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Ren S, Wang S, Lv S, Gao J, Mao Y, Liu Y, Xie Q, Zhang T, Zhao L, Shi J. The nociceptive inputs of the paraventricular hypothalamic nucleus in formalin stimulated mice. Neurosci Lett 2024; 841:137948. [PMID: 39179131 DOI: 10.1016/j.neulet.2024.137948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 08/03/2024] [Accepted: 08/20/2024] [Indexed: 08/26/2024]
Abstract
The paraventricular hypothalamic nucleus (PVH) is an important neuroendocrine center involved in pain regulation, but the nociceptive afferent routes for the nucleus are still unclear. We examined the profile of PVH receiving injurious information by a combination of retrograde tracing with Fluoro-Gold (FG) and FOS expression induced by formalin stimuli. The result showed that formalin injection induced significantly increased expression of FOS in the PVH, among which oxytocin containing neurons are one neuronal phenotype. Immunofluorescent staining of FG and FOS revealed that double labeled neurons were strikingly distributed in the area 2 of the cingulate cortex (Cg2), the lateral septal nucleus (LS), the periaqueductal gray (PAG), the posterior hypothalamic area (PH), and the lateral parabrachial nucleus (LPB). In the five regions, LPB had the biggest number and the highest ratio of FOS expression in FG labeled neurons, with main subnuclei distribution in the external, superior, dorsal, and central parts. Further immunofluorescent triple staining disclosed that about one third of FG and FOS double labeled neurons in the LPB were immunoreactive for calcitonin gene related peptide (CGRP). In conclusion, the present study demonstrates the nociceptive input profile of the PVH area under inflammatory pain and suggests that neurons in the LPB may play essential roles in transmitting noxious information to the PVH.
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Affiliation(s)
- Shuting Ren
- Department of Human Anatomy, Histology and Embryology & K. K. Leung Brain Research Centre, Preclinical School of Medicine, The Fourth Military Medical University, Xi'an 710032, China; Medical School of Yan'an University, Yan'an 716000, China
| | - Shumin Wang
- Department of Human Anatomy, Histology and Embryology & K. K. Leung Brain Research Centre, Preclinical School of Medicine, The Fourth Military Medical University, Xi'an 710032, China; Medical School of Yan'an University, Yan'an 716000, China
| | - Siting Lv
- Department of Human Anatomy, Histology and Embryology & K. K. Leung Brain Research Centre, Preclinical School of Medicine, The Fourth Military Medical University, Xi'an 710032, China; Medical School of Yan'an University, Yan'an 716000, China
| | - Jiaying Gao
- Department of Human Anatomy, Histology and Embryology & K. K. Leung Brain Research Centre, Preclinical School of Medicine, The Fourth Military Medical University, Xi'an 710032, China; Student Brigade, Preclinical School of Medicine, The Fourth Military Medical University, Xi'an 710032, China
| | - Yajie Mao
- Department of Human Anatomy, Histology and Embryology & K. K. Leung Brain Research Centre, Preclinical School of Medicine, The Fourth Military Medical University, Xi'an 710032, China; Student Brigade, Preclinical School of Medicine, The Fourth Military Medical University, Xi'an 710032, China
| | - Yuankun Liu
- Department of Human Anatomy, Histology and Embryology & K. K. Leung Brain Research Centre, Preclinical School of Medicine, The Fourth Military Medical University, Xi'an 710032, China; Medical School of Yan'an University, Yan'an 716000, China
| | - Qiongyao Xie
- Department of Human Anatomy, Histology and Embryology & K. K. Leung Brain Research Centre, Preclinical School of Medicine, The Fourth Military Medical University, Xi'an 710032, China; Student Brigade, Preclinical School of Medicine, The Fourth Military Medical University, Xi'an 710032, China
| | - Ting Zhang
- Department of Human Anatomy, Histology and Embryology & K. K. Leung Brain Research Centre, Preclinical School of Medicine, The Fourth Military Medical University, Xi'an 710032, China
| | - Lin Zhao
- Medical School of Yan'an University, Yan'an 716000, China.
| | - Juan Shi
- Department of Human Anatomy, Histology and Embryology & K. K. Leung Brain Research Centre, Preclinical School of Medicine, The Fourth Military Medical University, Xi'an 710032, China.
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Xia M, Wang T, Wang Y, Hu T, Chen D, Wang B. A neural perspective on the treatment of hypertension: the neurological network excitation and inhibition (E/I) imbalance in hypertension. Front Cardiovasc Med 2024; 11:1436059. [PMID: 39323755 PMCID: PMC11422145 DOI: 10.3389/fcvm.2024.1436059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/29/2024] [Indexed: 09/27/2024] Open
Abstract
Despite the increasing number of anti-hypertensive drugs have been developed and used in the clinical setting, persistent deficiencies persist, including issues such as lifelong dosage, combination therapy. Notwithstanding receiving the treatment under enduring these deficiencies, approximately 4 in 5 patients still fail to achieve reliable blood pressure (BP) control. The application of neuromodulation in the context of hypertension presents a pioneering strategy for addressing this condition, con-currently implying a potential central nervous mechanism underlying hypertension onset. We hypothesize that neurological networks, an essential component of maintaining appropriate neurological function, are involved in hypertension. Drawing on both peer-reviewed research and our laboratory investigations, we endeavor to investigate the underlying neural mechanisms involved in hypertension by identifying a close relationship between its onset of hypertension and an excitation and inhibition (E/I) imbalance. In addition to the involvement of excitatory glutamatergic and GABAergic inhibitory system, the pathogenesis of hypertension is also associated with Voltage-gated sodium channels (VGSCs, Nav)-mediated E/I balance. The overloading of glutamate or enhancement of glutamate receptors may be attributed to the E/I imbalance, ultimately triggering hypertension. GABA loss and GABA receptor dysfunction have also proven to be involved. Furthermore, we have identified that abnormalities in sodium channel expression and function alter neural excitability, thereby disturbing E/I balance and potentially serving as a mechanism underlying hypertension. These insights are expected to furnish potential strategies for the advancement of innovative anti-hypertensive therapies and a meaningful reference for the exploration of central nervous system (CNS) targets of anti-hypertensives.
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Affiliation(s)
- Min Xia
- Department of Anesthesiology, General Hospital of The Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
- Liaoning Provincial Key Laboratory of Cerebral Diseases, Department of Physiology, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development (R&D) of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
| | - Tianyu Wang
- Liaoning Provincial Key Laboratory of Cerebral Diseases, Department of Physiology, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development (R&D) of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
| | - Yizhu Wang
- Liaoning Provincial Key Laboratory of Cerebral Diseases, Department of Physiology, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development (R&D) of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
- College of Pharmacy, Dalian Medical University, Dalian, China
| | - Tingting Hu
- Department of Anesthesiology, General Hospital of The Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Defang Chen
- Liaoning Provincial Key Laboratory of Cerebral Diseases, Department of Physiology, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development (R&D) of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
- Emergency Intensive Care Unit, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bin Wang
- Liaoning Provincial Key Laboratory of Cerebral Diseases, Department of Physiology, College of Basic Medical Sciences, National-Local Joint Engineering Research Center for Drug Research and Development (R&D) of Neurodegenerative Diseases, Dalian Medical University, Dalian, China
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Zhang H, Zhu Z, Ma WX, Kong LX, Yuan PC, Bu LF, Han J, Huang ZL, Wang YQ. The contribution of periaqueductal gray in the regulation of physiological and pathological behaviors. Front Neurosci 2024; 18:1380171. [PMID: 38650618 PMCID: PMC11034386 DOI: 10.3389/fnins.2024.1380171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
Periaqueductal gray (PAG), an integration center for neuronal signals, is located in the midbrain and regulates multiple physiological and pathological behaviors, including pain, defensive and aggressive behaviors, anxiety and depression, cardiovascular response, respiration, and sleep-wake behaviors. Due to the different neuroanatomical connections and functional characteristics of the four functional columns of PAG, different subregions of PAG synergistically regulate various instinctual behaviors. In the current review, we summarized the role and possible neurobiological mechanism of different subregions of PAG in the regulation of pain, defensive and aggressive behaviors, anxiety, and depression from the perspective of the up-down neuronal circuits of PAG. Furthermore, we proposed the potential clinical applications of PAG. Knowledge of these aspects will give us a better understanding of the key role of PAG in physiological and pathological behaviors and provide directions for future clinical treatments.
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Affiliation(s)
- Hui Zhang
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
- Anhui Provincial Engineering Laboratory for Screening and Re-evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Wannan Medical College, Wuhu, China
| | - Zhe Zhu
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
| | - Wei-Xiang Ma
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
| | - Ling-Xi Kong
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
| | - Ping-Chuan Yuan
- Anhui Provincial Engineering Laboratory for Screening and Re-evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Wannan Medical College, Wuhu, China
| | - Li-Fang Bu
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
| | - Jun Han
- Anhui Provincial Engineering Laboratory for Screening and Re-evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Wannan Medical College, Wuhu, China
| | - Zhi-Li Huang
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi-Qun Wang
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
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Li D, Cao F, Han J, Wang M, Lai C, Zhang J, Xu T, Bouakaz A, Wan M, Ren P, Zhang S. The sustainable antihypertensive and target organ damage protective effect of transcranial focused ultrasound stimulation in spontaneously hypertensive rats. J Hypertens 2023; 41:852-866. [PMID: 36883470 DOI: 10.1097/hjh.0000000000003407] [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: 03/09/2023]
Abstract
OBJECTIVE In this study, we aimed to investigate the sustainable antihypertensive effects and protection against target organ damage caused by low-intensity focused ultrasound (LIFU) stimulation and the underlying mechanism in spontaneously hypertensive rats (SHRs) model. METHODS AND RESULTS SHRs were treated with ultrasound stimulation of the ventrolateral periaqueductal gray (VlPAG) for 20 min every day for 2 months. Systolic blood pressure (SBP) was compared among normotensive Wistar-Kyoto rats, SHR control group, SHR Sham group, and SHR LIFU stimulation group. Cardiac ultrasound imaging and hematoxylin-eosin and Masson staining of the heart and kidney were performed to assess target organ damage. The c-fos immunofluorescence analysis and plasma levels of angiotensin II, aldosterone, hydrocortisone, and endothelin-1 were measured to investigate the neurohumoral and organ systems involved. We found that SBP was reduced from 172 ± 4.2 mmHg to 141 ± 2.1 mmHg after 1 month of LIFU stimulation, P < 0.01. The next month of treatment can maintain the rat's blood pressure at 146 ± 4.2 mmHg at the end of the experiment. LIFU stimulation reverses left ventricular hypertrophy and improves heart and kidney function. Furthermore, LIFU stimulation enhanced the neural activity from the VLPAG to the caudal ventrolateral medulla and reduced the plasma levels of ANGII and Aldo. CONCLUSION We concluded that LIFU stimulation has a sustainable antihypertensive effect and protects against target organ damage by activating antihypertensive neural pathways from VLPAG to the caudal ventrolateral medulla and further inhibiting the renin-angiotensin system (RAS) activity, thereby supporting a novel and noninvasive alternative therapy to treat hypertension.
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Affiliation(s)
- Dapeng Li
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University
| | - Fangyuan Cao
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University
| | - Jie Han
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, China
| | - Mengke Wang
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University
| | - Chunhao Lai
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University
| | - Jingjing Zhang
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University
| | - Tianqi Xu
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University
| | | | - Mingxi Wan
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University
| | - Pengyu Ren
- Institute of Medical Artificial Intelligence
- Department of Neurosurgery, The Second Affiliated Hospital of Xi'an Jiaotong University
| | - Siyuan Zhang
- Key Laboratory of Biomedical Information Engineering of the Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University
- Sichuan Digital Economy Industry Development Research Institute, China
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Sanchez-Larsen A, Principe A, Ley M, Vaquerizo B, Langohr K, Rocamora R. Insular Role in Blood Pressure and Systemic Vascular Resistance Regulation. Neuromodulation 2023:S1094-7159(23)00006-5. [PMID: 36682902 DOI: 10.1016/j.neurom.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/08/2022] [Accepted: 12/28/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The insula is a brain area involved in the modulation of autonomic responses. Previous studies have focused mainly on its heart rate regulatory function, but its role in vascular control is not well defined. Ictal/postictal blood pressure (BP) fluctuations may have a role in the pathogenesis of sudden unexpected death in epilepsy. This study aims to characterize the insular influence on vascular regulation through direct high-frequency electrical stimulation (E-stim) of different insular regions during stereo-electroencephalographic studies. MATERIALS AND METHODS An observational, prospective study was conducted, involving people with epilepsy who underwent E-stim of depth electrodes implanted in the insular cortex. Patients with anatomical or electrophysiological insular abnormalities, E-stim producing after discharges, or any elicited symptoms were excluded. Variations of BP and systemic vascular resistance (SVR) during the insular stimuli were analyzed, comparing them with those observed during E-stim of control contacts implanted in cortical noneloquent regions and sham stimulations. RESULTS Fourteen patients were included, five implanted in the right insula and nine in the left. We analyzed 14 stimulations in the right insula, 18 in the left insula, 18 in control electrodes, and 13 sham stimulations. Most right insular responses were hypertensive, whereas most left ones were hypotensive. E-stim of the right insula produced a significant BP and SVR increase, whereas the left insula induced a significant BP decrease without SVR changes. The most remarkable changes were elicited in both posterior insulas, although the magnitude of BP changes was generally low. Control and sham stimulations did not induce BP or SVR changes. CONCLUSION Our findings on insular stimulation suggest an interhemispheric difference in its vascular regulatory function, with a vasopressor effect of the right insula and a vasodilator effect of the left one.
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Affiliation(s)
- Alvaro Sanchez-Larsen
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain; Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Alessandro Principe
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Miguel Ley
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Epilepsy Monitoring Unit, Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Beatriz Vaquerizo
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Department of Cardiology, Hospital del Mar, Barcelona, Spain
| | - Klaus Langohr
- Integrative Pharmacology and Systems Neuroscience Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Statistics and Operations Research, Universitat Politècnica de Catalunya-BarcelonaTech, Barcelona, Spain
| | - Rodrigo Rocamora
- Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Hospital del Mar Medical Research Institute, Barcelona, Spain
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McPherson KB, Ingram SL. Cellular and circuit diversity determines the impact of endogenous opioids in the descending pain modulatory pathway. Front Syst Neurosci 2022; 16:963812. [PMID: 36045708 PMCID: PMC9421147 DOI: 10.3389/fnsys.2022.963812] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/15/2022] [Indexed: 01/31/2023] Open
Abstract
The descending pain modulatory pathway exerts important bidirectional control of nociceptive inputs to dampen and/or facilitate the perception of pain. The ventrolateral periaqueductal gray (vlPAG) integrates inputs from many regions associated with the processing of nociceptive, cognitive, and affective components of pain perception, and is a key brain area for opioid action. Opioid receptors are expressed on a subset of vlPAG neurons, as well as on both GABAergic and glutamatergic presynaptic terminals that impinge on vlPAG neurons. Microinjection of opioids into the vlPAG produces analgesia and microinjection of the opioid receptor antagonist naloxone blocks stimulation-mediated analgesia, highlighting the role of endogenous opioid release within this region in the modulation of nociception. Endogenous opioid effects within the vlPAG are complex and likely dependent on specific neuronal circuits activated by acute and chronic pain stimuli. This review is focused on the cellular heterogeneity within vlPAG circuits and highlights gaps in our understanding of endogenous opioid regulation of the descending pain modulatory circuits.
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Affiliation(s)
- Kylie B. McPherson
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy,Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Susan L. Ingram
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States,*Correspondence: Susan L. Ingram
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O'Callaghan E, McBryde F, Patel N, Paton J. Examination of the periaqueductal gray as a site for controlling arterial pressure in the conscious spontaneously hypertensive rat. Auton Neurosci 2022; 240:102984. [DOI: 10.1016/j.autneu.2022.102984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/27/2022]
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Abstract
Much of biology is rhythmical and comprises oscillators that can couple. These have optimized energy efficiency and have been preserved during evolution. The respiratory and cardiovascular systems contain numerous oscillators, and importantly, they couple. This coupling is dynamic but essential for an efficient transmission of neural information critical for the precise linking of breathing and oxygen delivery while permitting adaptive responses to changes in state. The respiratory pattern generator and the neural network responsible for sympathetic and cardiovagal (parasympathetic) tone generation interact at many levels ensuring that cardiac output and regional blood flow match oxygen delivery to the lungs and tissues efficiently. The most classic manifestations of these interactions are respiratory sinus arrhythmia and the respiratory modulation of sympathetic nerve activity. These interactions derive from shared somatic and cardiopulmonary afferent inputs, reciprocal interactions between brainstem networks and inputs from supra-pontine regions. Disrupted respiratory-cardiovascular coupling can result in disease, where it may further the pathophysiological sequelae and be a harbinger of poor outcomes. This has been well documented by diminished respiratory sinus arrhythmia and altered respiratory sympathetic coupling in animal models and/or patients with myocardial infarction, heart failure, diabetes mellitus, and neurological disorders as stroke, brain trauma, Parkinson disease, or epilepsy. Future research needs to assess the therapeutic potential for ameliorating respiratory-cardiovascular coupling in disease.
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Affiliation(s)
- James P Fisher
- Manaaki Manawa-The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tymoteusz Zera
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Julian F R Paton
- Manaaki Manawa-The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
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Moran C, Sarangmat N, Gerard CS, Barua N, Ashida R, Woolley M, Pietrzyk M, Gill SS. Two Hundred Twenty-Six Consecutive Deep Brain Stimulation Electrodes Placed Using an "Asleep" Technique and the Neuro|MateTM Robot for the Treatment of Movement Disorders. Oper Neurosurg (Hagerstown) 2021; 19:530-538. [PMID: 32629477 DOI: 10.1093/ons/opaa176] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 04/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Robotics in neurosurgery has demonstrated widening indications and rapid growth in recent years. Robotic precision and reproducibility are especially pertinent to the field of functional neurosurgery. Deep brain stimulation (DBS) requires accurate placement of electrodes in order to maximize efficacy and minimize side effects. In addition, asleep techniques demand clear target visualization and immediate on-table verification of accuracy. OBJECTIVE To describe the surgical technique of asleep DBS surgery using the Neuro|MateTM Robot (Renishaw plc, Wotton-under-Edge, United Kingdom) and examine the accuracy of DBS lead placement in the subthalamic nucleus (STN) for the treatment of movement disorders. METHODS A single-center retrospective review of 113 patients who underwent bilateral STN/Zona Incerta electrode placement was performed. Accuracy of implantation was assessed using 5 measurements, Euclidian distance, radial error, depth error, angular error, and shift error. RESULTS A total of 226 planned vs actual electrode placements were analyzed. The mean 3-dimensional vector error calculated for 226 trajectories was 0.78 +/- 0.37 mm. The mean radial displacement off planned trajectory was 0.6 +/- 0.33 mm. The mean depth error, angular error, and shift error was 0.4 +/- 0.35 mm, 0.4 degrees, and 0.3 mm, respectively. CONCLUSION This report details our institution's method for DBS lead placement in patients under general anaesthesia using anatomical targeting without microelectrode recordings or intraoperative test stimulation for the treatment of movement disorders. This is the largest reported dataset of accuracy results in DBS surgery performed asleep. This novel robot-assisted operative technique results in sub-millimeter accuracy in DBS electrode placement.
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Affiliation(s)
- Catherine Moran
- Functional Neurosurgery Group, Clinical Neurosciences, University of Bristol, Bristol, United Kingdom.,Department of Neurosurgery, North Bristol Trust, Westbury-on-Trym, United Kingdom
| | - Nagaraja Sarangmat
- Department of Neurology, North Bristol Trust, Westbury-on-Trym, United Kingdom
| | - Carter S Gerard
- Department of Neurosurgery, North Bristol Trust, Westbury-on-Trym, United Kingdom
| | - Neil Barua
- Department of Neurosurgery, North Bristol Trust, Westbury-on-Trym, United Kingdom
| | - Reiko Ashida
- Department of Neurosurgery, North Bristol Trust, Westbury-on-Trym, United Kingdom
| | - Max Woolley
- Functional Neurosurgery Group, Clinical Neurosciences, University of Bristol, Bristol, United Kingdom.,Neurological Products Division, Renishaw Plc, Wotton-under-Edge, United Kingdom
| | - Mariusz Pietrzyk
- Neurological Products Division, Renishaw Plc, Wotton-under-Edge, United Kingdom
| | - Steven S Gill
- Functional Neurosurgery Group, Clinical Neurosciences, University of Bristol, Bristol, United Kingdom.,Department of Neurosurgery, North Bristol Trust, Westbury-on-Trym, United Kingdom
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10
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Abstract
In the past decade, efforts to improve blood pressure control have looked beyond conventional approaches of lifestyle modification and drug therapy to embrace interventional therapies. Based upon animal and human studies clearly demonstrating a key role for the sympathetic nervous system in the etiology of hypertension, the newer technologies that have emerged are predominantly aimed at neuromodulation of peripheral nervous system targets. These include renal denervation, baroreflex activation therapy, endovascular baroreflex amplification therapy, carotid body ablation, and pacemaker-mediated programmable hypertension control. Of these, renal denervation is the most mature, and with a recent series of proof-of-concept trials demonstrating the safety and efficacy of radiofrequency and more recently ultrasound-based renal denervation, this technology is poised to become available as a viable treatment option for hypertension in the foreseeable future. With regard to baroreflex activation therapy, endovascular baroreflex amplification, carotid body ablation, and programmable hypertension control, these are developing technologies for which more human data are required. Importantly, central nervous system control of the circulation remains a poorly understood yet vital component of the hypertension pathway and mandates further investigation. Technology to improve blood pressure control through deep brain stimulation of key cardiovascular control territories is, therefore, of interest. Furthermore, alternative nonsympathomodulatory intervention targeting the hemodynamics of the circulation may also be worth exploring for patients in whom sympathetic drive is less relevant to hypertension perpetuation. Herein, we review the aforementioned technologies with an emphasis on the preclinical data that underpin their rationale and the human evidence that supports their use.
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Affiliation(s)
- Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany (F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology (MIT), Cambridge, MA (F.M.)
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Unit, The University of Western Australia, Australia (M.S.)
- Departments of Cardiology (M.S.), Royal Perth Hospital, Australia
- Nephrology (M.S.), Royal Perth Hospital, Australia
- Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (M.S.)
| | - Melvin D Lobo
- William Harvey Research Institute and Barts NIHR Cardiovascular Biomedical Research Centre, Queen Mary University of London, United Kingdom (M.D.L.)
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom (M.D.L.)
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11
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Green AL, Paterson DJ. Using Deep Brain Stimulation to Unravel the Mysteries of Cardiorespiratory Control. Compr Physiol 2020; 10:1085-1104. [PMID: 32941690 DOI: 10.1002/cphy.c190039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article charts the history of deep brain stimulation (DBS) as applied to alleviate a number of neurological disorders, while in parallel mapping the electrophysiological circuits involved in generating and integrating neural signals driving the cardiorespiratory system during exercise. With the advent of improved neuroimaging techniques, neurosurgeons can place small electrodes into deep brain structures with a high degree accuracy to treat a number of neurological disorders, such as movement impairment associated with Parkinson's disease and neuropathic pain. As well as stimulating discrete nuclei and monitoring autonomic outflow, local field potentials can also assess how the neurocircuitry responds to exercise. This technique has provided an opportunity to validate in humans putative circuits previously identified in animal models. The central autonomic network consists of multiple sites from the spinal cord to the cortex involved in autonomic control. Important areas exist at multiple evolutionary levels, which include the anterior cingulate cortex (telencephalon), hypothalamus (diencephalon), periaqueductal grey (midbrain), parabrachial nucleus and nucleus of the tractus solitaries (brainstem), and the intermediolateral column of the spinal cord. These areas receive afferent input from all over the body and provide a site for integration, resulting in a coordinated efferent autonomic (sympathetic and parasympathetic) response. In particular, emerging evidence from DBS studies have identified the basal ganglia as a major sub-cortical cognitive integrator of both higher center and peripheral afferent feedback. These circuits in the basal ganglia appear to be central in coupling movement to the cardiorespiratory motor program. © 2020 American Physiological Society. Compr Physiol 10:1085-1104, 2020.
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Affiliation(s)
- Alexander L Green
- Division of Medical Sciences, Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David J Paterson
- Department of Physiology Anatomy and Genetics, University of Oxford, Oxford, UK
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12
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Li D, Cui Z, Xu S, Xu T, Wu S, Bouakaz A, Wan M, Zhang S. Low-Intensity Focused Ultrasound Stimulation Treatment Decreases Blood Pressure in Spontaneously Hypertensive Rats. IEEE Trans Biomed Eng 2020; 67:3048-3056. [PMID: 32086192 DOI: 10.1109/tbme.2020.2975279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We applied low-intensity focused ultrasound (LIFU) stimulation of the ventrolateral periaqueductal gray (vlPAG) in spontaneously hypertensive rats (SHRs) model to demonstrate the feasibility of LIFU stimulation to decrease blood pressure (BP). METHODS The rats were treated with LIFU stimulation for 20 min every day for one week. The change of BP and heart rate (HR) were recorded to evaluate the antihypertensive effect. Then the plasma levels of epinephrine (EPI), norepinephrine (NE), and angiotensin II (ANGII) were measured to evaluate the activity of the sympathetic nervous system (SNS) and the renin-angiotensin system (RAS). The c-fos immunofluorescence assay was performed to investigate the antihypertensive nerve pathway. Moreover, the biological safety of ultrasound sonication was examined. RESULTS The LIFU stimulation induced a significant reduction of BP in 8 SHRs. The mean systolic blood pressure (SBP) was reduced from 170 ± 4 mmHg to 128 ± 4.5 mmHg after a one-week treatment, p < 0.01. The activity of SNS and RAS were also inhibited. The results of the c-fos immunofluorescence assay showed that US stimulation of the vlPAG significantly enhanced the neuronal activity both in vlPAG and caudal ventrolateral medulla (CVLM) regions. And the US stimulation used in this study did not cause significant tissue damage, hemorrhage and cell apoptosis in the sonication region. CONCLUSION The results support that LIFU stimulation of the vlPAG could relieve hypertension in SHRs. SIGNIFICANCE The LIFU stimulation of the vlPAG could potentially be a new alternative non-invasive device therapy for hypertension.
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Abstract
PURPOSE OF REVIEW To give an overview on recent developments in permanent implant-based therapy of resistant hypertension. RECENT FINDINGS The American Heart Association (AHA) recently updated their guidelines to treat high blood pressure (BP). As elevated BP now is defined as a systolic BP above 120 mmHg, the prevalence of hypertension in the USA has increased from 32% (old definition of hypertension) to 46%. In the past years, device- and implant-mediated therapies have evolved and extensively studied in various patient populations. Despite an initial drawback in a randomized controlled trial (RCT) of bilateral carotid sinus stimulation (CSS), new and less invasive and unilateral systems for baroreflex activation therapy (BAT) with the BAROSTIM NEO® have been developed which show promising results in small non-randomized controlled (RCT) studies. Selective vagal nerve stimulation (VNS) has been successfully evaluated in rodents, but has not yet been tested in humans. A new endovascular approach to reshape the carotid sinus to lower BP (MobiusHD™) has been introduced (baroreflex amplification therapy) with favorable results in non-RCT trials. However, long-term results are not yet available for this treatment option. A specific subgroup of patients, those with indication for a 2-chamber cardiac pacemaker, may benefit from a new stimulation paradigm which reduces the AV latency and therefore limits the filling time of the left ventricle. The most invasive approach for resistant hypertension still is the neuromodulation by deep brain stimulation (DBS), which has been shown to significantly lower BP in single cases. Implant-mediated therapy remains a promising approach for the treatment of resistant hypertension. Due to their invasiveness, such treatment options must prove superiority over conventional therapies with regard to safety and efficacy before they can be generally offered to a wider patient population. Overall, BAROSTIM NEO® and MobiusHD™, for which large RCTs will soon be available, are likely to meet those criteria and may represent the first implant-mediated therapeutical options for hypertension, while the use of DBS probably will be reserved for individual cases. The utility of VNS awaits appropriate assessment.
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Long-term stimulation of cardiac vagal preganglionic neurons reduces blood pressure in the spontaneously hypertensive rat. J Hypertens 2019; 36:2444-2452. [PMID: 30045362 DOI: 10.1097/hjh.0000000000001871] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Arterial hypertension is associated with autonomic nervous system dysfunction. Different interventional strategies have been implemented in recent years for the reduction of sympathetic activity in patients with hypertension. However, the therapeutic benefit of increasing vagal tone in hypertensive patients remains largely unexplored. OBJECTIVE Here, we describe the effects of long-term activation of vagal neural pathways on arterial pressure, heart rate arterial pressure variability and spontaneous baroreflex sensitivity in spontaneously hypertensive rats (SHR) and normotensive Wistar rats. METHODS Brainstem vagal preganglionic neurons residing in the dorsal vagal motor nucleus (DVMN) were targeted with a lentiviral vector to induce the expression of an artificial G(s) protein-coupled receptor termed designer receptors exclusively activated by designer drugs (DREADD-Gs). The transduced neurons were activated daily by systemic administration of otherwise inert ligand clozapine-n-oxide. Arterial pressure measurements were recorded in conscious freely moving animals after 21 consecutive days of DVMN stimulation. RESULTS Resting arterial pressure was significantly lower in SHRs expressing DREADD-Gs in the DVMN, compared with control SHRs expressing enhanced green fluorescent protein. No changes in arterial pressure were detected in Wistar rats expressing DREADD-Gs compared with rats expressing enhanced green fluorescent protein in the DVMN. Pharmacogenetic activation of DREADD-Gs-expressing DVMN neurons in SHRs was accompanied with increased baroreflex sensitivity and a paradoxical decrease in cardio-vagal components of heart rate and systolic arterial pressure variability in SHRs. CONCLUSION These results suggest that long-term activation of vagal parasympathetic pathways is beneficial in restoring autonomic balance in an animal model of neurogenic hypertension and might be an effective therapeutic approach for the management of hypertension.
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Farrell SM, Green A, Aziz T. The Use of Neuromodulation for Symptom Management. Brain Sci 2019; 9:brainsci9090232. [PMID: 31547392 PMCID: PMC6769574 DOI: 10.3390/brainsci9090232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 01/23/2023] Open
Abstract
Pain and other symptoms of autonomic dysregulation such as hypertension, dyspnoea and bladder instability can lead to intractable suffering. Incorporation of neuromodulation into symptom management, including palliative care treatment protocols, is becoming a viable option scientifically, ethically, and economically in order to relieve suffering. It provides further opportunity for symptom control that cannot otherwise be provided by pharmacology and other conventional methods.
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Affiliation(s)
- Sarah Marie Farrell
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Alexander Green
- Nuffield department of clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Tipu Aziz
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
- Nuffield department of clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
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16
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Lacuey N, Hampson JP, Theeranaew W, Zonjy B, Vithala A, Hupp NJ, Loparo KA, Miller JP, Lhatoo SD. Cortical Structures Associated With Human Blood Pressure Control. JAMA Neurol 2019; 75:194-202. [PMID: 29181526 DOI: 10.1001/jamaneurol.2017.3344] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance A better understanding of the role of cortical structures in blood pressure control may help us understand cardiovascular collapse that may lead to sudden unexpected death in epilepsy (SUDEP). Objective To identify cortical control sites for human blood pressure regulation. Design, Setting, and Participants Patients with intractable epilepsy undergoing intracranial electrode implantation as a prelude to epilepsy surgery in the Epilepsy Monitoring Unit at University Hospitals Cleveland Medical Center were potential candidates for this study. Inclusion criteria were patients 18 years or older who had electrodes implanted in one or more of the regions of interest and in whom deep brain electrical stimulation was indicated for mapping of ictal onset or eloquent cortex as a part of the presurgical evaluation. Twelve consecutive patients were included in this prospective case series from June 1, 2015, to February 28, 2017. Main Outcomes and Measures Changes in continuous, noninvasive, beat-by-beat blood pressure parameter responses from amygdala, hippocampal, insular, orbitofrontal, temporal, cingulate, and subcallosal stimulation. Electrocardiogram, arterial oxygen saturation, end-tidal carbon dioxide, nasal airflow, and abdominal and thoracic plethysmography were monitored. Results Among 12 patients (7 female; mean [SD] age, 44.25 [12.55] years), 9 electrodes (7 left and 2 right) all in Brodmann area 25 (subcallosal neocortex) in 4 patients produced striking systolic hypotensive changes. Well-maintained diastolic arterial blood pressure and narrowed pulse pressure indicated stimulation-induced reduction in sympathetic drive and consequent probable reduction in cardiac output rather than bradycardia or peripheral vasodilation-induced hypotension. Frequency-domain analysis of heart rate and blood pressure variability showed a mixed picture. No other stimulated structure produced significant blood pressure changes. Conclusions and Relevance These findings suggest that Brodmann area 25 has a role in lowering systolic blood pressure in humans. It is a potential symptomatogenic zone for peri-ictal hypotension in patients with epilepsy.
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Affiliation(s)
- Nuria Lacuey
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Johnson P Hampson
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Wanchat Theeranaew
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Cleveland, Ohio.,Department of Electrical Engineering and Computer Sciences, Case School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Bilal Zonjy
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Cleveland, Ohio
| | - Ajay Vithala
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Norma J Hupp
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kenneth A Loparo
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Cleveland, Ohio.,Department of Electrical Engineering and Computer Sciences, Case School of Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Jonathan P Miller
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Samden D Lhatoo
- Epilepsy Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Cleveland, Ohio
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17
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Cardiovascular autonomic responses in patients with Parkinson disease to pedunculopontine deep brain stimulation. Clin Auton Res 2019; 29:615-624. [DOI: 10.1007/s10286-019-00634-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/22/2019] [Indexed: 11/26/2022]
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18
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Ems R, Garg A, Ostergard TA, Miller JP. Potential Deep Brain Stimulation Targets for the Management of Refractory Hypertension. Front Neurosci 2019; 13:93. [PMID: 30858796 PMCID: PMC6397890 DOI: 10.3389/fnins.2019.00093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/25/2019] [Indexed: 11/13/2022] Open
Abstract
Hypertension is the single greatest contributor to human disease and mortality affecting over 75 million people in the United States alone. Hypertension is defined according to the American College of Cardiology as systolic blood pressure (SBP) greater than 120 mm Hg and diastolic blood pressure (DBP) above 80 mm Hg measured on two separate occasions. While there are multiple medication classes available for blood pressure control, fewer than 50% of hypertensive patients maintain appropriate control. In fact, 0.5% of patients are refractory to medical treatment which is defined as uncontrolled blood pressure despite treatment with five classes of antihypertensive agents. With new guidelines to define hypertension that will increase the incidence of hypertension world-wide, the prevalence of refractory hypertension is expected to increase. Thus, investigation into alternative methods of blood pressure control will be crucial to reduce comorbidities such as higher risk of myocardial infarction, cardiovascular accident, aneurysm formation, heart failure, coronary artery disease, end stage renal disease, arrhythmia, left ventricular hypertrophy, intracerebral hemorrhage, hypertensive enchaphelopathy, hypertensive retinopathy, glomerulosclerosis, limb loss due to arterial occlusion, and sudden death. Recently, studies demonstrated efficacious treatment of neurological diseases with deep brain stimulation (DBS) for Tourette's, depression, intermittent explosive disorder, epilepsy, chronic pain, and headache as these diseases have defined neurophysiology with anatomical targets. Currently, clinical applications of DBS is limited to neurological conditions as such conditions have well-defined neurophysiology and anatomy. However, rapidly expanding knowledge about neuroanatomical controls of systemic conditions such as hypertension are expanding the possibilities for DBS neuromodulation. Within the central autonomic network (CAN), multiple regions play a role in homeostasis and blood pressure control that could be DBS targets. While the best defined autonomic target is the ventrolateral periaqueductal gray matter, other targets including the subcallosal neocortex, subthalamic nucleus (STN), posterior hypothalamus, rostrocaudal cingulate gyrus, orbitofrontal gyrus, and insular cortex are being further characterized as potential targets. This review aims to summarize the current knowledge regarding neurologic contribution to the pathophysiology of hypertension, delineate the complex interactions between neuroanatomic structures involved in blood pressure homeostasis, and then discuss the potential for using DBS as a treatment for refractory hypertension.
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Affiliation(s)
| | | | | | - Jonathan P. Miller
- Department of Neurological Surgery, Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
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19
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Hart EC. Human hypertension, sympathetic activity and the selfish brain. Exp Physiol 2018; 101:1451-1462. [PMID: 27519960 DOI: 10.1113/ep085775] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/10/2016] [Indexed: 12/19/2022]
Abstract
NEW FINDINGS What is the topic of this review? This review article revisits an historical hypothesis that cerebral hypoperfusion, caused by elevated cerebral vascular resistances, causes the onset of high sympathetic nerve activity and hypertension in humans. What advances does it highlight? The review article highlights new evidence indicating that congenital cerebrovascular abnormalities, namely vertebral artery hypoplasia and an incomplete posterior circle of Willis, may play a role in the onset of hypertension. Despite the harmful consequences of high blood pressure (hypertension; e.g. stroke, renal failure, dementia and even death), the underlying physiological mechanisms that cause the onset of hypertension are poorly understood. The most established finding is that hypertension occurs alongside activation of the sympathetic nervous system, yet exactly what triggers this in humans is ambiguous. This review discusses evidence for elevated sympathetic nerve activity, particularly in human hypertension, and revisits an historical theory regarding the aetiology underlying human hypertension that was proposed by Seymour Kety and John Dickinson in the 1940s-1950s. My research group hypothesizes that elevated sympathetic nerve activity and hypertension develop as a fundamental mechanism to maintain adequate cerebral blood flow, which is now termed Cushing's mechanism or the selfish brain hypothesis. Moreover, it goes against the traditional belief that high cerebrovascular resistance is a consequence of hypertension; we propose that this elevated resistance drives hypertension. This review discusses historical and new evidence in animals and humans supporting this hypothesis. In particular, unique human data indicating a higher prevalence of congenital cerebral vascular abnormalities in hypertension are considered.
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Affiliation(s)
- Emma C Hart
- School of Physiology, Pharmacology and Neuroscience, Clinical Research and Imaging Centre, University of Bristol, Bristol, UK
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20
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Abstract
Hypertension continues to be a major contributor to global morbidity and mortality, fuelled by an abundance of patients with uncontrolled blood pressure despite the multitude of pharmacological options available. This may occur as a consequence of true resistant hypertension, through an inability to tolerate current pharmacological therapies, or non-adherence to antihypertensive medication. In recent years, there has been a rapid expansion of device-based therapies proposed as novel non-pharmacological approaches to treating resistant hypertension. In this review, we discuss seven novel devices—renal nerve denervation, baroreflex activation therapy, carotid body ablation, central iliac arteriovenous anastomosis, deep brain stimulation, median nerve stimulation, and vagal nerve stimulation. We highlight how the devices differ, the varying degrees of evidence available to date and upcoming trials. This review also considers the possible factors that may enable appropriate device selection for different hypertension phenotypes.
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Affiliation(s)
- Fu L Ng
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK.,Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, William Harvey Research Institute, Queen Mary University London, London, EC1M 6BQ, UK
| | - Manish Saxena
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK.,Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, William Harvey Research Institute, Queen Mary University London, London, EC1M 6BQ, UK
| | - Felix Mahfoud
- Department of Internal Medicine, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Atul Pathak
- Department of Cardiovascular Medicine, Hypertension and Heart Failure Unit, Health Innovation Lab (Hi-Lab) Clinique Pasteur, Toulouse, France
| | - Melvin D Lobo
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK. .,Barts NIHR Cardiovascular Biomedical Research Unit, Charterhouse Square, William Harvey Research Institute, Queen Mary University London, London, EC1M 6BQ, UK.
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21
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Geuter S, Koban L, Wager TD. The Cognitive Neuroscience of Placebo Effects: Concepts, Predictions, and Physiology. Annu Rev Neurosci 2017; 40:167-188. [PMID: 28399689 DOI: 10.1146/annurev-neuro-072116-031132] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Placebos have been used ubiquitously throughout the history of medicine. Expectations and associative learning processes are important psychological determinants of placebo effects, but their underlying brain mechanisms are only beginning to be understood. We examine the brain systems underlying placebo effects on pain, autonomic, and immune responses. The ventromedial prefrontal cortex (vmPFC), insula, amygdala, hypothalamus, and periaqueductal gray emerge as central brain structures underlying placebo effects. We argue that the vmPFC is a core element of a network that represents structured relationships among concepts, providing a substrate for expectations and a conception of the situation-the self in context-that is crucial for placebo effects. Such situational representations enable multidimensional predictions, or priors, that are combined with incoming sensory information to construct percepts and shape motivated behavior. They influence experience and physiology via descending pathways to physiological effector systems, including the spinal cord and other peripheral organs.
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Affiliation(s)
- Stephan Geuter
- Institute of Cognitive Science, University of Colorado, Boulder, Colorado 80309; , , .,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado 80309
| | - Leonie Koban
- Institute of Cognitive Science, University of Colorado, Boulder, Colorado 80309; , , .,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado 80309
| | - Tor D Wager
- Institute of Cognitive Science, University of Colorado, Boulder, Colorado 80309; , , .,Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado 80309
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23
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Roy HA, Green AL, Aziz TZ. State of the Art: Novel Applications for Deep Brain Stimulation. Neuromodulation 2017; 21:126-134. [DOI: 10.1111/ner.12604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/19/2017] [Accepted: 03/11/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Holly A. Roy
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
| | - Alexander L. Green
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
| | - Tipu Z. Aziz
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
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24
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McBryde FD, Hart EC, Ramchandra R, Paton JF. Evaluating the carotid bodies and renal nerves as therapeutic targets for hypertension. Auton Neurosci 2017; 204:126-130. [DOI: 10.1016/j.autneu.2016.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 11/30/2022]
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25
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Lobo MD, Sobotka PA, Pathak A. Interventional procedures and future drug therapy for hypertension. Eur Heart J 2017; 38:1101-1111. [PMID: 27406184 PMCID: PMC5400047 DOI: 10.1093/eurheartj/ehw303] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/09/2016] [Accepted: 06/16/2016] [Indexed: 02/06/2023] Open
Abstract
Hypertension management poses a major challenge to clinicians globally once non-drug (lifestyle) measures have failed to control blood pressure (BP). Although drug treatment strategies to lower BP are well described, poor control rates of hypertension, even in the first world, suggest that more needs to be done to surmount the problem. A major issue is non-adherence to antihypertensive drugs, which is caused in part by drug intolerance due to side effects. More effective antihypertensive drugs are therefore required which have excellent tolerability and safety profiles in addition to being efficacious. For those patients who either do not tolerate or wish to take medication for hypertension or in whom BP control is not attained despite multiple antihypertensives, a novel class of interventional procedures to manage hypertension has emerged. While most of these target various aspects of the sympathetic nervous system regulation of BP, an additional procedure is now available, which addresses mechanical aspects of the circulation. Most of these new devices are supported by early and encouraging evidence for both safety and efficacy, although it is clear that more rigorous randomized controlled trial data will be essential before any of the technologies can be adopted as a standard of care.
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Affiliation(s)
- Melvin D. Lobo
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Paul A. Sobotka
- The Ohio State University, Columbus, OH, USA
- ROX Medical, San Clemente, CA, USA
| | - Atul Pathak
- Department of Cardiovascular Medicine, Hypertension and Heart Failure Unit, Health Innovation Lab (Hi-Lab) Clinique Pasteur, Toulouse, France
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O'Callaghan EL, Hart EC, Sims-Williams H, Javed S, Burchell AE, Papouchado M, Tank J, Heusser K, Jordan J, Menne J, Haller H, Nightingale AK, Paton JFR, Patel NK. Chronic Deep Brain Stimulation Decreases Blood Pressure and Sympathetic Nerve Activity in a Drug- and Device-Resistant Hypertensive Patient. Hypertension 2017; 69:522-528. [PMID: 28242717 DOI: 10.1161/hypertensionaha.116.08972] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erin L O'Callaghan
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Emma C Hart
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Hugh Sims-Williams
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Shazia Javed
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Amy E Burchell
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Mark Papouchado
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Jens Tank
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Karsten Heusser
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Jens Jordan
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Jan Menne
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Hermann Haller
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Angus K Nightingale
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Julian F R Paton
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.)
| | - Nikunj K Patel
- From the School of Physiology and Pharmacology (E.L.O'C., E.C.H., J.F.R.P.), CardioNomics, Clinical Research and Imaging Centre (E.C.H., A.E.B., A.K.N., J.F.R.P.), University of Bristol, United Kingdom; Department of Neurosurgery (H.S.-W., S.J., N.K.P.), Department of Cardiology (M.P.), North Bristol NHS Trust, Southmead Hospital, United Kingdom; Department of Cardiology, Bristol Heart Institute, United Kingdom (A.E.B., A.K.N.); Institute for Clinical Pharmacology (J.T., K.H., J.J.) and Department of Nephrology (J.M., H.H.), Hannover Medical School, Germany; and Institute for Aerospace Medicine, German Center for Aerospace Medicine, Cologne, Germany (J.T., J.J.).
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27
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Device Therapies for Resistant Hypertension. Clin Ther 2016; 38:2152-2158. [DOI: 10.1016/j.clinthera.2016.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/21/2016] [Accepted: 08/31/2016] [Indexed: 12/18/2022]
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Purinergic receptors in the carotid body as a new drug target for controlling hypertension. Nat Med 2016; 22:1151-1159. [PMID: 27595323 DOI: 10.1038/nm.4173] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/27/2016] [Indexed: 11/09/2022]
Abstract
In view of the high proportion of individuals with resistance to antihypertensive medication and/or poor compliance or tolerance of this medication, new drugs to treat hypertension are urgently needed. Here we show that peripheral chemoreceptors generate aberrant signaling that contributes to high blood pressure in hypertension. We discovered that purinergic receptor P2X3 (P2rx3, also known as P2x3) mRNA expression is upregulated substantially in chemoreceptive petrosal sensory neurons in rats with hypertension. These neurons generate both tonic drive and hyperreflexia in hypertensive (but not normotensive) rats, and both phenomena are normalized by the blockade of P2X3 receptors. Antagonism of P2X3 receptors also reduces arterial pressure and basal sympathetic activity and normalizes carotid body hyperreflexia in conscious rats with hypertension; no effect was observed in rats without hypertension. We verified P2X3 receptor expression in human carotid bodies and observed hyperactivity of carotid bodies in individuals with hypertension. These data support the identification of the P2X3 receptor as a potential new target for the control of human hypertension.
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29
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Basiago A, Binder DK. Effects of Deep Brain Stimulation on Autonomic Function. Brain Sci 2016; 6:brainsci6030033. [PMID: 27537920 PMCID: PMC5039462 DOI: 10.3390/brainsci6030033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 12/22/2022] Open
Abstract
Over the course of the development of deep brain stimulation (DBS) into a well-established therapy for Parkinson's disease, essential tremor, and dystonia, its utility as a potential treatment for autonomic dysfunction has emerged. Dysfunction of autonomic processes is common in neurological diseases. Depending on the specific target in the brain, DBS has been shown to raise or lower blood pressure, normalize the baroreflex, to alter the caliber of bronchioles, and eliminate hyperhidrosis, all through modulation of the sympathetic nervous system. It has also been shown to improve cortical control of the bladder, directly induce or inhibit the micturition reflex, and to improve deglutition and gastric emptying. In this review, we will attempt to summarize the relevant available studies describing these effects of DBS on autonomic function, which vary greatly in character and magnitude with respect to stimulation target.
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Affiliation(s)
- Adam Basiago
- School of Medicine, University of California, Riverside, CA 92521, USA.
| | - Devin K Binder
- Division of Biomedical Sciences, School of Medicine, University of California, 1247 Webber Hall, Riverside, CA 92521, USA.
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30
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Rossi S, Santarnecchi E, Valenza G, Ulivelli M. The heart side of brain neuromodulation. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2016; 374:rsta.2015.0187. [PMID: 27044999 DOI: 10.1098/rsta.2015.0187] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 05/03/2023]
Abstract
Neuromodulation refers to invasive, minimally invasive or non-invasive techniques to stimulate discrete cortical or subcortical brain regions with therapeutic purposes in otherwise intractable patients: for example, thousands of advanced Parkinsonian patients, as well as patients with tremor or dystonia, benefited by deep brain stimulation (DBS) procedures (neural targets: basal ganglia nuclei). A new era for DBS is currently opening for patients with drug-resistant depression, obsessive-compulsive disorders, severe epilepsy, migraine and chronic pain (neural targets: basal ganglia and other subcortical nuclei or associative fibres). Vagal nerve stimulation (VNS) has shown clinical benefits in patients with pharmacoresistant epilepsy and depression. Non-invasive brain stimulation neuromodulatory techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are also being increasingly investigated for their therapeutic potential in several neurological and psychiatric disorders. In this review, we first address the most common neural targets of each of the mentioned brain stimulation techniques, and the known mechanisms of their neuromodulatory action on stimulated brain networks. Then, we discuss how DBS, VNS, rTMS and tDCS could impact on the function of brainstem centres controlling vital functions, critically reviewing their acute and long-term effects on brain sympathetic outflow controlling heart function and blood pressure. Finally, as there is clear experimental evidence in animals that brain stimulation can affect autonomic and heart functions, we will try to give a critical perspective on how it may enhance our understanding of the cortical/subcortical mechanisms of autonomic cardiovascular regulation, and also if it might find a place among therapeutic opportunities in patients with otherwise intractable autonomic dysfunctions.
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Affiliation(s)
- Simone Rossi
- Gaetano Valenza, Monica Ulivelli Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab. (Si-BIN Lab.), Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
| | - Emiliano Santarnecchi
- Gaetano Valenza, Monica Ulivelli Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab. (Si-BIN Lab.), Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Gaetano Valenza
- Department of Information Engineering, and Research Center E. Piaggio, University of Pisa, 56122 Pisa, Italy Neuroscience Statistics Research Lab, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02115, USA Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Monica Ulivelli
- Gaetano Valenza, Monica Ulivelli Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab. (Si-BIN Lab.), Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
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31
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Hering D, Schlaich M. The Role of Central Nervous System Mechanisms in Resistant Hypertension. Curr Hypertens Rep 2016; 17:58. [PMID: 26070453 DOI: 10.1007/s11906-015-0570-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Arterial hypertension remains a primary global health problem with significant impact on cardiovascular morbidity and mortality. The low rate of hypertension control and failure to achieve target blood pressure levels particularly among high-risk patients with resistant hypertension has triggered renewed interest in unravelling the underlying mechanisms to implement therapeutic approaches for better patient management. Here, we summarize the crucial role of neurogenic mechanisms in drug-resistant hypertension, with a specific focus on central control of blood pressure, the factors involved in central integration of afferent signalling to increase sympathetic drive in resistant hypertension, and briefly review recently introduced interventional strategies distinctively targeting sympathetic activation.
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Affiliation(s)
- Dagmara Hering
- School of Medicine and Pharmacology - Royal Perth Hospital Unit, The University of Western Australia, Level 3 MRF Building, Rear 50 Murray Street, Perth, WA, 6000 MDBP: M570, Australia,
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32
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Ratcliffe LEK, Pijacka W, McBryde FD, Abdala AP, Moraes DJ, Sobotka PA, Hart EC, Narkiewicz K, Nightingale AK, Paton JFR. CrossTalk opposing view: Which technique for controlling resistant hypertension? Carotid chemoreceptor denervation/modulation. J Physiol 2015; 592:3941-4. [PMID: 25225253 DOI: 10.1113/jphysiol.2013.268227] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- L E K Ratcliffe
- CardioNomics Research Group, Clinical Research and Imaging Centre and School of Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD, UK
| | - W Pijacka
- CardioNomics Research Group, Clinical Research and Imaging Centre and School of Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD, UK
| | - F D McBryde
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - A P Abdala
- CardioNomics Research Group, Clinical Research and Imaging Centre and School of Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD, UK
| | - D J Moraes
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049-900, SP, Brazil
| | - P A Sobotka
- The Ohio State University, 2015 Marywood Lane West, St Paul, MN, 55118, USA
| | - E C Hart
- CardioNomics Research Group, Clinical Research and Imaging Centre and School of Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD, UK
| | - K Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Debinki 7c, 80-952, Gdansk, Poland
| | - A K Nightingale
- CardioNomics Research Group, Clinical Research and Imaging Centre and School of Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD, UK
| | - J F R Paton
- CardioNomics Research Group, Clinical Research and Imaging Centre and School of Physiology and Pharmacology, University of Bristol, Bristol, BS8 1TD, UK
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33
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O'Callaghan EL, McBryde FD, Burchell AE, Ratcliffe LEK, Nicolae L, Gillbe I, Carr D, Hart EC, Nightingale AK, Patel NK, Paton JFR. Deep brain stimulation for the treatment of resistant hypertension. Curr Hypertens Rep 2015; 16:493. [PMID: 25236853 DOI: 10.1007/s11906-014-0493-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hypertension is a leading risk factor for the development of several cardiovascular diseases. As the global prevalence of hypertension increases, so too has the recognition of resistant hypertension. Whilst figures vary, the proportion of hypertensive patients that are resistant to multiple drug therapies have been reported to be as high as 16.4 %. Resistant hypertension is typically associated with elevated sympathetic activity and abnormal homeostatic reflex control and is termed neurogenic hypertension because of its presumed central autonomic nervous system origin. This resistance to conventional pharmacological treatment has stimulated a plethora of medical devices to be investigated for use in hypertension, with varying degrees of success. In this review, we discuss a new therapy for drug-resistant hypertension, deep brain stimulation. The utility of deep brain stimulation in resistant hypertension was first discovered in patients with concurrent neuropathic pain, where it lowered blood pressure and improved baroreflex sensitivity. The most promising central target for stimulation is the ventrolateral periaqueductal gray, which has been well characterised in animal studies as a control centre for autonomic outflow. In this review, we will discuss the promise and potential mechanisms of deep brain stimulation in the treatment of severe, resistant hypertension.
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Affiliation(s)
- Erin L O'Callaghan
- School of Physiology & Pharmacology, University of Bristol, Bristol, BS8 1TD, UK
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34
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Wachter R, Menne J. Interventionelle Strategien zur Behandlung der Hypertonie. Internist (Berl) 2015; 56:240-7. [DOI: 10.1007/s00108-014-3569-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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35
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Li Y, Li H, Gao Q, Yuan D, Zhao J. Structural gray matter change early in male patients with HIV. Int J Clin Exp Med 2014; 7:3362-3369. [PMID: 25419369 PMCID: PMC4238549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 08/26/2014] [Indexed: 06/04/2023]
Abstract
The purpose of this study is to characterize brain gray matter volumetric changes in HIV seropositive without neurocognitive impairment and seronegative men in Asia. We investigate 36 males with HIV seropositive (mean age 34.5±9.1 years) and 33 age- and gender-matched seronegative controls (mean age 31.4±7.6 years) in Asia. The cognitive competence of 36 males with HIV seropositive has no impaired based on performance in the international HIV dementia scale. High-resolution T1-weighted magnetic resonance imaging is performed on a 3.0 T MR system using a standard 32-channel birdcage head coil. Voxel-based morphometry is used to derive volumetric measurements at the level of the individual voxel (p < 0.001, none corrected for multiple comparisons). Compared to the control group, HIV seropositive male lower gray matter volumes are found in left inferior frontal gyrus triangular part and orbital part, left superior temporal gyrus, right middle frontal gyrus and ant cingulum; significant increases gray matter volumes can be seen in Periaqueductal gray and gray around lateral ventricle. HIV infection can change the gray matter volume early without cognitive competence impaired and MR can recognize that changes.
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Affiliation(s)
- Yunfang Li
- Department of Radiology, Affiliated Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Hongjun Li
- Department of Radiology, Affiliated Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Quansheng Gao
- Laboratory of The Animal Center, Academy of Military Medical SciencesBeijing, China
| | - Da Yuan
- Department of Radiology, Affiliated Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Jing Zhao
- Department of Radiology, Affiliated Beijing You’an Hospital, Capital Medical University, Beijing, China
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36
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Johansson V, Garwicz M, Kanje M, Halldenius L, Schouenborg J. Thinking Ahead on Deep Brain Stimulation: An Analysis of the Ethical Implications of a Developing Technology. AJOB Neurosci 2014; 5:24-33. [PMID: 24587963 PMCID: PMC3933012 DOI: 10.1080/21507740.2013.863243] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Deep brain stimulation (DBS) is a developing technology. New generations of DBS technology are already in the pipeline, yet this particular fact has been largely ignored among ethicists interested in DBS. Focusing only on ethical concerns raised by the current DBS technology is, albeit necessary, not sufficient. Since current bioethical concerns raised by a specific technology could be quite different from the concerns it will raise a couple of years ahead, an ethical analysis should be sensitive to such alterations, or it could end up with results that soon become dated. The goal of this analysis is to address these changing bioethical concerns, to think ahead on upcoming and future DBS concerns both in terms of a changing technology and changing moral attitudes. By employing the distinction between inherent and noninherent bioethical concerns we identify and make explicit the particular limits and potentials for change within each category, respectively, including how present and upcoming bioethical concerns regarding DBS emerge and become obsolete. Many of the currently identified ethical problems with DBS, such as stimulation-induced mania, are a result of suboptimal technology. These challenges could be addressed by technical advances, while for instance perceptions of an altered body image caused by the mere awareness of having an implant may not. Other concerns will not emerge until the technology has become sophisticated enough for new uses to be realized, such as concerns on DBS for enhancement purposes. As a part of the present analysis, concerns regarding authenticity are used as an example.
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37
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Hyam JA, Aziz TZ, Green AL. Control of the lungs via the human brain using neurosurgery. PROGRESS IN BRAIN RESEARCH 2014; 209:341-66. [PMID: 24746057 DOI: 10.1016/b978-0-444-63274-6.00018-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neurosurgery can alter cardiorespiratory performance via central networks and includes deep brain stimulation (DBS), a routinely employed therapy for movement disorders and chronic pain syndromes. We review the established cardiovascular effects of DBS and the presumed mechanism by which they are produced via the central autonomic network. We then review the respiratory effects of DBS, including modulation of respiratory rate and lung function indices, and the mechanisms via which these may occur. We conclude by highlighting the potential future therapeutic applications of DBS for intractable airway diseases.
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Affiliation(s)
- Jonathan A Hyam
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
| | - Tipu Z Aziz
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alexander L Green
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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38
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Affiliation(s)
- Thelma Lovick
- Physiology and Pharmacology; University of Bristol; Bristol BS8 1TD UK
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39
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Schroeder C, Heusser K, Brinkmann J, Menne J, Oswald H, Haller H, Jordan J, Tank J, Luft FC. Truly Refractory Hypertension. Hypertension 2013; 62:231-5. [DOI: 10.1161/hypertensionaha.113.01240] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Christoph Schroeder
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Karsten Heusser
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Julia Brinkmann
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Jan Menne
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Hanno Oswald
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Hermann Haller
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Jens Jordan
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Jens Tank
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
| | - Friedrich C. Luft
- From the Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (C.S., K.H., J.B., J.J., J.T.); Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany (J.M., H.H.); Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (H.O.); Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN (F.C.L.); and Experimental Clinical Research Center, Charité Berlin-Buch, Germany (C.S., F.C.L.)
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Santisteban MM, Zubcevic J, Baekey DM, Raizada MK. Dysfunctional brain-bone marrow communication: a paradigm shift in the pathophysiology of hypertension. Curr Hypertens Rep 2013; 15:377-89. [PMID: 23715920 PMCID: PMC3714364 DOI: 10.1007/s11906-013-0361-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
It is widely accepted that the pathophysiology of hypertension involves autonomic nervous system dysfunction, as well as a multitude of immune responses. However, the close interplay of these systems in the development and establishment of high blood pressure and its associated pathophysiology remains elusive and is the subject of extensive investigation. It has been proposed that an imbalance of the neuro-immune systems is a result of an enhancement of the "proinflammatory sympathetic" arm in conjunction with dampening of the "anti-inflammatory parasympathetic" arm of the autonomic nervous system. In addition to the neuronal modulation of the immune system, it is proposed that key inflammatory responses are relayed back to the central nervous system and alter the neuronal communication to the periphery. The overall objective of this review is to critically discuss recent advances in the understanding of autonomic immune modulation, and propose a unifying hypothesis underlying the mechanisms leading to the development and maintenance of hypertension, with particular emphasis on the bone marrow, as it is a crucial meeting point for neural, immune, and vascular networks.
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Affiliation(s)
- Monica M. Santisteban
- Department of Physiology and Functional Genomics, University of Florida, College of Medicine. 1600 SW Archer Road, PO Box 100274, Gainesville, FL 32610
| | - Jasenka Zubcevic
- Department of Physiology and Functional Genomics, University of Florida, College of Medicine. 1600 SW Archer Road, PO Box 100274, Gainesville, FL 32610
| | - David M. Baekey
- Department of Physiological Sciences, University of Florida, College of Veterinary Medicine. 1600 SW Archer Road, PO Box 100144, Gainesville, FL 32610
| | - Mohan K. Raizada
- Department of Physiology and Functional Genomics, University of Florida, College of Medicine. 1600 SW Archer Road, PO Box 100274, Gainesville, FL 32610
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Sobotka PA, Osborn JW, Paton JF. Restoring autonomic balance: future therapeutic targets. EUROINTERVENTION 2013; 9 Suppl R:R140-8. [DOI: 10.4244/eijv9sra24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Paton JFR, Sobotka PA, Fudim M, Engelman ZJ, Engleman ZJ, Hart ECJ, McBryde FD, Abdala AP, Marina N, Gourine AV, Lobo M, Patel N, Burchell A, Ratcliffe L, Nightingale A. The carotid body as a therapeutic target for the treatment of sympathetically mediated diseases. Hypertension 2012; 61:5-13. [PMID: 23172927 DOI: 10.1161/hypertensionaha.111.00064] [Citation(s) in RCA: 218] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Julian F R Paton
- School of Physiology and Pharmacology, Bristol Heart Institute, University of Bristol, Bristol BS8 1TD, United Kingdom.
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Hyam JA, Kringelbach ML, Silburn PA, Aziz TZ, Green AL. The autonomic effects of deep brain stimulation--a therapeutic opportunity. Nat Rev Neurol 2012; 8:391-400. [PMID: 22688783 DOI: 10.1038/nrneurol.2012.100] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Deep brain stimulation (DBS) is an expanding field in neurosurgery and has already provided important insights into the fundamental mechanisms underlying brain function. One of the most exciting emerging applications of DBS is modulation of blood pressure, respiration and micturition through its effects on the autonomic nervous system. DBS stimulation at various sites in the central autonomic network produces rapid changes in the functioning of specific organs and physiological systems that are distinct from its therapeutic effects on central nervous motor and sensory systems. For example, DBS modulates several parameters of cardiovascular function, including heart rate, blood pressure, heart rate variability, baroreceptor sensitivity and blood pressure variability. The beneficial effects of DBS also extend to improvements in lung function. This article includes an overview of the anatomy of the central autonomic network, which consists of autonomic nervous system components in the cortex, diencephalon and brainstem that project to the spinal cord or cranial nerves. The effects of DBS on physiological functioning (particularly of the cardiovascular and respiratory systems) are discussed, and the potential for these findings to be translated into therapies for patients with autonomic diseases is examined.
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Affiliation(s)
- Jonathan A Hyam
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Department of Psychiatry, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK.
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Jordan J, Grassi G. Sometimes you simply have to wait: sympathetic activity in women with hypertensive pregnancies. J Hypertens 2012; 30:1111-3. [PMID: 22573079 DOI: 10.1097/hjh.0b013e328353e104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tam GM, Yan BP, Shetty SV, Lam YY. Transcatheter renal artery sympathetic denervation for resistant hypertension: an old paradigm revisited. Int J Cardiol 2012; 164:277-81. [PMID: 22336259 DOI: 10.1016/j.ijcard.2012.01.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 01/22/2012] [Indexed: 02/08/2023]
Abstract
Resistant hypertension, defined as the failure to achieve target blood pressure despite concurrent use of 3 antihypertensive agents of different classes, is estimated to affect 20-30% of hypertensive patients. These patients are vulnerable to cardiovascular, cerebrovascular and renal complications. There is ample evidence that sympathetic nervous system hyperactivity contributes to the initiation, maintenance and progression of hypertension. The renal sympathetic nervous system, in particular, has been identified as a major culprit for the development and progression of hypertension, heart failure and chronic kidney disease in both preclinical and human studies. Traditional surgical sympathectomy proposed in 1940s was halted due to unacceptable operative risk and the emergence of anti-hypertensive medications. Recently, catheter-based renal sympathetic denervation by radiofrequency ablation has shown encouraging intermediate-term results with minimal complications in patients with resistant hypertension. This review summarizes the patho-physiological role of the renal sympathetic nervous system and the potential application of renal denervation therapy for the treatment of resistant hypertension.
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Affiliation(s)
- Guang-Ming Tam
- Prince of Wales Hospital, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
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The sympathetic nervous system and blood pressure in humans: implications for hypertension. J Hum Hypertens 2011; 26:463-75. [PMID: 21734720 DOI: 10.1038/jhh.2011.66] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A neurogenic component to primary hypertension (hypertension) is now well established. Along with raised vasomotor tone and increased cardiac output, the chronic activation of the sympathetic nervous system in hypertension has a diverse range of pathophysiological consequences independent of any increase in blood pressure. This review provides a perspective on the actions and interactions of angiotensin II, inflammation and vascular dysfunction/brain hypoperfusion in the pathogenesis and progression of neurogenic hypertension. The optimisation of current treatment strategies and the exciting recent developments in the therapeutic targeting of the sympathetic nervous system to control hypertension (for example, catheter-based renal denervation and carotid baroreceptor stimulation) will be outlined.
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