link to acute kidney injury (AKI), while type 4 represent cardiovascular involvement in chronic kidney disese (CKD) patients. Type 5 CRS represent cardiac and renal involvement in several diseases such as sepsis, hepato - renal syndrome and immune - mediated diseases.
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Affiliation(s)
- L Di Lullo
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro Rome, Italy.
| | - A Bellasi
- Department of Nephrology and Dialysis, S. Anna Hospital, Como, Italy
| | - V Barbera
- Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro Rome, Italy
| | - D Russo
- Division of Nephrology, University of Naples "Federico II", Napoli, Italy
| | - L Russo
- Division of Nephrology, University of Naples "Federico II", Napoli, Italy
| | - B Di Iorio
- Department of Nephrology and Dialysis, A. Landolfi Hospital, Solofra, Avellino, Italy
| | - M Cozzolino
- Department of Health Sciences, Renal Division, San Paolo Hospital, University of Milan, Italy
| | - C Ronco
- International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
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Sallam MY, El-Gowilly SM, Abdel-Galil AGA, El-Mas MM. Cyclosporine counteracts endotoxemia-evoked reductions in blood pressure and cardiac autonomic dysfunction via central sGC/MAPKs signaling in rats. Eur J Pharmacol 2017; 797:143-152. [DOI: 10.1016/j.ejphar.2017.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/13/2017] [Accepted: 01/19/2017] [Indexed: 12/23/2022]
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Wei C, Louis H, Schmitt M, Albuisson E, Orlowski S, Levy B, Kimmoun A. Effects of low doses of esmolol on cardiac and vascular function in experimental septic shock. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:407. [PMID: 27998289 PMCID: PMC5175382 DOI: 10.1186/s13054-016-1580-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/25/2016] [Indexed: 12/22/2022]
Abstract
Background Administration of a selective β1-blocker, such as esmolol, in human septic shock has demonstrated cardiovascular protective effects related to heart rate reduction. Certain experimental data also indicate that esmolol exerts systemic anti-inflammatory and beneficial effects on vascular tone. Thus, the present study aimed to determine whether a non-chronotropic dose of esmolol maintains its protective cardiovascular and anti-inflammatory effects in experimental septic shock. Methods Four hours after cecal ligation and puncture (CLP), Wistar male rats were randomly allocated to the following groups (n = 8): CLP, CLP + E-1 (esmolol: 1 mg.kg−1.h−1), CLP + E-5 (esmolol: 5 mg.kg−1.h−1), CLP + E-18 (esmolol: 18 mg.kg−1.h−1). An additional eight rats underwent sham operation. All rats received a continuous infusion of saline, analgesic and antibiotics 4 hours after the surgery. Assessment at 18 hours included in vivo cardiac function assessed by echocardiography and ex vivo vasoreactivity assessed by myography. Circulating cytokine levels (IL-6 and IL-10) were measured by ELISA. Cardiac and vascular protein expressions of p-NF-κB, IκBα, iNOS, p-AKT/AKT and p-eNOS/eNOS were assessed by western blotting. Results CLP induced tachycardia, hypotension, cardiac output reduction, hyperlactatemia and vascular hypo-responsiveness to vasopressors. Compared to CLP animals, heart rate was unchanged in CLP + E-1 and CLP + E-5 but was reduced in CLP + E-18. Stroke volume, cardiac output, mean arterial pressure and lactatemia were improved in CLP + E-1 and CLP + E-5, while vascular responsiveness to phenylephrine was only improved in CLP + E-5 and CLP + E-18. Plasma IL-6 levels were decreased in all esmolol groups. p-NF-κB was decreased in both cardiac and vascular tissues in CLP + E-5 and CLP + E-18. Conclusion In experimental septic shock, low doses of esmolol still improved cardiac function and vasoreactivity. These benefits appear to be associated with a modulation of inflammatory pathways. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1580-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chaojie Wei
- INSERM U 1116, Groupe Choc, Equipe 2, Faculté de Médecine, Vandoeuvre les Nancy, France.,Université de Lorraine, Nancy, France
| | - Huguette Louis
- Université de Lorraine, Nancy, France.,INSERM U 1116, Groupe Choc, Equipe 1, Faculté de Médecine, Vandoeuvre les Nancy, France
| | - Margaux Schmitt
- INSERM U 1116, Groupe Choc, Equipe 2, Faculté de Médecine, Vandoeuvre les Nancy, France
| | - Eliane Albuisson
- Université de Lorraine, Nancy, France.,Unité ESPRI-BioBase, CHRU Nancy, Vandoeuvre les Nancy, France
| | - Sophie Orlowski
- INSERM U 1116, Groupe Choc, Equipe 2, Faculté de Médecine, Vandoeuvre les Nancy, France.,Université de Lorraine, Nancy, France
| | - Bruno Levy
- INSERM U 1116, Groupe Choc, Equipe 2, Faculté de Médecine, Vandoeuvre les Nancy, France. .,Université de Lorraine, Nancy, France. .,CHU Nancy, Service de Réanimation Médicale Brabois, Pole Cardiovasculaire et Réanimation Médicale, Hôpital Brabois, Vandoeuvre les Nancy, France.
| | - Antoine Kimmoun
- INSERM U 1116, Groupe Choc, Equipe 2, Faculté de Médecine, Vandoeuvre les Nancy, France.,Université de Lorraine, Nancy, France.,CHU Nancy, Service de Réanimation Médicale Brabois, Pole Cardiovasculaire et Réanimation Médicale, Hôpital Brabois, Vandoeuvre les Nancy, France
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Boudet G, Walther G, Courteix D, Obert P, Lesourd B, Pereira B, Chapier R, Vinet A, Chamoux A, Naughton G, Poirier P, Dutheil F. Paradoxical dissociation between heart rate and heart rate variability following different modalities of exercise in individuals with metabolic syndrome: The RESOLVE study. Eur J Prev Cardiol 2016; 24:281-296. [PMID: 27856807 DOI: 10.1177/2047487316679523] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Aims To analyse the effects of different modalities of exercise training on heart rate variability (HRV) in individuals with metabolic syndrome (MetS). Methods and results Eighty MetS participants (aged 50-70 years) were housed and managed in an inpatient medical centre for 21 days, including weekends. Physical activity and food intake/diet were intensively monitored. Participants were randomly assigned into three training groups, differing only by intensity of exercise: moderate-endurance-moderate-resistance ( re), high-resistance-moderate-endurance ( Re), and moderate-resistance-high-endurance ( rE). HRV was recorded before and after the intervention by 24-hour Holter electrocardiogram. Although mean 24-hour heart rate decreased more in Re than re (-11.6 ± 1.6 vs. -4.8 ± 2.1%; P = 0.010), low frequency/high frequency decreased more in re than Re (-20.4 ± 5.5% vs. + 20.4 ± 9.1%; P = 0.002) and rE (-20.4 ± 5.5% vs. -0.3 ± 11.1%; P = 0.003). Very low frequency increased more in Re than re (+121.2 ± 35.7 vs. 42.9 ± 11.3%; P = 0.004). For all HRV parameters, rE ranged between re and Re values. Low frequency/high frequency changes were linked with visceral fat loss only in re (coefficient 5.9, 95% CI 1.9-10.0; P = 0.004). By day 21, HRV parameters of MetS groups (heart rate -8.6 ± 1.0%, standard deviation of R-R intervals + 34.0 ± 6.6%, total power + 63.3 ± 11.1%; P < 0.001) became closer to values of 50 aged-matched healthy controls. Conclusions A 3-week residential programme with intensive volumes of physical activity (15-20 hours per week) enhanced HRV in individuals with MetS. Participants with moderate intensity of training had greater improvements in sympathovagal balance, whereas those with high intensity in resistance training had greater decreases in heart rate and greater increases in very low frequency. Modality-specific relationships were observed between enhanced HRV and visceral fat loss. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT00917917.
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Affiliation(s)
- Gil Boudet
- 1 University Clermont Auvergne, Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological conditions (AME2P, EA3533), France.,2 University Hospital of Clermont Ferrand (CHU), Preventive and Occupational Medicine, France
| | | | - Daniel Courteix
- 1 University Clermont Auvergne, Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological conditions (AME2P, EA3533), France
| | | | - Bruno Lesourd
- 1 University Clermont Auvergne, Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological conditions (AME2P, EA3533), France
| | - Bruno Pereira
- 4 University Hospital of Clermont Ferrand (CHU), Clinical Research and Innovation Direction, France
| | - Robert Chapier
- 1 University Clermont Auvergne, Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological conditions (AME2P, EA3533), France
| | - Agnès Vinet
- 3 University of Avignon, LaPEC EA4278, France
| | - Alain Chamoux
- 2 University Hospital of Clermont Ferrand (CHU), Preventive and Occupational Medicine, France
| | - Geraldine Naughton
- 5 Australian Catholic University, School of Exercise Science, Faculty of Health, Australia
| | - Paul Poirier
- 6 Centre de recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada.,7 Faculté de Pharmacie, Université Laval, Canada
| | - Frédéric Dutheil
- 1 University Clermont Auvergne, Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological conditions (AME2P, EA3533), France.,2 University Hospital of Clermont Ferrand (CHU), Preventive and Occupational Medicine, France.,5 Australian Catholic University, School of Exercise Science, Faculty of Health, Australia.,8 CNRS, UMR 6024, Physiological and Psychosocial Stress, University Clermont Auvergne, France
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Ronco C, Di Lullo L. Cardiorenal Syndrome in Western Countries: Epidemiology, Diagnosis and Management Approaches. KIDNEY DISEASES 2016; 2:151-163. [PMID: 28232932 DOI: 10.1159/000448749] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 07/28/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND It is well established that a large number of hospitalized patients present various degrees of heart and kidney dysfunction; primary disease of the heart or kidney often involves dysfunction or injury to the other. SUMMARY Based on above-cited organ cross-talk, the term cardiorenal syndrome (CRS) was proposed. Although CRS was usually referred to as abruption of kidney function following heart injury, it is now clearly established that it can describe negative effects of an impaired renal function on the heart and circulation. The historical lack of clear syndrome definition and complexity of diseases contributed to a waste of precious time especially concerning diagnosis and therapeutic strategies. The effective classification of CRS proposed in a Consensus Conference by the Acute Dialysis Quality Group essentially divides CRS into two main groups, cardiorenal and renocardiac CRS, on the basis of primum movens of disease (cardiac or renal); both cardiorenal and renocardiac CRS are then divided into acute and chronic according to disease onset. Type 5 CRS integrates all cardiorenal involvement induced by systemic disease. KEY MESSAGES Prevalence and incidence data show a widespread increase of CRS also due to an increasing incidence of acute and chronic cardiovascular disease, such as acute decompensated heart failure, arterial hypertension and valvular heart disease. Patients with chronic kidney disease present various degrees of cardiovascular involvement especially due to chronic inflammatory status, volume and pressure overload and secondary hyperparathyroidism leading to a higher incidence of calcific heart disease. The following review will focus on the main aspects (epidemiology, risk factors, diagnostic tools and protocols, therapeutic approaches) of CRS in Western countries (Europe and United States).
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Affiliation(s)
- Claudio Ronco
- International Renal Research Institute (IRRIV), S. Bortolo Hospital, Vicenza, Italy
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, L. Parodi-Delfino Hospital, Colleferro, Italy
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Alvarez SM, Katsamanis Karavidas M, Coyle SM, Lu SE, Macor M, Oikawa LO, Lehrer PM, Calvano SE, Lowry SF. Low-dose steroid alters in vivo endotoxin-induced systemic inflammation but does not influence autonomic dysfunction. ACTA ACUST UNITED AC 2016; 13:358-68. [DOI: 10.1177/0968051907086465] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Severe injury and infection are associated with autonomic dysfunction. Diminished heart rate variability (HRV) is also observed as a component of autonomic dysfunction and is induced by endotoxin administration to healthy subjects. It is established that low-dose glucocorticoid administration diminishes the systemic inflammatory manifestations of endotoxinemia but the influence of this anti-inflammatory intervention on overall autonomic dysfunction and HRV responses to endotoxin is unknown. This study was designed to assess the influence of a low-dose hydrocortisone infusion upon endotoxin-elicited systemic inflammatory responses including phenotypic features, cytokine production, and parameters of HRV. Of 19 subjects studied, nine received a continuous infusion of hydrocortisone (3 µg/kg/min continuously over 6 h) prior to intravenous administration of Escherichia coli endotoxin (2 ng/kg, CC-RE, Lot #2) while 10 healthy subjects received only the endotoxin after a 6-h period of saline control infusion. Serial determinations of vital signs, heart rate variability assessments, and cytokine levels were obtained over the subsequent 24 h. Prior cortisol infusion diminished the peak TNF-α ( P < 0.01) and IL-6 ( P < 0.0001) responses after endotoxin challenge, as compared to saline infusion controls and diminished the peak core temperature response to endotoxin ( P < 0.01). In contrast to the influence of cortisol on the above parameters of systemic inflammation, the significant endotoxin-induced decreases in HRV time and frequency domains were not influenced by prior hydrocortisone treatment. Hence, alterations in autonomic dysfunction occur despite hydrocortisone attenuation of other traditional systemic manifestations of endotoxinemia. The maintenance or restoration of autonomic balance is not influenced by glucocorticoid administration.
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Affiliation(s)
- Sonia M. Alvarez
- Division of Surgical Sciences, UMDNJ-Robert Wood Johnson Medical School, Now Brunswick, New Jersey, USA
| | | | - Susette M. Coyle
- Division of Surgical Sciences, UMDNJ-Robert Wood Johnson Medical School, Now Brunswick, New Jersey, USA
| | - Shou-En Lu
- Department of Biostatistics, UMDNJ-School of Public Health, New Brunswick, New Jersey, USA
| | - Marie Macor
- Division of Surgical Sciences, UMDNJ-Robert Wood Johnson Medical School, Now Brunswick, New Jersey, USA
| | - Leo O. Oikawa
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Paul M. Lehrer
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Steve E. Calvano
- Division of Surgical Sciences, UMDNJ-Robert Wood Johnson Medical School, Now Brunswick, New Jersey, USA
| | - Stephen F. Lowry
- Division of Surgical Sciences, UMDNJ-Robert Wood Johnson Medical School, Now Brunswick, New Jersey, USA,
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Aliberti S, Tobaldini E, Giuliani F, Nunziata V, Casazza G, Suigo G, D'Adda A, Bonaiti G, Roveda A, Queiroz A, Monzani V, Pesci A, Blasi F, Montano N. Cardiovascular autonomic alterations in hospitalized patients with community-acquired pneumonia. Respir Res 2016; 17:98. [PMID: 27491412 PMCID: PMC4973093 DOI: 10.1186/s12931-016-0414-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/21/2016] [Indexed: 01/08/2023] Open
Abstract
Background Alterations of cardiac autonomic control (CAC) are associated with poor outcomes in patients with infectious and non-infectious diseases. No evaluation of CAC in patients with community-acquired pneumonia (CAP) has been performed so far. The aim of the study was to assess CAC in patients with CAP and evaluate the impact of its alterations on disease severity and clinical outcomes in a multicenter, prospective, observational study. Methods Consecutive patients hospitalized for CAP were enrolled between 2011 and 2013 two university hospitals in Italy. CAC was assessed by linear spectral and non-linear symbolic analysis of heart rate variability. The presence of severe CAP was evaluated on hospital admission. The primary study outcome was time to clinical stability (TCS) during hospitalization. Results Among the 75 patients enrolled (median age: 75 years; 57 % males), a significantly lower total variability and reduction of sympathetic rhythmical component with predominant respiratory modulation was detected in comparison to controls. Among CAP patients affected by a severe CAP on admission, CAC showed a lower sympathetic modulation and predominant parasympathetic oscillatory rhythm. At the multivariate analysis, variables independently correlated with a TCS >7 days were total power, as marker of total variability, [OR (95 % CI): 0.997 (0.994–1.000), p = 0.0454] and sympathetic modulation [OR (95 % CI): 0.964 (0.932–0.998), p = 0.0367]. Conclusions Loss of sympathetic rhythmical oscillation is associated with a more severe disease and worse early clinical outcome in hospitalized patients with CAP. Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0414-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.
| | - Eleonora Tobaldini
- Departments of Internal Medicine, and Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Fabio Giuliani
- Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Vanessa Nunziata
- Departments of Internal Medicine, and Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Giovanni Casazza
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Via Giovanni Battista Grassi 74, Milan, Italy
| | - Giulia Suigo
- Health Science Department, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Alice D'Adda
- Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Giulia Bonaiti
- Health Science Department, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Andrea Roveda
- Departments of Internal Medicine, and Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Andreia Queiroz
- Departments of Internal Medicine, and Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.,Department of Physical Education, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Valter Monzani
- Department of Emergency Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Alberto Pesci
- Health Science Department, University of Milan Bicocca, Clinica Pneumologica, AO San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Nicola Montano
- Departments of Internal Medicine, and Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
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44
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Modulation by Central MAPKs/PI3K/sGc of the TNF-α/iNOS-dependent Hypotension and Compromised Cardiac Autonomic Control in Endotoxic Rats. J Cardiovasc Pharmacol 2016; 68:171-81. [DOI: 10.1097/fjc.0000000000000400] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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45
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Central GABAA receptors are involved in inflammatory and cardiovascular consequences of endotoxemia in conscious rats. Naunyn Schmiedebergs Arch Pharmacol 2015; 389:279-88. [PMID: 26685896 DOI: 10.1007/s00210-015-1201-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023]
Abstract
γ-Aminobutyric acid (GABA), the principal brain inhibitory neurotransmitter, modulates inflammatory and neurodegenerative disease. Here, we tested the hypothesis that central GABAergic neurotransmission mediates the detrimental inflammatory, hemodynamic, and cardiac autonomic actions of endotoxemia. The effects of drugs that block GABA receptors or interfere with GABA uptake or degradation on blood pressure (BP), heart rate (HR), and HR variability (HRV) responses elicited by i.v. lipopolysaccharide (LPS) were assessed in conscious rats. The hypotensive effect of LPS (10 mg/kg) was blunted after intracisternal (i.c.) administration of bicuculline (GABAA receptor antagonist) or saclofen (GABAB receptor antagonist). By contrast, the concomitant LPS-evoked tachycardia and decreases in time domain and frequency domain indices of HRV (measures of cardiac autonomic control) were abolished upon treatment with bicuculline but not saclofen. Increases in serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) caused by LPS disappeared in the presence of bicuculline or saclofen, whereas LPS-evoked increases in serum nitric oxide metabolites (NOx) were counteracted by bicuculline only. None of the endotoxemia effects was altered in rats treated with i.c. tiagabine (GABA reuptake inhibitor) or vigabatrin (GABA transaminase inhibitor). These data suggest a major role for central GABAA receptors in the inflammatory and cardiovascular effects of endotoxemia.
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ZILA I, MOKRA D, KOPINCOVA J, KOLOMAZNIK M, JAVORKA M, CALKOVSKA A. Heart Rate Variability and Inflammatory Response in Rats With Lipopolysaccharide-Induced Endotoxemia. Physiol Res 2015; 64:S669-76. [DOI: 10.33549/physiolres.933226] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the study was to evaluate short-term heart rate variability (HRV) as an index of cardiac autonomic control in rats with lipopolysaccharide (LPS)-induced endotoxemia. Animals were injected intraperitoneally with LPS (100 µg/kg b.w.) and control group with an equivalent volume of saline. ECG recordings were done before (base) and 60, 120, 180, 240 and 300 min after LPS or saline administration. HRV magnitude was quantified by time and frequency-domain analysis (mean RR interval, SDRR, RMSSD, spectral powers in low (LF) and high frequency (HF) bands. Heart tissue homogenates and plasma were analyzed to determine interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α) and oxidative stress level (TBARS). Administration of lipopolysaccharide was followed by continuous rise in colonic body temperature compared to saline-treated controls. Endotoxemia in rats was accompanied by significant decrease in HRV spectral activity in high-frequency range at maximal body temperature (logHFpower: 1.2±0.5 vs. 1.9±0.6 ms2, P<0.01). Increased IL-6 was found in heart tissue homogenates of LPS rats (8.0±0.6 vs. 26.4±4.8 pg/ml, (P<0.05). In conclusions, reduced HRV in HF band may indicate a decreased parasympathetic activity in LPS-induced endotoxemia as basic characteristics of altered cardiac control during response to endotoxemia.
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Affiliation(s)
| | | | | | | | | | - A. CALKOVSKA
- Department of Physiology and Martin Biomedical Centre, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovak Republic
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47
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Huang C, Alamili M, Rosenberg J, Gögenur I. Heart rate variability is reduced during acute uncomplicated diverticulitis. J Crit Care 2015; 32:189-95. [PMID: 26776154 DOI: 10.1016/j.jcrc.2015.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/30/2015] [Accepted: 12/07/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of the present study was to report the trajectory of heart rate variability (HRV) indices during a low-grade acute inflammation and their associations to biomarkers for infection. METHODS Twelve patients with uncomplicated acute diverticulitis completed this observational study, which composed of 3 sessions of continuous HRV recording from 9 PM to 8 AM during ongoing diverticulitis and at complete remission (baseline). The blood samples were collected at each study session measuring C-reactive protein (CRP) and leukocytes. RESULTS This study showed that the trajectories of the HRV indices were decreased both in time and frequency domains during acute diverticulitis compared to baseline. In particular, the indices reflecting the balance of sympathetic and parasympathetic activities were affected: standard deviation of normal-to-normal beats (P = .003), low-frequency power (P < .001), and total power (P = .001). These HRV changes indicate alterations in the autonomic nervous system during acute inflammation. All reductions of mean HRV indices had significant (P < .001) correlations to increased CRP correlations to increased CRP levels during diverticulitis suggesting inflammatory involvement in the observed HRV alterations. CONCLUSION We found substantial HRV depression in relation to acute uncomplicated diverticulitis, and this was associated with the elevated CRP levels.
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Affiliation(s)
- Chenxi Huang
- Department of Surgery, University of Copenhagen, Roskilde and Køge Hospitals, DK-4600, Køge, Denmark; Department of Surgical Gastroenterology, University of Copenhagen, Herlev Hospital, DK-2730, Herlev, Denmark.
| | - Mahdi Alamili
- Department of Surgery, University of Copenhagen, Roskilde and Køge Hospitals, DK-4600, Køge, Denmark
| | - Jacob Rosenberg
- Department of Surgical Gastroenterology, University of Copenhagen, Herlev Hospital, DK-2730, Herlev, Denmark
| | - Ismail Gögenur
- Department of Surgery, University of Copenhagen, Roskilde and Køge Hospitals, DK-4600, Køge, Denmark
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48
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Cooper TM, McKinley PS, Seeman TE, Choo TH, Lee S, Sloan RP. Heart rate variability predicts levels of inflammatory markers: Evidence for the vagal anti-inflammatory pathway. Brain Behav Immun 2015; 49:94-100. [PMID: 25541185 PMCID: PMC4476948 DOI: 10.1016/j.bbi.2014.12.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/21/2014] [Accepted: 12/13/2014] [Indexed: 11/19/2022] Open
Abstract
Evidence from numerous animal models shows that vagal activity regulates inflammatory responses by decreasing cytokine release. Heart rate variability (HRV) is a reliable index of cardiac vagal regulation and should be inversely related to levels of inflammatory markers. Inflammation is also regulated by sympathetic inputs, but only one previous paper controlled for this. In a larger and more representative sample, we sought to replicate those results and examine potential sex differences in the relationship between HRV and inflammatory markers. Using data from the MIDUS II study, we analyzed the relationship between 6 inflammatory markers and both HF-HRV and LF-HRV. After controlling for sympathetic effects measured by urinary norepinephrine as well as a host of other factors, LF-HRV was found to be inversely associated with fibrinogen, CRP and IL-6, while HF-HRV was inversely associated with fibrinogen and CRP. We did not observe consistent sex differences. These results support the existence of the vagal anti-inflammatory pathway and suggest that it has similar effects in men and women.
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Affiliation(s)
- Timothy M Cooper
- Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States.
| | - Paula S McKinley
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States.
| | - Teresa E Seeman
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
| | - Tse-Hwei Choo
- New York State Psychiatric Institute, New York, NY, United States.
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States.
| | - Richard P Sloan
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States.
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49
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Ziegler D, Strom A, Strassburger K, Nowotny B, Zahiragic L, Nowotny PJ, Carstensen-Kirberg M, Herder C, Szendroedi J, Roden M. Differential Patterns and Determinants of Cardiac Autonomic Nerve Dysfunction during Endotoxemia and Oral Fat Load in Humans. PLoS One 2015; 10:e0124242. [PMID: 25893426 PMCID: PMC4403853 DOI: 10.1371/journal.pone.0124242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/27/2015] [Indexed: 11/24/2022] Open
Abstract
The autonomic nervous system (ANS) plays an important role in regulating the metabolic homeostasis and controlling immune function. ANS alterations can be detected by reduced heart rate variability (HRV) in conditions like diabetes and sepsis. We determined the effects of experimental conditions mimicking inflammation and hyperlipidemia on HRV and heart rate (HR) in relation to the immune, metabolic, and hormonal responses resulting from these interventions. Sixteen lean healthy subjects received intravenous (i.v.) low-dose endotoxin (lipopolysaccharide [LPS]), i.v. fat, oral fat, and i.v. glycerol (control) for 6 hours, during which immune, metabolic, hormonal, and five HRV parameters (pNN50, RMSSD, low-frequency (LF) and high-frequency (HF) power, and LF/HF ratio) were monitored and energy metabolism and insulin sensitivity (M-value) were assessed. LPS infusion induced an increase (AUC) in HR and LF/HF ratio and decline in pNN50 and RMSSD, while oral fat resulted in elevated HR and a transient (hours 1-2) decrease in pNN50, RMSSD, and HF power. During LPS infusion, ΔIL-1ra levels and ΔIL-1ra and ΔIL-1ß gene expression correlated positively with ΔLF/HF ratio and inversely with ΔRMSSD. During oral fat intake, ΔGLP-1 tended to correlate positively with ΔHR and inversely with ΔpNN50 and ΔRMSSD. Following LPS infusion, lipid oxidation correlated positively with HR and inversely with pNN50 and RMSSD, whereas HRV was not related to M-value. In conclusion, suppression of vagal tone and sympathetic predominance during endotoxemia are linked to anti-inflammatory processes and lipid oxidation but not to insulin resistance, while weaker HRV changes in relation to the GLP-1 response are noted during oral fat load.
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Affiliation(s)
- Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, University Hospital, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
- * E-mail:
| | - Alexander Strom
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Klaus Strassburger
- Institute of Biometrics and Epidemiology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Bettina Nowotny
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Lejla Zahiragic
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, University Hospital, Düsseldorf, Germany
| | - Peter J. Nowotny
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
| | - Maren Carstensen-Kirberg
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Julia Szendroedi
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, University Hospital, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, University Hospital, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
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50
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Murray JM, Thompson AM, Vitsky A, Hawes M, Chuang WL, Pacheco J, Wilson S, McPherson JM, Thurberg BL, Karey KP, Andrews L. Nonclinical safety assessment of recombinant human acid sphingomyelinase (rhASM) for the treatment of acid sphingomyelinase deficiency:the utility of animal models of disease in the toxicological evaluation of potential therapeutics. Mol Genet Metab 2015; 114:217-25. [PMID: 25092414 DOI: 10.1016/j.ymgme.2014.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/07/2014] [Accepted: 07/07/2014] [Indexed: 11/28/2022]
Abstract
Recombinant human acid sphingomyelinase (rhASM) is being developed as an enzyme replacement therapy for patients with acid sphingomyelinase deficiency (Niemann-Pick disease types A and B), which causes sphingomyelin to accumulate in lysosomes. In the acid sphingomyelinase knock-out (ASMKO) mouse, intravenously administered rhASM reduced tissue sphingomyelin levels in a dose-dependent manner. When rhASM was administered to normal rats, mice, and dogs, no toxicity was observed up to a dose of 30mg/kg. However, high doses of rhASM≥10mg/kg administered to ASMKO mice resulted in unexpected toxicity characterized by cardiovascular shock, hepatic inflammation, adrenal hemorrhage, elevations in ceramide and cytokines (especially IL-6, G-CSF, and keratinocyte chemoattractant [KC]), and death. The toxicity could be completely prevented by the administration of several low doses (3mg/kg) of rhASM prior to single or repeated high doses (≥20mg/kg). These results suggest that the observed toxicity involves the rapid breakdown of large amounts of sphingomyelin into ceramide and/or other toxic downstream metabolites, which are known signaling molecules with cardiovascular and pro-inflammatory effects. Our results suggest that the nonclinical safety assessment of novel therapeutics should include the use of specific animal models of disease whenever feasible.
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Affiliation(s)
- James M Murray
- Department of Pharmacology and Toxicology, Genzyme Corporation, Framingham, MA 01701, USA.
| | - Anne Marie Thompson
- Department of Pharmacology and Toxicology, Genzyme Corporation, Framingham, MA 01701, USA
| | - Allison Vitsky
- Department of Pathology, Genzyme Corporation, Framingham, MA 01701, USA
| | - Michael Hawes
- Department of Pathology, Genzyme Corporation, Framingham, MA 01701, USA
| | - Wei-Lien Chuang
- Department of Biologics Structural and Functional Research, Genzyme Corporation, Framingham, MA 01701, USA
| | - Joshua Pacheco
- Department of Biologics Structural and Functional Research, Genzyme Corporation, Framingham, MA 01701, USA
| | - Stephen Wilson
- Charles River Laboratories, Preclinical Services, Reno, NV 89511, USA
| | - John M McPherson
- Department of Biologics Research and Development, Genzyme Corporation, Framingham, MA 01701, USA
| | - Beth L Thurberg
- Department of Pathology, Genzyme Corporation, Framingham, MA 01701, USA
| | - Kenneth P Karey
- Early Process Development, Genzyme Corporation, Framingham, MA 01701, USA
| | - Laura Andrews
- Department of Pharmacology and Toxicology, Genzyme Corporation, Framingham, MA 01701, USA
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