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Wu XL, Zhang L, Zhang J, Sun J, Li YY, Yang KZ, Liu Y, Gao XY, Liu QG. Acupuncture modulation of the ACE/Ang II/AT1R and ACE2/Ang(1-7)/MasR pathways in the rostral ventrolateral medulla reduces sympathetic output and prevents cardiac injury caused by SHR hypertension. Neuroreport 2024; 35:839-845. [PMID: 38973500 DOI: 10.1097/wnr.0000000000002073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Acupuncture can reduce blood pressure, heart rate (HR), and ameliorate cardiac damage by modulating the excitability of the sympathetic nervous system, but the exact mechanism of this effect remains unclear. This study investigated the potential mechanisms of acupuncture in the treatment of cardiac damage in hypertension. Spontaneously hypertensive rats (SHR) were used as the hypertension model with Wistar-Kyoto rats as the control. Manual acupuncture, electroacupuncture, and metoprolol were used as interventions. Systolic and diastolic blood pressure (SBP, DBP) plus HR were monitored with cardiac structure determined using Masson staining. Angiotensin II (Ang II) and norepinephrine in myocardium were detected with ELISA as was Ang(1-7) and gamma aminobutyric acid (GABA) in the rostral ventrolateral medulla (RVLM). Expression of mRNA for collagen type I (Col-I), Col-III, actin α1 (ACTA1), and thrombospondin 4 (THBS4) in myocardium was detected using real-time PCR. Expression of angiotensin converting enzyme (ACE), Ang II, angiotensin II type 1 receptor (AT1R), ACE2, and Mas receptor (MasR) proteins in RVLM was monitored using western blot. After manual acupuncture and electroacupuncture treatment, SHRs showed decreased SBP, DBP and HR, reduced myocardial damage. There was decreased expression of the ACE/Ang II/AT1R axis, and increased expression of the ACE2/Ang(1-7)/MasR axis within the RVLM. GABA levels were increased within the RVLM and norepinephrine levels were decreased in myocardial tissue. Metoprolol was more effective than either manual acupuncture or electroacupuncture. Acupuncture directed against hypertensive cardiac damage may be associated with regulation of ACE/Ang II/AT1R and the ACE2/Ang(1-7)/MasR pathway within the RLVM to reduce cardiac sympathetic excitability.
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Affiliation(s)
- Xiao-Li Wu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing
| | - Lin Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing
| | - Jing Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing
| | - Jiao Sun
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing
| | - Yin-Yin Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing
| | - Ke-Zhen Yang
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Yu Liu
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xin-Yu Gao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing
| | - Qing-Guo Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing
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Serum Catestatin Levels Correlate with Ambulatory Blood Pressure and Indices of Arterial Stiffness in Patients with Primary Hypertension. Biomolecules 2022; 12:biom12091204. [PMID: 36139043 PMCID: PMC9496451 DOI: 10.3390/biom12091204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 11/25/2022] Open
Abstract
Accumulating data suggests that catestatin, an eclectic neuroendocrine peptide, is involved in the pathophysiology of primary hypertension (PH). Nevertheless, clinical studies concerning its role in PH are still scarce. Therefore, in the present study, we aimed to explore an association between serum catestatin levels, ambulatory blood pressure (BP) and arterial stiffness in patients with PH and healthy controls. In this single-center study, 72 patients aged 40−70 diagnosed with PH, and 72 healthy controls were included. In patients with PH, serum catestatin concentrations were significantly higher in comparison to the healthy controls (29.70 (19.33−49.48) ng/mL vs. 5.83 (4.21−8.29) ng/mL, p < 0.001). Untreated patients had significantly higher serum catestatin than patients treated with antihypertensive drugs (41.61 (22.85−63.83) ng/mL vs. 24.77 (16.41−40.21) ng/mL, p = 0.005). Multiple linear regression analysis showed that serum catestatin levels retained a significant association with mean arterial pressure (β ± standard error, 0.8123 ± 0.3037, p < 0.009) after model adjustments for age, sex and body mass index. Finally, catestatin levels positively correlated with pulse wave velocity (r = 0.496, p < 0.001) and central augmentation index (r = 0.441, p < 0.001), but not with peripheral resistance. In summary, increased serum catestatin concentration in PH, predominantly in the untreated subgroup, and its association with ambulatory BP and arterial stiffness address the role of this peptide in PH.
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Soomro QH, Charytan DM. Cardiovascular autonomic nervous system dysfunction in chronic kidney disease and end-stage kidney disease: disruption of the complementary forces. Curr Opin Nephrol Hypertens 2021; 30:198-207. [PMID: 33395034 DOI: 10.1097/mnh.0000000000000686] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Several nontraditional risk factors have been the focus of research in an attempt to understand the disproportionately high cardiovascular morbidity and mortality in chronic kidney disease (CKD) and end-stage kidney disease (ESKD) populations. One such category of risk factors is cardiovascular autonomic dysfunction. Its true prevalence in the CKD/ESKD population is unknown but existing evidence suggests it is common. Due to lack of standardized diagnostic and treatment options, this condition remains undiagnosed and untreated in many patients. In this review, we discuss current evidence pointing toward the role of autonomic nervous system (ANS) dysfunction in CKD, building off of crucial historical evidence and thereby highlighting the areas in need for future research interest. RECENT FINDINGS There are several key mediators and pathways leading to cardiovascular autonomic dysfunction in CKD and ESKD. We review studies exploring the mechanisms involved and discuss the current measurement tools and indices to evaluate the ANS and their pitfalls. There is a strong line of evidence establishing the temporal sequence of worsening autonomic function and kidney function and vice versa. Evidence linking ANS dysfunction and arrhythmia, sudden cardiac death, intradialytic hypotension, heart failure and hypertension are discussed. SUMMARY There is a need for early recognition and referral of CKD and ESKD patients suspected of cardiovascular ANS dysfunction to prevent the downstream effects described in this review.There are many unknowns in this area and a clear need for further research.
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Affiliation(s)
- Qandeel H Soomro
- Nephrology Division, Department of Medicine, NYU Langone Medical Center, New York, New York, USA
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Yu Y, Hu L, Xu Y, Wu S, Chen Y, Zou W, Zhang M, Wang Y, Gu Y. Impact of blood glucose control on sympathetic and vagus nerve functional status in patients with type 2 diabetes mellitus. Acta Diabetol 2020; 57:141-150. [PMID: 31367992 PMCID: PMC6997255 DOI: 10.1007/s00592-019-01393-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/23/2019] [Indexed: 02/08/2023]
Abstract
AIMS Present study observed the impact of blood glucose control on sympathetic and vagus functional status in type 2 diabetes mellitus (DM) patients through observing the association between glycosylated hemoglobin (HbA1c) level and sympathetic and vagus functional status detected by heart rate recovery (HRR) and heart rate variability (HRV) assessments. METHODS Consecutive hospitalized DM patients were divided into well glycemic control group (HbA1c < 7.0%, group WGC, n = 100) and poor glycemic control group (HbA1c ≥ 7.0%, group PGC, n = 100), 100 hospitalized patients without DM served as control group (group C). All subjects underwent blood biochemistry test, treadmill exercise testing and 24-h Holter monitoring. RESULTS HRR and HRV parameters were significantly lower in group WGC and PGC than in group C. Standard deviation of NN intervals (SDNN), standard deviation of all 5-min average NN intervals (SDANN), very low frequency (VLF) values were significantly lower in group PGC than in group WGC. HbA1c level was negatively correlated with HRR1, SDNN, SDANN, VLF, low frequency and high frequency. Logistic regression analysis showed that lower SDNN, SDANN and VLF values were risk factors for high HbA1c levels in DM patients after adjusting for gender, age and beta-blocker use in the model 1, and for gender, age, beta-blocker use, coronary artery disease and hypertension in the model 2. CONCLUSIONS Present results indicate that sympathetic and vagal functional status are impaired independent of HbA1c level, while poor glycemic control is related to more significant neurocardiac dysfunction in DM patients.
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Affiliation(s)
- Yijun Yu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Liqun Hu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Yanling Xu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Shiwei Wu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Yafei Chen
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Wusong Zou
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Mingjing Zhang
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Yuting Wang
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China
| | - Ye Gu
- Department of Cardiology, Wuhan Fourth Hospital; Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, HanZheng Street 473#, QiaoKou District, Wuhan, 430033, China.
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Leversha S, Allen AM, May CN, Ramchandra R. Intrathecal Administration of Losartan Reduces Directly Recorded Cardiac Sympathetic Nerve Activity in Ovine Heart Failure. Hypertension 2019; 74:896-902. [PMID: 31378100 DOI: 10.1161/hypertensionaha.119.12937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Early and preferential activation of cardiac sympathetic nerve activity (CSNA) is one of the strongest prognostic markers of heart failure (HF) in patients. Our previous studies have implicated central angiotensin mechanisms as playing a critical role in generating this increase in cardiac sympathetic drive. However, it is unclear if inhibition of AT1R (angiotensin type-1 receptors) in different neural groups in the sympathetic pathway to the heart, such as the sympathetic preganglionic neurons in the intermediolateral column of the spinal cord, can reduce cardiac sympathetic drive. We hypothesized that in HF, localized intrathecal administration of the AT1R antagonist losartan, specifically into the T1-2 subarachnoid space, would decrease CSNA. In normal conscious sheep, intrathecal infusion of Ang II (angiotensin II; 3.0 nmol/mL per hour), significantly increased mean arterial pressure and CSNA; this effect was abolished by prior administration of losartan (1 mg/h). In an ovine rapid ventricular pacing model of HF, the resting levels of heart rate and CSNA were significantly elevated compared with normals. Intrathecal infusion of losartan (1 mg/h) in HF significantly reduced CSNA and heart rate but did not change arterial pressure. The AT1R binding density in the spinal cord was also elevated in the HF group. Our data suggest that AT1Rs within the spinal cord are responsible, in part, for the increased CSNA in HF and may represent a target for the selective reduction of CSNA in HF.
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Affiliation(s)
- Simon Leversha
- From the Florey Institute of Neuroscience and Mental Health (S.L., C.N.M., R.R.), University of Melbourne, Parkville, Australia.,Department of Physiology (S.L., A.M.A.), University of Melbourne, Parkville, Australia
| | - Andrew M Allen
- Department of Physiology (S.L., A.M.A.), University of Melbourne, Parkville, Australia
| | - Clive N May
- From the Florey Institute of Neuroscience and Mental Health (S.L., C.N.M., R.R.), University of Melbourne, Parkville, Australia
| | - Rohit Ramchandra
- From the Florey Institute of Neuroscience and Mental Health (S.L., C.N.M., R.R.), University of Melbourne, Parkville, Australia.,Department of Physiology, University of Auckland, New Zealand (R.R.)
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The renin-angiotensin system in cardiovascular autonomic control: recent developments and clinical implications. Clin Auton Res 2018; 29:231-243. [PMID: 30413906 DOI: 10.1007/s10286-018-0572-5] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
Complex and bidirectional interactions between the renin-angiotensin system (RAS) and autonomic nervous system have been well established for cardiovascular regulation under both physiological and pathophysiological conditions. Most research to date has focused on deleterious effects of components of the vasoconstrictor arm of the RAS on cardiovascular autonomic control, such as renin, angiotensin II, and aldosterone. The recent discovery of prorenin and the prorenin receptor have further increased our understanding of RAS interactions in autonomic brain regions. Therapies targeting these RAS components, such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers, are commonly used for treatment of hypertension and cardiovascular diseases, with blood pressure-lowering effects attributed in part to sympathetic inhibition and parasympathetic facilitation. In addition, a vasodilatory arm of the RAS has emerged that includes angiotensin-(1-7), ACE2, and alamandine, and promotes beneficial effects on blood pressure in part by reducing sympathetic activity and improving arterial baroreceptor reflex function in animal models. The role of the vasodilatory arm of the RAS in cardiovascular autonomic regulation in clinical populations, however, has yet to be determined. This review will summarize recent developments in autonomic mechanisms involved in the effects of the RAS on cardiovascular regulation, with a focus on newly discovered pathways and therapeutic targets for this hormone system.
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