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Chikopela T, Mwesigwa N, Masenga SK, Kirabo A, Shibao CA. The Interplay of HIV and Long COVID in Sub-Saharan Africa: Mechanisms of Endothelial Dysfunction. Curr Cardiol Rep 2024; 26:859-871. [PMID: 38958890 DOI: 10.1007/s11886-024-02087-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW Long COVID affects approximately 5 million people in Africa. This disease is characterized by persistent symptoms or new onset of symptoms after an acute SARS-CoV-2 infection. Specifically, the most common symptoms include a range of cardiovascular problems such as chest pain, orthostatic intolerance, tachycardia, syncope, and uncontrolled hypertension. Importantly, these conditions appear to have endothelial dysfunction as the common denominator, which is often due to impaired nitric oxide (NO) mechanisms. This review discusses the role of mechanisms contributing to endothelial dysfunction in Long COVID, particularly in people living with HIV. RECENT FINDINGS Recent studies have reported that increased inflammation and oxidative stress, frequently observed in Long COVID, may contribute to NO dysfunction, ultimately leading to decreased vascular reactivity. These mechanisms have also been reported in people living with HIV. In regions like Africa, where HIV infection is still a major public health challenge with a prevalence of approximately 26 million people in 2022. Specifically, endothelial dysfunction has been reported as a major mechanism that appears to contribute to cardiovascular diseases and the intersection with Long COVID mechanisms is of particular concern. Further, it is well established that this population is more likely to develop Long COVID following infection with SARS-CoV-2. Therefore, concomitant infection with SARS-CoV-2 may lead to accelerated cardiovascular disease. We outline the details of the worsening health problems caused by Long COVID, which exacerbate pre-existing conditions such as endothelial dysfunction. The overlapping mechanisms of HIV and SARS-CoV-2, particularly the prolonged inflammatory response and chronic hypoxia, may increase susceptibility to Long COVID. Addressing these overlapping health issues is critical as it provides clinical entry points for interventions that could improve and enhance outcomes and quality of life for those affected by both HIV and Long COVID in the region.
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Affiliation(s)
- Theresa Chikopela
- Department of Human Physiology, Faculty of Medicine, Lusaka Apex Medical University, Lusaka, Zambia
| | - Naome Mwesigwa
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, 37332-0615, USA
| | - Sepiso K Masenga
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Annet Kirabo
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, 37332-0615, USA
| | - Cyndya A Shibao
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, 37332-0615, USA.
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Raitamaa L, Kautto J, Tuunanen J, Helakari H, Huotari N, Järvelä M, Korhonen V, Kiviniemi V. Association of body-mass index with physiological brain pulsations across adulthood - a fast fMRI study. Int J Obes (Lond) 2024; 48:1011-1018. [PMID: 38553569 PMCID: PMC11216984 DOI: 10.1038/s41366-024-01515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND/OBJECTIVE Obesity is a risk factor for several brain-related health issues, and high body-mass index (BMI) is associated with an increased risk for several neurological conditions, including cognitive decline and dementia. Cardiovascular, respiratory, and vasomotor brain pulsations have each been shown to drive intracranial cerebrovascular fluid (CSF) flow, which is linked to the brain metabolite efflux that sustains homeostasis. While these three physiological pulsations are demonstrably altered in numerous brain diseases, there is no previous investigation of the association between physiological brain pulsations and BMI. SUBJECTS/METHODS We measured the amplitudes of the physiological brain pulsations using amplitude of low frequency fluctation (ALFF) based method with resting-state functional magnetic resonance imaging via high temporal resolution whole-brain magnetic resonance encephalography (MREG) in 115 healthy subjects. We next undertook multiple linear regression to model the BMI effect voxel-wise whole-brain on very low frequency (VLF), respiration, cardiovascular, and respiratory induced modulation of cardiovascular pulsation amplitudes with age, pulse pressure, and gender as nuisance variables. RESULTS In our study population, BMI was positively associated with the amplitudes of vasomotor, respiratory, and respiratory induced modulations of cardiovascular pulsations (p < 0.05), while negatively associated with the amplitudes of cardiovascular pulsations (p < 0.05). CONCLUSIONS The findings suggest that BMI is a significant factor in alterations of cardiovascular pulsation of neurofluids. As physiological pulsations are the drivers of CSF flow and subsequent metabolite clearance, these results emphasize the need for further research into the mechanisms through which obesity affects brain clearance.
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Affiliation(s)
- Lauri Raitamaa
- Oulu Functional NeuroImaging (OFNI), Diagnostic Imaging, Medical Research Center (MRC), Finland Oulu University Hospital, 90029, Oulu, Finland.
- Research Unit of Health Sciences and Technology (HST), Faculty of Medicine, University of Oulu, 90220, Oulu, Finland.
| | - Joona Kautto
- Oulu Functional NeuroImaging (OFNI), Diagnostic Imaging, Medical Research Center (MRC), Finland Oulu University Hospital, 90029, Oulu, Finland
- Research Unit of Health Sciences and Technology (HST), Faculty of Medicine, University of Oulu, 90220, Oulu, Finland
| | - Johanna Tuunanen
- Oulu Functional NeuroImaging (OFNI), Diagnostic Imaging, Medical Research Center (MRC), Finland Oulu University Hospital, 90029, Oulu, Finland
- Research Unit of Health Sciences and Technology (HST), Faculty of Medicine, University of Oulu, 90220, Oulu, Finland
| | - Heta Helakari
- Oulu Functional NeuroImaging (OFNI), Diagnostic Imaging, Medical Research Center (MRC), Finland Oulu University Hospital, 90029, Oulu, Finland
- Research Unit of Health Sciences and Technology (HST), Faculty of Medicine, University of Oulu, 90220, Oulu, Finland
| | - Niko Huotari
- Oulu Functional NeuroImaging (OFNI), Diagnostic Imaging, Medical Research Center (MRC), Finland Oulu University Hospital, 90029, Oulu, Finland
- Research Unit of Health Sciences and Technology (HST), Faculty of Medicine, University of Oulu, 90220, Oulu, Finland
| | - Matti Järvelä
- Oulu Functional NeuroImaging (OFNI), Diagnostic Imaging, Medical Research Center (MRC), Finland Oulu University Hospital, 90029, Oulu, Finland
- Research Unit of Health Sciences and Technology (HST), Faculty of Medicine, University of Oulu, 90220, Oulu, Finland
| | - Vesa Korhonen
- Oulu Functional NeuroImaging (OFNI), Diagnostic Imaging, Medical Research Center (MRC), Finland Oulu University Hospital, 90029, Oulu, Finland
- Research Unit of Health Sciences and Technology (HST), Faculty of Medicine, University of Oulu, 90220, Oulu, Finland
| | - Vesa Kiviniemi
- Oulu Functional NeuroImaging (OFNI), Diagnostic Imaging, Medical Research Center (MRC), Finland Oulu University Hospital, 90029, Oulu, Finland
- Research Unit of Health Sciences and Technology (HST), Faculty of Medicine, University of Oulu, 90220, Oulu, Finland
- Oulu Center for Cell-Matrix Research, Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu, University of Oulu, Oulu, Finland
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Fedorowski A, Fanciulli A, Raj SR, Sheldon R, Shibao CA, Sutton R. Cardiovascular autonomic dysfunction in post-COVID-19 syndrome: a major health-care burden. Nat Rev Cardiol 2024; 21:379-395. [PMID: 38163814 DOI: 10.1038/s41569-023-00962-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
Cardiovascular autonomic dysfunction (CVAD) is a malfunction of the cardiovascular system caused by deranged autonomic control of circulatory homeostasis. CVAD is an important component of post-COVID-19 syndrome, also termed long COVID, and might affect one-third of highly symptomatic patients with COVID-19. The effects of CVAD can be seen at both the whole-body level, with impairment of heart rate and blood pressure control, and in specific body regions, typically manifesting as microvascular dysfunction. Many severely affected patients with long COVID meet the diagnostic criteria for two common presentations of CVAD: postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia. CVAD can also manifest as disorders associated with hypotension, such as orthostatic or postprandial hypotension, and recurrent reflex syncope. Advances in research, accelerated by the COVID-19 pandemic, have identified new potential pathophysiological mechanisms, diagnostic methods and therapeutic targets in CVAD. For clinicians who daily see patients with CVAD, knowledge of its symptomatology, detection and appropriate management is more important than ever. In this Review, we define CVAD and its major forms that are encountered in post-COVID-19 syndrome, describe possible CVAD aetiologies, and discuss how CVAD, as a component of post-COVID-19 syndrome, can be diagnosed and managed. Moreover, we outline directions for future research to discover more efficient ways to cope with this prevalent and long-lasting condition.
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Affiliation(s)
- Artur Fedorowski
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
- Department of Medicine, Karolinska Institute, Stockholm, Sweden.
- Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | | | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert Sheldon
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cyndya A Shibao
- Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard Sutton
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Cardiology, Hammersmith Hospital, National Heart & Lung Institute, Imperial College, London, UK
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Nardone M, Sayegh ALC, Fan JL, Fisher JP. Does endothelial ischemic reperfusion injury augment sympathetic neurovascular transduction? Clin Auton Res 2024; 34:375-378. [PMID: 38767808 DOI: 10.1007/s10286-024-01037-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Massimo Nardone
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - Ana Luiza C Sayegh
- Department of Physiology, University of Auckland, 85 Park Road, Grafton, Auckland, 1142, New Zealand
| | - Jui-Lin Fan
- Department of Physiology, University of Auckland, 85 Park Road, Grafton, Auckland, 1142, New Zealand
| | - James P Fisher
- Department of Physiology, University of Auckland, 85 Park Road, Grafton, Auckland, 1142, New Zealand.
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Xiao X, Deng X, Zhang G, Liu M, Fu D, Yang P, Li X, Jiang H. Monitoring of the regulatory ability and regulatory state of the autonomic nervous system and its application to the management of hypertensive patients: a study protocol for randomised controlled trials. BMJ Open 2023; 13:e063434. [PMID: 37286315 DOI: 10.1136/bmjopen-2022-063434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Many causes lead to sympathetic-vagus imbalance, which promotes the development of hypertension and accelerates the process of target organ damage. Many studies have shown that exercise training and heart rate variability (HRV) biofeedback can improve diseases caused by autonomic nerve dysfunction, such as hypertension. Based on these theories and the Yin-Yang balance theory of traditional Chinese medicine and Cannon's homeostasis theory, we have developed an assessment system of autonomic nerve regulation system and a harmony instrument. In this study, we aimed to find a new way to control blood pressure of hypertensive patients via cardiopulmonary resonance indices-based respiratory feedback training. METHODS AND ANALYSIS This is a prospective, randomised, parallel-controlled clinical trial, which aims to evaluate the effectiveness and safety of biofeedback therapy and exercise rehabilitation combined intervention in hypertension management. 176 healthy individuals will be recruited to get their autonomic nerve function parameters as normal control, while 352 hypertensive patients will be enrolled and randomly divided into a conventional treatment group and an experiment group in a ratio of 1:1. All patients will continue to receive standard hypertension blood pressure treatment, except that patients in the experiment group will have to complete additional daily respiratory training for 6 months. The primary outcome is the difference of clinical systolic blood pressure (SBP) between the two groups after 6 months of intervention. The secondary outcomes include the changes in the mean SBP and diastolic blood pressure (DBP) by 24-hour blood pressure monitoring, home SBP, clinical and home DBP, clinical and home heart rate, the standard-reaching rate of clinic and home SBP and the incidence of composite endpoint events at 6 months. ETHICS AND DISSEMINATION This study has been approved by the clinical research ethics committee of China-Japan Friendship Hospital (No. 2018-132 K98-2), the results of this study will be disseminated via peer-reviewed publications or conference presentations. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry, ChiCTR1800019457, registered on 12 August 2018.
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Affiliation(s)
- Xiang Xiao
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Xinyi Deng
- Peking University Health Science Center, Beijing, China
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Gaoyu Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | - Mengru Liu
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Dongliang Fu
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Peng Yang
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Xianlun Li
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Hong Jiang
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
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Faria D, Moll-Bernardes RJ, Testa L, Moniz CM, Rodrigues EC, Rodrigues AG, Araujo A, Alves MJ, Ono BE, Izaias JE, Salemi VM, Jordão CP, Amaro-Vicente G, Rondon MU, Ludwig KR, Craighead DH, Rossman MJ, Consolim-Colombo FM, De Angelis K, Irigoyen MC, Seals DR, Negrão CE, Sales AR. Sympathetic Neural Overdrive, Aortic Stiffening, Endothelial Dysfunction, and Impaired Exercise Capacity in Severe COVID-19 Survivors: A Mid-Term Study of Cardiovascular Sequelae. Hypertension 2023; 80:470-481. [PMID: 36416143 PMCID: PMC9847692 DOI: 10.1161/hypertensionaha.122.19958] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND COVID-19 has become a dramatic health problem during this century. In addition to high mortality rate, COVID-19 survivors are at increased risk for cardiovascular diseases 1-year after infection. Explanations for these manifestations are still unclear but can involve a constellation of biological alterations. We hypothesized that COVID-19 survivors compared with controls exhibit sympathetic overdrive, vascular dysfunction, cardiac morpho-functional changes, impaired exercise capacity, and increased oxidative stress. METHODS Nineteen severe COVID-19 survivors and 19 well-matched controls completed the study. Muscle sympathetic nerve activity (microneurography), brachial artery flow-mediated dilation and blood flow (Doppler-Ultrasound), carotid-femoral pulse wave velocity (Complior), cardiac morpho-functional parameters (echocardiography), peak oxygen uptake (cardiopulmonary exercise testing), and oxidative stress were measured ~3 months after hospital discharge. Complementary experiments were conducted on human umbilical vein endothelial cells cultured with plasma samples from subjects. RESULTS Muscle sympathetic nerve activity and carotid-femoral pulse wave velocity were greater and brachial artery flow-mediated dilation, brachial artery blood flow, E/e' ratio, and peak oxygen uptake were lower in COVID-19 survivors than in controls. COVID-19 survivors had lower circulating antioxidant markers compared with controls, but there were no differences in plasma-treated human umbilical vein endothelial cells nitric oxide production and reactive oxygen species bioactivity. Diminished peak oxygen uptake was associated with sympathetic overdrive, vascular dysfunction, and reduced diastolic function in COVID-19 survivors. CONCLUSIONS Our study revealed that COVID-19 survivors have sympathetic overactivation, vascular dysfunction, cardiac morpho-functional changes, and reduced exercise capacity. These findings indicate the need for further investigation to determine whether these manifestations are persistent longer-term and their impact on the cardiovascular health of COVID-19 survivors.
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Affiliation(s)
- Diego Faria
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil (D.F., R.J.M.-B., E.C.R., B.E.O., J.E.I., A.R.K.S.).,D’Or Institute for Research and Education (IDOR), São Paulo, Brazil (D.F., L.T., C.M.V.M., B.E.O., J.E.I., A.R.K.S.)
| | - Renata J. Moll-Bernardes
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil (D.F., R.J.M.-B., E.C.R., B.E.O., J.E.I., A.R.K.S.)
| | - Laura Testa
- D’Or Institute for Research and Education (IDOR), São Paulo, Brazil (D.F., L.T., C.M.V.M., B.E.O., J.E.I., A.R.K.S.)
| | - Camila M.V. Moniz
- D’Or Institute for Research and Education (IDOR), São Paulo, Brazil (D.F., L.T., C.M.V.M., B.E.O., J.E.I., A.R.K.S.)
| | - Erika C. Rodrigues
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil (D.F., R.J.M.-B., E.C.R., B.E.O., J.E.I., A.R.K.S.)
| | - Amanda G. Rodrigues
- Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil (A.G.R., M.J.N.N.A., V.M.C.S., C.P.J., F.M.C.-C., M.C.C.I., C.E.N., A.R.K.S.)
| | - Amanda Araujo
- Department of Physiology, Federal University of São Paulo (UNIFESP), Brazil (A.A., K.D.A.)
| | - Maria J.N.N. Alves
- Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil (A.G.R., M.J.N.N.A., V.M.C.S., C.P.J., F.M.C.-C., M.C.C.I., C.E.N., A.R.K.S.)
| | - Bruna E. Ono
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil (D.F., R.J.M.-B., E.C.R., B.E.O., J.E.I., A.R.K.S.).,D’Or Institute for Research and Education (IDOR), São Paulo, Brazil (D.F., L.T., C.M.V.M., B.E.O., J.E.I., A.R.K.S.)
| | - João E. Izaias
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil (D.F., R.J.M.-B., E.C.R., B.E.O., J.E.I., A.R.K.S.).,D’Or Institute for Research and Education (IDOR), São Paulo, Brazil (D.F., L.T., C.M.V.M., B.E.O., J.E.I., A.R.K.S.)
| | - Vera M.C. Salemi
- Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil (A.G.R., M.J.N.N.A., V.M.C.S., C.P.J., F.M.C.-C., M.C.C.I., C.E.N., A.R.K.S.)
| | - Camila P. Jordão
- Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil (A.G.R., M.J.N.N.A., V.M.C.S., C.P.J., F.M.C.-C., M.C.C.I., C.E.N., A.R.K.S.)
| | - Graziela Amaro-Vicente
- School of Physical Education and Sport, University of São Paulo, Brazil (G.A.-V., M.U.P.B.R., C.E.N.)
| | - Maria U.P.B. Rondon
- School of Physical Education and Sport, University of São Paulo, Brazil (G.A.-V., M.U.P.B.R., C.E.N.)
| | - Katelyn R. Ludwig
- Department of Integrative Physiology, University of Colorado Boulder, CO (K.R.L., D.H.C., M.J.R., D.R.S.)
| | - Daniel H. Craighead
- Department of Integrative Physiology, University of Colorado Boulder, CO (K.R.L., D.H.C., M.J.R., D.R.S.)
| | - Matthew J. Rossman
- Department of Integrative Physiology, University of Colorado Boulder, CO (K.R.L., D.H.C., M.J.R., D.R.S.)
| | - Fernanda M. Consolim-Colombo
- Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil (A.G.R., M.J.N.N.A., V.M.C.S., C.P.J., F.M.C.-C., M.C.C.I., C.E.N., A.R.K.S.)
| | - Katia De Angelis
- Department of Physiology, Federal University of São Paulo (UNIFESP), Brazil (A.A., K.D.A.)
| | - Maria C.C. Irigoyen
- Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil (A.G.R., M.J.N.N.A., V.M.C.S., C.P.J., F.M.C.-C., M.C.C.I., C.E.N., A.R.K.S.)
| | - Douglas R. Seals
- Department of Integrative Physiology, University of Colorado Boulder, CO (K.R.L., D.H.C., M.J.R., D.R.S.)
| | - Carlos E. Negrão
- Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil (A.G.R., M.J.N.N.A., V.M.C.S., C.P.J., F.M.C.-C., M.C.C.I., C.E.N., A.R.K.S.).,School of Physical Education and Sport, University of São Paulo, Brazil (G.A.-V., M.U.P.B.R., C.E.N.)
| | - Allan R.K. Sales
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil (D.F., R.J.M.-B., E.C.R., B.E.O., J.E.I., A.R.K.S.).,D’Or Institute for Research and Education (IDOR), São Paulo, Brazil (D.F., L.T., C.M.V.M., B.E.O., J.E.I., A.R.K.S.).,Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Brazil (A.G.R., M.J.N.N.A., V.M.C.S., C.P.J., F.M.C.-C., M.C.C.I., C.E.N., A.R.K.S.)
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Konstam MA, Mann DL, Udelson JJE, Ardell JL, De Ferrari GM, Cowie MR, Klein HU, Gregory DD, Massaro JM, Libbus I, DiCarlo LA, Butler J, Parker JD, Teerlink JR. Advances in Our Clinical Understanding of Autonomic Regulation Therapy Using Vagal Nerve Stimulation in Patients Living With Heart Failure. Front Physiol 2022; 13:857538. [PMID: 35530511 PMCID: PMC9068946 DOI: 10.3389/fphys.2022.857538] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
The ANTHEM-HF, INOVATE-HF, and NECTAR-HF clinical studies of autonomic regulation therapy (ART) using vagus nerve stimulation (VNS) systems have collectively provided dose-ranging information enabling the development of several working hypotheses on how stimulation frequency can be utilized during VNS for tolerability and improving cardiovascular outcomes in patients living with heart failure (HF) and reduced ejection fraction (HFrEF). Changes in heart rate dynamics, comprising reduced heart rate (HR) and increased HR variability, are a biomarker of autonomic nerve system engagement and cardiac control, and appear to be sensitive to VNS that is delivered using a stimulation frequency that is similar to the natural operating frequency of the vagus nerve. Among prior studies, the ANTHEM-HF Pilot Study has provided the clearest evidence of autonomic engagement with VNS that was delivered using a stimulation frequency that was within the operating range of the vagus nerve. Achieving autonomic engagement was accompanied by improvement from baseline in six-minute walk duration (6MWD), health-related quality of life, and left ventricular EF (LVEF), over and above those achieved by concomitant guideline-directed medical therapy (GDMT) administered to counteract harmful neurohormonal activation, with relative freedom from deleterious effects. Autonomic engagement and positive directional changes have persisted over time, and an exploratory analysis suggests that improvement in autonomic tone, symptoms, and physical capacity may be independent of baseline NT-proBNP values. Based upon these encouraging observations, prospective, randomized controlled trials examining the effects on symptoms and cardiac function as well as natural history have been warranted. A multi-national, large-scale, randomized, controlled trial is well underway to determine the outcomes associated with ART using autonomic nervous system engagement as a guide for VNS delivery.
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Affiliation(s)
- Marvin A Konstam
- The CardioVascular Center at Tufts Medical Center, Boston, MA, United States
| | - Douglas L Mann
- Center for Cardiovascular Research, Washington University School of Medicine, Saint Louis, MO, United States
| | | | - Jeffrey L Ardell
- UCLA Neurocardiology Program of Excellence, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Martin R Cowie
- School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
| | - Helmut U Klein
- Division of Cardiology, University of Rochester Medical Center, Rochester, NY, United States
| | - Douglas D Gregory
- Clinical Cardiovascular Science Foundation, Boston, MA, United States
| | - Joseph M Massaro
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, United States
| | - Imad Libbus
- LivaNova USA Incorporated, Houston, TX, United States
| | | | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - John D Parker
- University of Toronto, University Health Network, Toronto, ON, Canada
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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8
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Natali LH, Troiano JA, Potje SR, Dias DP, Antoniali C. Pregnancy restores altered sympathetic vasomotor modulation and parasympathetic cardiac modulation in hypertensive rats. Pregnancy Hypertens 2022; 28:180-188. [DOI: 10.1016/j.preghy.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 11/27/2022]
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9
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2021 Distinguished Scientists of the American Heart Association. Hypertension 2021; 78:1158-1160. [PMID: 34455815 DOI: 10.1161/hypertensionaha.121.18160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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S K, V A, Paul-Prasanth B, M V, A RS, P UD. Aqueous extract of large cardamom inhibits vascular damage, oxidative stress, and metabolic changes in fructose-fed hypertensive rats. Clin Exp Hypertens 2021; 43:622-632. [PMID: 34281445 DOI: 10.1080/10641963.2021.1925682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Since metabolic abnormalities such as elevated glucose level and imbalanced lipid profiles increase the risk for hypertension and cause endothelial dysfunction, we evaluated the effect of aqueous extract of large cardamom (AELC) on fructose-induced metabolic hypertension and oxidative stress. METHODS The male Sprague-Dawley rats were divided into 6 groups with 5 rats in each group, and each group was fed with 10% fructose in drinking water for 8 weeks. Starting from week 5, animals were treated with 50, 100, and 200 mg/kg/day AELC or Losartan (10 mg/kg/day). Systolic, diastolic, and mean arterial blood pressure was measured once in every seven days using the tail-cuff method. Vascular function, plasma nitric oxide (NO), glucose, lipid profiles, serum biochemical, and anti-oxidant parameters were also evaluated. RESULTS Rats fed with fructose showed higher blood pressure, serum cholesterol, and triglyceride levels, but decreased in the AELC or Losartan treatment group. Treatments with AELC prevented exaggerated plasma glucose and oxidative stress and restored the nitric oxide level in fructose-fed rats. Besides, it also reduced vascular proliferation and improved the relaxation response of acetylcholine in the aorta pre-contracted with phenylephrine. CONCLUSION In summary, the obtained results suggest that AELC can prevent and reverse the high blood pressure induced by fructose, probably by restoring nitric oxide level and by improving altered metabolic parameters.
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Affiliation(s)
- Kanthlal S
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Arya V
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | | | - Vijayakumar M
- Department. Of Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rema Shree A
- Spices Board of India, Ministry of Commerce and Industry, Govt. of India, Sugandha Bhavan, Palarivattom, Cochin, India
| | - Uma Devi P
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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11
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Covassin N, Bukartyk J, Singh P, Calvin AD, St Louis EK, Somers VK. Effects of Experimental Sleep Restriction on Ambulatory and Sleep Blood Pressure in Healthy Young Adults: A Randomized Crossover Study. Hypertension 2021; 78:859-870. [PMID: 34247512 DOI: 10.1161/hypertensionaha.121.17622] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Naima Covassin
- Department of Cardiovascular Medicine (N.C., J.B., P.S., V.K.S.), Mayo Clinic, Rochester, MN
| | - Jan Bukartyk
- Department of Cardiovascular Medicine (N.C., J.B., P.S., V.K.S.), Mayo Clinic, Rochester, MN
| | - Prachi Singh
- Department of Cardiovascular Medicine (N.C., J.B., P.S., V.K.S.), Mayo Clinic, Rochester, MN.,Pennington Biomedical Research Center, Baton Rouge, LA (P.S.)
| | - Andrew D Calvin
- Department of Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, WI (A.D.C.)
| | - Erik K St Louis
- Center for Sleep Medicine, Department of Neurology (E.K.S.L.), Mayo Clinic, Rochester, MN.,Division of Pulmonary and Critical Care Medicine, Department of Medicine (E.K.S.L.), Mayo Clinic, Rochester, MN
| | - Virend K Somers
- Department of Cardiovascular Medicine (N.C., J.B., P.S., V.K.S.), Mayo Clinic, Rochester, MN
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12
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Abstract
Dr Irvine Page proposed the Mosaic Theory of Hypertension in the 1940s advocating that hypertension is the result of many factors that interact to raise blood pressure and cause end-organ damage. Over the years, Dr Page modified his paradigm, and new concepts regarding oxidative stress, inflammation, genetics, sodium homeostasis, and the microbiome have arisen that allow further refinements of the Mosaic Theory. A constant feature of this approach to understanding hypertension is that the various nodes are interdependent and that these almost certainly vary between experimental models and between individuals with hypertension. This review discusses these new concepts and provides an introduction to other reviews in this compendium of Circulation Research.
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Affiliation(s)
- David G. Harrison
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center
| | - Thomas M. Coffman
- Cardiovascular and Metabolic Disorders Research Program, Duke-National University of Singapore Medical School
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13
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Fu Z, Wang F, Liu X, Hu J, Su J, Lu X, Lu A, Cho JM, Symons JD, Zou CJ, Yang T. Soluble (pro)renin receptor induces endothelial dysfunction and hypertension in mice with diet-induced obesity via activation of angiotensin II type 1 receptor. Clin Sci (Lond) 2021; 135:793-810. [PMID: 33625485 PMCID: PMC9215112 DOI: 10.1042/cs20201047] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 12/19/2022]
Abstract
Until now, renin-angiotensin system (RAS) hyperactivity was largely thought to result from angiotensin II (Ang II)-dependent stimulation of the Ang II type 1 receptor (AT1R). Here we assessed the role of soluble (pro)renin receptor (sPRR), a product of site-1 protease-mediated cleavage of (pro)renin receptor (PRR), as a possible ligand of the AT1R in mediating: (i) endothelial cell dysfunction in vitro and (ii) arterial dysfunction in mice with diet-induced obesity. Primary human umbilical vein endothelial cells (HUVECs) treated with a recombinant histidine-tagged sPRR (sPRR-His) exhibited IκBα degradation concurrent with NF-κB p65 activation. These responses were secondary to sPRR-His evoked elevations in Nox4-derived H2O2 production that resulted in inflammation, apoptosis and reduced NO production. Each of these sPRR-His-evoked responses was attenuated by AT1R inhibition using Losartan (Los) but not ACE inhibition using captopril (Cap). Further mechanistic exploration revealed that sPRR-His activated AT1R downstream Gq signaling pathway. Immunoprecipitation coupled with autoradiography experiments and radioactive ligand competitive binding assays indicate sPRR directly interacts with AT1R via Lysine199 and Asparagine295. Important translational relevance was provided by findings from obese C57/BL6 mice that sPRR-His evoked endothelial dysfunction was sensitive to Los. Besides, sPRR-His elevated blood pressure in obese C57/BL6 mice, an effect that was reversed by concurrent treatment with Los but not Cap. Collectively, we provide solid evidence that the AT1R mediates the functions of sPRR during obesity-related hypertension. Inhibiting sPRR signaling should be considered further as a potential therapeutic intervention in the treatment and prevention of cardiovascular disorders involving elevated blood pressure.
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Affiliation(s)
- Ziwei Fu
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Fei Wang
- Department of Internal Medicine, University of Utah and Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Xiyang Liu
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jiajia Hu
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jiahui Su
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiaohan Lu
- Department of Internal Medicine, University of Utah and Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Aihua Lu
- Institute of Hypertension, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jae Min Cho
- Department of Nutrition and Integrative Physiology; Division of Endocrinology, Metabolism, and Diabetes, Molecular Medicine Program; University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - J. David Symons
- Department of Nutrition and Integrative Physiology; Division of Endocrinology, Metabolism, and Diabetes, Molecular Medicine Program; University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Chang-Jiang Zou
- Department of Internal Medicine, University of Utah and Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Tianxin Yang
- Department of Internal Medicine, University of Utah and Veterans Affairs Medical Center, Salt Lake City, Utah, USA
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14
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Quadri SS, Cooper C, Ghaffar D, Vaishnav H, Nahar L. The Pathological Role of Pro(Renin) Receptor in Renal Inflammation. J Exp Pharmacol 2021; 13:339-344. [PMID: 33776491 PMCID: PMC7989955 DOI: 10.2147/jep.s297682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/23/2021] [Indexed: 12/17/2022] Open
Abstract
(Pro)renin receptor (PRR) is the recently discovered component of the renin-angiotensin-aldosterone system (RAS). Many organs contain their own RAS, wherein PRR can exert organ-specific localized effects. The Binding of prorenin/renin to PRR activates angiotensin-dependent and independent pathways which leads to the development of physiological and pathological effects. Continued progress in PRR research suggests that the upregulation of PRR contributes to the development of hypertension, glomerular injury, and progression of kidney disease and inflammation. In the current review, we highlight the function of the PRR in renal inflammation in pathophysiological conditions.
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Affiliation(s)
- Syed S Quadri
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN, USA
| | - Caleb Cooper
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN, USA
| | - Dawood Ghaffar
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN, USA
| | - Hitesh Vaishnav
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN, USA
| | - Ludmila Nahar
- Department of Medicine, School of Medicine/John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
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15
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Chopoorian AH, Wahba A, Celedonio J, Nwazue V, Smith EC, Garland EM, Paranjape S, Okamoto LE, Black BK, Biaggioni I, Raj SR, Gamboa A. Impaired Endothelial Function in Patients With Postural Tachycardia Syndrome. Hypertension 2021; 77:1001-1009. [PMID: 33486983 DOI: 10.1161/hypertensionaha.120.16238] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study is to evaluate endothelial function in postural tachycardia syndrome (PoTS), a poorly understood chronic condition characterized by a state of consistent orthostatic tachycardia (delta heart rate ≥30 beats per minute) upon standing without orthostatic hypotension. Nineteen patients with PoTS and 9 healthy controls were studied after 3 days of a fixed, caffeine-free, normal sodium (150 milliequivalents/day) diet. All participants underwent autonomic function testing, including sinus arrhythmia, valsalva maneuver, hyperventilation, cold pressor, handgrip, and a standing test with catecholamine measurements, followed by endothelial function testing. We analyzed 3 measures of endothelial function: percent brachial flow-mediated dilation, digital pulsatile arterial tonometry, and postischemic percent leg blood flow. Flow-mediated dilation was significantly lower in patients with PoTS (6.23±3.54% for PoTS) than in healthy controls (10.6±4.37% for controls versus, P=0.014). PoTS and controls had similar digital pulsatile arterial tonometry (1.93±0.40 arbitrary units for controls versus 2.13±0.63 arbitrary units for PoTS). PoTS had similar but suggestive percent leg blood flow to controls (313±158% for PoTS versus 468±236% for controls, P=0.098). Patients with PoTS have significantly reduced flow-mediated dilation compared with healthy controls, suggesting that PoTS is characterized by endothelial dysfunction in conduit arteries. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01308099.
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Affiliation(s)
- Abby H Chopoorian
- From the Vanderbilt University School of Medicine (A.H.C.), Vanderbilt University Medical Center, Nashville, TN
| | - Amr Wahba
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Jorge Celedonio
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Victor Nwazue
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Emily C Smith
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Emily M Garland
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Sachin Paranjape
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Luis E Okamoto
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Bonnie K Black
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Italo Biaggioni
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN.,Department of Pharmacology, Vanderbilt University, Nashville, TN (I.B.)
| | - Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada (S.R.R.)
| | - Alfredo Gamboa
- Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine (A.W., J.C., V.N., E.C.S., E.M.G., S.P., L.E.O., B.K.B., I.B., A.G.), Vanderbilt University Medical Center, Nashville, TN
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16
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Lopes H, Egan B. Visceral adiposity syndrome and cardiometabolism. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-32717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The distribution of fat in the human body is related to hemodynamic and metabolic homeostasis. Brown fat is inversely related to body mass index and is associated with a lower probability of developing diabetes. Beige adipose tissue shares some functional characteristics with brown adipose tissue. White adipose tissue constitutes the majority of the fatty tissue and is mainly distributed in the subcutaneous and abdominal cavity. Intra-abdominal white fat has gained prominence in recent years for its association with cardiovascular risk factors and higher cardiovascular mortality. This review article discusses the human adaptation in the environment, a sympathovagal and hypothalamic-pituitary-adrenal imbalance as a possible cause of increased visceral adiposity and its consequences on cardiometabolism.
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17
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Lipphardt M, Dihazi H, Maas JH, Schäfer AK, Amlaz SI, Ratliff BB, Koziolek MJ, Wallbach M. Syndecan-4 as a Marker of Endothelial Dysfunction in Patients with Resistant Hypertension. J Clin Med 2020; 9:jcm9093051. [PMID: 32971813 PMCID: PMC7564403 DOI: 10.3390/jcm9093051] [Citation(s) in RCA: 7] [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: 08/08/2020] [Revised: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Arterial hypertension (HTN) is one of the most relevant cardiovascular risk factors. Nowadays multiple pharmaceutical treatment options exist with novel interventional methods (e.g., baroreflex activation therapy (BAT)) as a last resort to treat patients with resistant HTN. Although pathophysiology behind resistant HTN is still not fully understood. There is evidence that selected biomarkers may be involved in the pathophysiology of HTN. (2) Methods: We investigated serum SDC4-levels in patients suffering from resistant HTN before and 6 months after BAT implantation. We collected 19 blood samples from patients with resistant HTN and blood pressure above target and measured serum SDC4-levels. (3) Results: Our results showed high serum SDC4-levels in patients with resistant HTN as compared to a healthy population. Patients with both, resistant HTN and diabetes mellitus type II, demonstrated higher serum SDC4-levels. β-blockers had lowering effects on serum SDC4-levels, whereas calcium channel blockers were associated with higher levels of serum SDC4. BAT implantation did not lead to a significant difference in serum SDC4-levels after 6 months of therapy. (4) Conclusion: Based on our results we propose SDC4 is elevated in patients suffering from resistant HTN. Thus, SDC4 might be a potential marker for endothelial dysfunction in patients with resistant hypertension.
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Affiliation(s)
- Mark Lipphardt
- Department of Nephrology and Rheumatology, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany; (H.D.); (A.-K.S.); (M.J.K.); (M.W.)
- Correspondence: ; Tel.: +49-(0)-551-39-65309; Fax: +49-(0)-551-39-8906
| | - Hassan Dihazi
- Department of Nephrology and Rheumatology, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany; (H.D.); (A.-K.S.); (M.J.K.); (M.W.)
| | - Jens-Holger Maas
- Department of Transfusion Medicine, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany;
| | - Ann-Kathrin Schäfer
- Department of Nephrology and Rheumatology, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany; (H.D.); (A.-K.S.); (M.J.K.); (M.W.)
| | - Saskia I. Amlaz
- Department of Cardiology and Pneumology, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany;
| | - Brian B. Ratliff
- Renal Research Institute and Departments of Medicine, Pharmacology, and Physiology, New York Medical College, Valhalla, NY 10595, USA;
| | - Michael J. Koziolek
- Department of Nephrology and Rheumatology, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany; (H.D.); (A.-K.S.); (M.J.K.); (M.W.)
| | - Manuel Wallbach
- Department of Nephrology and Rheumatology, Göttingen University Medical Center, Georg August University, 37073 Göttingen, Germany; (H.D.); (A.-K.S.); (M.J.K.); (M.W.)
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18
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Biaggioni I, Shibao CA, Diedrich A, Muldowney JAS, Laffer CL, Jordan J. Blood Pressure Management in Afferent Baroreflex Failure: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 74:2939-2947. [PMID: 31806138 DOI: 10.1016/j.jacc.2019.10.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 12/14/2022]
Abstract
Afferent baroreflex failure is most often due to damage of the carotid sinus nerve because of neck surgery or radiation. The clinical picture is characterized by extreme blood pressure lability with severe hypertensive crises, hypotensive episodes, and orthostatic hypotension, making it the most difficult form of hypertension to manage. There is little evidence-based data to guide treatment. Recommendations rely on understanding the underlying pathophysiology, relevant clinical pharmacology, and anecdotal experience. The goal of treatment should be improving quality of life rather than normalization of blood pressure, which is rarely achievable. Long-acting central sympatholytic drugs are the mainstay of treatment, used at the lowest doses that prevent the largest hypertensive surges. Short-acting clonidine should be avoided because of rebound hypertension, but can be added to control residual hypertensive episodes, often triggered by mental stress or exertion. Hypotensive episodes can be managed with countermeasures and short-acting pressor agents if necessary.
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Affiliation(s)
- Italo Biaggioni
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Autonomic Dysfunction Center, Nashville, Tennessee.
| | - Cyndya A Shibao
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Autonomic Dysfunction Center, Nashville, Tennessee
| | - André Diedrich
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Autonomic Dysfunction Center, Nashville, Tennessee
| | - James A S Muldowney
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Autonomic Dysfunction Center, Nashville, Tennessee; Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cheryl L Laffer
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany; Aerospace Medicine, University of Cologne, Cologne, Germany
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19
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Herat LY, Magno AL, Rudnicka C, Hricova J, Carnagarin R, Ward NC, Arcambal A, Kiuchi MG, Head GA, Schlaich MP, Matthews VB. SGLT2 Inhibitor-Induced Sympathoinhibition: A Novel Mechanism for Cardiorenal Protection. JACC Basic Transl Sci 2020; 5:169-179. [PMID: 32140623 PMCID: PMC7046513 DOI: 10.1016/j.jacbts.2019.11.007] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 02/09/2023]
Abstract
SGLT2 inhibitors improve cardiovascular outcomes. SGLT2 inhibitor–induced sympathetic nervous system inhibition may be an underlying mechanism. Chemical denervation in neurogenic hypertensive mice reduces renal SGLT2 expression. SGLT2 inhibition lowered blood pressure and resulted in significantly reduced tyrosine hydroxylase and norepinephrine levels in the kidney tissue of neurogenic hypertensive mice. Crosstalk between the sympathetic nervous system and SGLT2 regulation appears as a key mechanism of the cardiorenal protective effects demonstrated with SGLT2 inhibition.
Recent clinical trial data suggest a cardiorenal protective effect of sodium glucose cotransporter 2 (SGLT2) inhibition. We demonstrate that chemical denervation in neurogenic hypertensive Schlager (BPH/2J) mice reduced blood pressure, improved glucose homeostasis, and reduced renal SGLT2 protein expression. Inhibition of SGLT2 prevented weight gain, reduced blood pressure, significantly reduced elevations of tyrosine hydroxylase and norepinephrine, and protects against endothelial dysfunction. These findings provide evidence for significant crosstalk between activation of the sympathetic nervous system and SGLT2 regulation and possible ancillary effects on endothelial function, which may contribute to the observed cardiorenal protective effects of SGLT2 inhibition.
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Affiliation(s)
- Lakshini Y Herat
- Dobney Hypertension Centre, School of Biomedical Science, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Aaron L Magno
- Research Centre, Royal Perth Hospital, Perth, Australia
| | | | - Jana Hricova
- Dobney Hypertension Centre, School of Biomedical Science, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Natalie C Ward
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia.,School of Public Health, Curtin University, Perth, Australia.,Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Angelique Arcambal
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia.,Université de La Réunion, Saint-Denis, Réunion, France
| | - Marcio G Kiuchi
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Geoff A Head
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.,Department of Cardiology and Department of Nephrology, Royal Perth Hospital, Perth, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, School of Biomedical Science, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
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20
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Gatineau E, Gong MC, Yiannikouris F. Soluble Prorenin Receptor Increases Blood Pressure in High Fat-Fed Male Mice. Hypertension 2019; 74:1014-1020. [PMID: 31378099 PMCID: PMC6739191 DOI: 10.1161/hypertensionaha.119.12906] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/25/2019] [Indexed: 01/13/2023]
Abstract
Obesity-related hypertension is a major public health concern. We recently demonstrated that plasma levels of the soluble form of the prorenin receptor (sPRR) were elevated in obesity-associated hypertension. Therefore, in the present study, we investigated the contribution of sPRR to blood pressure (BP) elevation in the context of obesity. High fat-fed C57BL/6 male mice were infused with vehicle or sPRR (30 µg/kg per day) via subcutaneously implanted osmotic minipump for 4 weeks. BP parameters were recorded using radiotelemetry devices. Male mice infused with sPRR exhibited higher systolic BP and mean arterial pressure and lower spontaneous baroreflex sensitivity than mice infused with vehicle. To define mechanisms involved in systolic BP elevation, mice were injected with an AT1R (Ang II [angiotensin II] type 1 receptor) antagonist (losartan), a muscarinic receptor antagonist (atropine), a β-adrenergic antagonist (propranolol), and a ganglionic blocker (chlorisondamine). Losartan did not blunt sPRR-induced elevation in systolic BP. Chlorisondamine treatment exacerbated the decrease in mean arterial pressure in male mice infused with sPRR. These results demonstrated that sPRR induced autonomic nervous dysfunction. Interestingly, plasma leptin levels were increased in high fat-fed C57BL/6 male mice infused with sPRR. Overall, our results indicated that sPRR increased systolic BP through an impairment of the baroreflex sensitivity and an increase in the sympathetic tone potentially mediated by leptin in high fat-fed C57BL/6 male mice.
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Affiliation(s)
- Eva Gatineau
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY
| | - Ming C. Gong
- Department of Physiology, University of Kentucky, Lexington, KY
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Lambert EA, Esler MD, Schlaich MP, Dixon J, Eikelis N, Lambert GW. Obesity-Associated Organ Damage and Sympathetic Nervous Activity. Hypertension 2019; 73:1150-1159. [DOI: 10.1161/hypertensionaha.118.11676] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Elisabeth A. Lambert
- From the Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia (E.A.L., N.E., G.W.L.)
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.A.L., M.D.E., N.E., G.W.L.)
| | - Murray D. Esler
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.A.L., M.D.E., N.E., G.W.L.)
| | - Markus P. Schlaich
- Dobney Hypertension Centre, School of Medicine–Royal Perth Hospital Unit, University of Western Australia (M.P.S.)
| | - John Dixon
- Clinical Obesity Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.D.)
| | - Nina Eikelis
- From the Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia (E.A.L., N.E., G.W.L.)
| | - Gavin W. Lambert
- From the Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia (E.A.L., N.E., G.W.L.)
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.A.L., M.D.E., N.E., G.W.L.)
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Sleep, Autonomic Nervous Function and Atherosclerosis. Int J Mol Sci 2019; 20:ijms20040794. [PMID: 30781734 PMCID: PMC6412503 DOI: 10.3390/ijms20040794] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 12/12/2022] Open
Abstract
Behavioral and psychosocial factors related to development of cardiovascular disease have been gaining increased attention. Notably, sleep is considered to be one of the most important behavioral factors involved in progression of atherosclerosis and cardiovascular events, with autonomic nervous function a potential mechanism. Several studies have shown associations of sleep and autonomic dysfunction with major surrogate markers of atherosclerosis, such as carotid intima-media thickness and arterial stiffness. Endocrinological, immunological, oxidative, inflammatory, and metabolic responses, as well as endothelial dysfunction may mediate the effects of the autonomic nervous system. For this review, we examined recent findings related to sleep, autonomic nervous dysfunction, and atherosclerosis, with the aim of understanding the involved pathophysiological mechanisms.
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Abstract
PURPOSE OF REVIEW Weight loss is strongly associated with improvement in blood pressure; however, the mechanism of weight loss can impact the magnitude and sustainability of blood pressure reduction. RECENT FINDINGS Five drugs-orlistat, lorcaserin, liraglutide, phentermine/topiramate, and naltrexone/bupropion-are currently approved for weight loss therapy in the USA. Naltrexone/bupropion results in an increase in in-office and ambulatory blood pressure compared to placebo. Other therapies are associated with modest lowering of blood pressure, and are generally well-tolerated; nonetheless, evidence is limited regarding their effect on blood pressure, particularly longitudinally, in individuals with hypertension. Although weight loss medications can be an effective adjunct to lifestyle modifications in individuals with obesity, there is limited evidence regarding their benefit with regard to blood pressure. Future studies evaluating the effectiveness of weight loss medications should include careful assessment of their short- and long-term impact on blood pressure in individuals with hypertension.
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Barkhidarian B, Khorshidi M, Shab-Bidar S, Hashemi B. Effects of L-citrulline supplementation on blood pressure: A systematic review and meta-analysis. AVICENNA JOURNAL OF PHYTOMEDICINE 2019; 9:10-20. [PMID: 30788274 PMCID: PMC6369322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE We aimed to conduct a systematic review and meta-analysis of clinical trials that examined the effects of L-citrulline supplementation on blood pressure (BP). MATERIALS AND METHODS We searched MEDLINE, SCOPUS, PUBMED and Google scholar databases from inception to November 16, 2017 and 811 papers were identified, of which 8 trials with 10 data sets met the inclusion criteria. Inclusion criteria were: (1) application of randomized clinical trial with either crossover or parallel designs; (2) studies conducted in adults (≥18 y); (3) oral supplementation with L-citrulline compared to control group; (4) expression of sufficient data about systolic and diastolic BP at baseline and at the end of the study in each group. BP effects were pooled by random-effects models, with trials weighted by inverse variance. RESULTS The included studies' sample size ranged between 12 and 34 subjects. The mean age of the participants in these trials ranged between 22 and 71 years. Dosage of L-citrulline supplementation varied from 3 to 9 g/day. Duration of the intervention ranged between 1 and 17 weeks. The pooled changes in systolic and diastolic BP were (MD, -4.10 mm Hg; 95% CI [-7.94, -0.26]; p=0.037) and (MD -2.08 mm Hg; 95% CI [-4.32, 0.16]; P=0.069), respectively. The subgroup analysis showed a significant diastolic BP reduction in studies that used doses of ≥6 g/day (MD -2.75 mm Hg; 95% CI [-5.37, -0.12]; p=0.04). CONCLUSION Our results suggest that L-citrulline supplementation may reduce systolic BP. A significant reduction in diastolic BP was observed only in the studies that used doses ≥ 6 g/day.
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Affiliation(s)
| | - Masoud Khorshidi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran,Corresponding Author: Tel: +9821 88955805, Fax: +9821 88984861,
| | - Baran Hashemi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Yuan X, Wu Q, Liu X, Zhang H, Xiu R. Transcriptomic profile analysis of brain microvascular pericytes in spontaneously hypertensive rats by RNA-Seq. Am J Transl Res 2018; 10:2372-2386. [PMID: 30210677 PMCID: PMC6129547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 07/12/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Changes in the structure and function of micro-vessels is the pathogenic basis of organ damage in cardiovascular and cerebrovascular diseases. Microcirculation is primarily affected in hypertension, resulting in increased vascular resistance. Pericytes are contractile cells that are embedded in the basement membrane of capillaries, and regulate endothelial cell membrane maturation, capillary blood flow, cell debris removal, and stability of endothelial cells. However, the exact role of brain microvascular pericytes in the pathogenesis of hypertension has not been elucidated. METHODS Brain microvascular pericytes were isolated from spontaneously hypertensive rats (SHR) and wild type Wistar Kyoto (WKY) rats. The transcriptomes of SHR and WKY pericytes were analyzed by RNA-Seq, and the differentially expressed genes (DEGs) were screened by Ballgown, and Student's t test was used to be used to compare differences between groups. DAVID was used for the GO-enrichment analysis and KEGG pathway analysis of the DEGs, and an interaction network between the significant signaling pathways and DEGs was constructed. RESULTS A total of 1356 DEGs were identified between the WKY and the SHR group pericytes (P value < 0.05, Fold change > 1.5), of which 733 were upregulated and 623 downregulated. The genes with greatest betweenness centrality values were Itgb1, Vcam-1 and MMP-9. Based on KEGG analysis, 34 interacting signaling pathways and 43 interacting genes were screened, and MAPK, p53, Wnt, Jak-STAT, TGF-beta, VEGF and PPAR signaling pathways were the key nodes. CONCLUSIONS Several DEGs and signaling pathways were identified in the brain microvascular pericytes of SHR rats compared to the WKY rats. Our findings will lay the foundation to study the role of brain microvascular pericytes in the development of spontaneous hypertension.
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Affiliation(s)
- Xiaochen Yuan
- Key Laboratory for Microcirculation, Ministry of HealthBeijing, China
- Institute of Microcirculation, Chinese Academy Medical Sciences & Pecking Union Medical CollegeBeijing, China
| | - Qingbin Wu
- Key Laboratory for Microcirculation, Ministry of HealthBeijing, China
- Institute of Microcirculation, Chinese Academy Medical Sciences & Pecking Union Medical CollegeBeijing, China
| | - Xueting Liu
- Key Laboratory for Microcirculation, Ministry of HealthBeijing, China
- Institute of Microcirculation, Chinese Academy Medical Sciences & Pecking Union Medical CollegeBeijing, China
| | - Honggang Zhang
- Key Laboratory for Microcirculation, Ministry of HealthBeijing, China
- Institute of Microcirculation, Chinese Academy Medical Sciences & Pecking Union Medical CollegeBeijing, China
| | - Ruijuan Xiu
- Key Laboratory for Microcirculation, Ministry of HealthBeijing, China
- Institute of Microcirculation, Chinese Academy Medical Sciences & Pecking Union Medical CollegeBeijing, China
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Vranish JR, Holwerda SW, Young BE, Credeur DP, Patik JC, Barbosa TC, Keller DM, Fadel PJ. Exaggerated Vasoconstriction to Spontaneous Bursts of Muscle Sympathetic Nerve Activity in Healthy Young Black Men. Hypertension 2017; 71:192-198. [PMID: 29203629 DOI: 10.1161/hypertensionaha.117.10229] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/05/2017] [Accepted: 09/22/2017] [Indexed: 12/16/2022]
Abstract
Blacks have the highest prevalence of hypertension, putting them at greater risk of cardiovascular disease and death. Previous studies have reported that, relative to whites, healthy black men have augmented pressor responses to sympathoexcitatory stressors. Although important, these studies do not inform about the resting state and the influence of spontaneous changes in resting muscle sympathetic nerve activity (MSNA). Likewise, little is known about the transduction of MSNA into a vascular response at rest on a beat-to-beat basis. Accordingly, we tested the hypothesis that relative to whites, blacks would exhibit greater vasoconstriction and pressor responses following spontaneous bursts of MSNA. Mean arterial pressure, common femoral artery blood flow, and MSNA were continuously recorded during 20 minutes of supine rest in 35 young healthy men (17 blacks and 18 whites). Signal averaging was used to characterize changes in leg vascular conductance, total vascular conductance, and mean arterial pressure following spontaneous MSNA bursts. Blacks demonstrated significantly greater decreases in leg vascular conductance (blacks: -15.0±1.0%; whites: -11.5±1.2%; P=0.042) and total vascular conductance (blacks: -8.6±0.9%; whites: -5.1±0.4%; P=0.001) following MSNA bursts, which resulted in greater mean arterial pressure increases (blacks: +5.2±0.6 mm Hg; whites: +3.9±0.3 mm Hg; P=0.04). These exaggerated responses in blacks compared with whites were present whether MSNA bursts occurred in isolation (singles) or in combination (multiples) and were graded with increases in burst height. Collectively, these findings suggest that healthy young black men exhibit augmented sympathetic vascular transduction at rest and provide novel insight into potential mechanism(s) by which this population may develop hypertension later in life.
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Affiliation(s)
- Jennifer R Vranish
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Seth W Holwerda
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Benjamin E Young
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Daniel P Credeur
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Jordan C Patik
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Thales C Barbosa
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - David M Keller
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.)
| | - Paul J Fadel
- From the Department of Kinesiology, University of Texas at Arlington (J.R.V., B.E.Y., J.C.P., T.C.B., D.M.K., P.J.F.); School of Kinesiology, University of Southern Mississippi, Hattiesburg (D.P.C.); and Department of Health and Human Physiology, University of Iowa, Iowa City (S.W.H.).
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Kiuchi MG, Chen S, Hoye NA. The effects of different physical activities on atrial fibrillation in patients with hypertension and chronic kidney disease. Kidney Res Clin Pract 2017; 36:264-273. [PMID: 28904878 PMCID: PMC5592894 DOI: 10.23876/j.krcp.2017.36.3.264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/06/2017] [Accepted: 06/30/2017] [Indexed: 02/06/2023] Open
Abstract
Background Atrial fibrillation (AF) is highly common, and is most frequently observed in individuals with hypertension and structural cardiac disease. Sympathetic hyperactivity plays a fundamental role in the progression, maintenance and aggravation of arrhythmia. Endurance exercise training clearly lowers sympathetic activity in sympathoexcitatory disease states, and is well-tolerated by patients with chronic kidney disease (CKD). Methods We assessed 50 CKD patients with hypertension. Each patient provided a complete medical history and underwent a physical examination. We used an implantable cardiac monitor over a 3-year follow-up period to evaluate the effects of high-intensity interval training (HIIT) and moderate exercise (ModEx) physical activity protocols on AF occurrence, and determined the effectiveness of these protocols in improving renal function. Subjects were followed up every 6 months after the beginning of the intervention. Results During the 3-year follow-up, AF onset was higher in CKD patients who engaged in HIIT (72%) than in those who engaged in ModEx (24%) (hazard ratio, 3.847; 95% confidence interval, 1.694–8.740, P = 0.0013 by log-rank test). Both groups exhibited significant intra-group changes in the mean systolic 24-hour ambulatory blood pressure measurements (ABPM) between baseline and 12, 24, and 36 months. There were also significant differences in the mean systolic 24-hour ABPM between the groups at the same time points. Conclusion In CKD patients with hypertension, improvements in AF onset, renal function and some echocardiographic parameters were more evident in subjects who engaged in ModEx than in those who engaged in HIIT during 3 years of follow-up.
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Affiliation(s)
- Márcio Galindo Kiuchi
- Artificial Cardiac Stimulation Division, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil.,Electrophysiology Division, Department of Medicine, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil
| | - Shaojie Chen
- Department of Cardiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Neil Alexander Hoye
- Department of Renal Medicine, St James's University Hospital, Leeds, United Kingdom
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Guarino D, Nannipieri M, Iervasi G, Taddei S, Bruno RM. The Role of the Autonomic Nervous System in the Pathophysiology of Obesity. Front Physiol 2017; 8:665. [PMID: 28966594 PMCID: PMC5606212 DOI: 10.3389/fphys.2017.00665] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/22/2017] [Indexed: 12/18/2022] Open
Abstract
Obesity is reaching epidemic proportions globally and represents a major cause of comorbidities, mostly related to cardiovascular disease. The autonomic nervous system (ANS) dysfunction has a two-way relationship with obesity. Indeed, alterations of the ANS might be involved in the pathogenesis of obesity, acting on different pathways. On the other hand, the excess weight induces ANS dysfunction, which may be involved in the haemodynamic and metabolic alterations that increase the cardiovascular risk of obese individuals, i.e., hypertension, insulin resistance and dyslipidemia. This article will review current evidence about the role of the ANS in short-term and long-term regulation of energy homeostasis. Furthermore, an increased sympathetic activity has been demonstrated in obese patients, particularly in the muscle vasculature and in the kidneys, possibily contributing to increased cardiovascular risk. Selective leptin resistance, obstructive sleep apnea syndrome, hyperinsulinemia and low ghrelin levels are possible mechanisms underlying sympathetic activation in obesity. Weight loss is able to reverse metabolic and autonomic alterations associated with obesity. Given the crucial role of autonomic dysfunction in the pathophysiology of obesity and its cardiovascular complications, vagal nerve modulation and sympathetic inhibition may serve as therapeutic targets in this condition.
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Affiliation(s)
- Daniela Guarino
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy.,Institute of Clinical Physiology of CNRPisa, Italy.,Scuola Superiore Sant'AnnaPisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy
| | | | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy
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Affiliation(s)
- Gary L Pierce
- From the Department of Health and Human Physiology (G.L.P.), Abboud Cardiovascular Research Center (G.L.P.), and UIHC Center for Hypertension Research (G.L.P.), The University of Iowa, Iowa City.
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da Silva Franco N, Lubaczeuski C, Guizoni DM, Victorio JA, Santos-Silva JC, Brum PC, Carneiro EM, Davel AP. Propranolol treatment lowers blood pressure, reduces vascular inflammatory markers and improves endothelial function in obese mice. Pharmacol Res 2017; 122:35-45. [DOI: 10.1016/j.phrs.2017.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 04/25/2017] [Accepted: 05/17/2017] [Indexed: 12/26/2022]
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Figueroa A, Wong A, Jaime SJ, Gonzales JU. Influence of L-citrulline and watermelon supplementation on vascular function and exercise performance. Curr Opin Clin Nutr Metab Care 2017; 20:92-98. [PMID: 27749691 DOI: 10.1097/mco.0000000000000340] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW L-Citrulline, either synthetic or in watermelon, may improve vascular function through increased L-arginine bioavailability and nitric oxide synthesis. This article analyses potential vascular benefits of L-citrulline and watermelon supplementation at rest and during exercise. RECENT FINDINGS There is clear evidence that acute L-citrulline ingestion increases plasma L-arginine, the substrate for endothelial nitric oxide synthesis. However, the subsequent acute improvement in nitric oxide production and mediated vasodilation is inconsistent, which likely explains the inability of acute L-citrulline or watermelon to improve exercise tolerance. Recent studies have shown that chronic L-citrulline supplementation increases nitric oxide synthesis, decreases blood pressure, and may increase peripheral blood flow. These changes are paralleled by improvements in skeletal muscle oxygenation and performance during endurance exercise. The antihypertensive effect of L-citrulline/watermelon supplementation is evident in adults with prehypertension or hypertension, but not in normotensives. However, L-citrulline supplementation may attenuate the blood pressure response to exercise in normotensive men. SUMMARY The beneficial vascular effects of L-citrulline/watermelon supplementation may stem from improvements in the L-arginine/nitric oxide pathway. Reductions in resting blood pressure with L-citrulline/watermelon supplementation may have major implications for individuals with prehypertension and hypertension. L-Citrulline supplementation, but not acute ingestion, have shown to improve exercise performance in young healthy adults.
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Affiliation(s)
- Arturo Figueroa
- aDepartment of Nutrition, Food, and Exercise Sciences, Florida State University, Tallahassee, Florida bDepartment of Health and Human Performance, Marymount University, Arlington, Virginia cDepartment of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA
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Howden EJ, Lawley JS, Esler M, Levine BD. Potential role of endurance training in altering renal sympathetic nerve activity in CKD? Auton Neurosci 2016; 204:74-80. [PMID: 27908698 DOI: 10.1016/j.autneu.2016.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/16/2016] [Accepted: 11/23/2016] [Indexed: 12/20/2022]
Abstract
Chronic kidney disease (CKD), is characterized by a progressive loss of renal function and increase in cardiovascular risk. In this review paper, we discuss the pathophysiology of increased sympathetic nerve activity in CKD patients and raise the possibility of endurance exercise being an effective countermeasure to address this problem. We specifically focus on the potential role of endurance training in altering renal sympathetic nerve activity as increased renal sympathetic nerve activity negatively impacts kidney function as well indirectly effects multiple other systems and organs. Recent technological advances in device based therapy have highlighted the detrimental effect of elevated renal sympathetic nerve activity in CKD patients, with kidney function and blood pressure being improved post renal artery nerve denervation in selected patients. These developments provide optimism for the development of alternative and/or complementary strategies to lower renal sympathetic nerve activity. However, appropriately designed studies are required to confirm preliminary observations, as the widespread use of the renal denervation approach to lower sympathetic activity presently has limited feasibility. Endurance training may be one alternative strategy to reduce renal sympathetic nerve activity. Here we review the role of endurance training as a potential alternative or adjunctive to current therapy in CKD patients. We also provide recommendations for future research to assist in establishing an evidence base for the use of endurance training to lower renal sympathetic activity in CKD patients.
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Affiliation(s)
- Erin J Howden
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX 75231, United States; University of Texas Southwestern Medical Center, Dallas, TX 75231, United States; Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
| | - Justin S Lawley
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX 75231, United States; University of Texas Southwestern Medical Center, Dallas, TX 75231, United States
| | - Murray Esler
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX 75231, United States; University of Texas Southwestern Medical Center, Dallas, TX 75231, United States
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