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Kiuchi MG, Carnagarin R, Matthews VB, Schlaich MP. Multi-organ denervation: a novel approach to combat cardiometabolic disease. Hypertens Res 2023; 46:1747-1758. [PMID: 37088807 PMCID: PMC10319631 DOI: 10.1038/s41440-023-01287-x] [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: 10/06/2022] [Revised: 02/17/2023] [Accepted: 04/02/2023] [Indexed: 04/25/2023]
Abstract
Cardiometabolic disorders are associated with a substantial loss in quality of life and pose a large burden on healthcare systems worldwide. Overactivation of the sympathetic nervous system has been shown to be a key player in several aspects relating to cardiometabolic disturbances. While diet- and exercise-induced approaches to help reduce weight remains the main strategy to combat metabolic disorders, this is often difficult to achieve. Current pharmacological approaches result in variable responses in different patient cohorts and long-term efficacy may be limited by medication side effects and non-adherence in the long term. There is a clear clinical need for complementary therapies to curb the burden of cardiometabolic disease. One such approach may include interventional sympathetic neuromodulation of organs relevant to cardiometabolic control. Data from sham-controlled clinical trials demonstrate the feasibility, safety and efficacy of catheter-based renal denervation. In analogy, denervation of the common hepatic artery is now feasible in humans and may prove to be similarly useful in modulating sympathetic overdrive directed towards the liver, pancreas and duodenum. Such a targeted multi-organ neuromodulation strategy may beneficially influence multiple aspects of the cardiometabolic disease continuum including blood pressure, glucose and lipid control.
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Affiliation(s)
- Márcio Galindo Kiuchi
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, WA, Australia.
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia.
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
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Asirvatham-Jeyaraj N, Fiege JK, Han R, Foss J, Banek CT, Burbach BJ, Razzoli M, Bartolomucci A, Shimizu Y, Panoskaltsis-Mortari A, Osborn JW. Renal Denervation Normalizes Arterial Pressure With No Effect on Glucose Metabolism or Renal Inflammation in Obese Hypertensive Mice. Hypertension 2016; 68:929-36. [PMID: 27550916 PMCID: PMC5016252 DOI: 10.1161/hypertensionaha.116.07993] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 07/31/2016] [Indexed: 12/18/2022]
Abstract
Hypertension often occurs in concurrence with obesity and diabetes mellitus, commonly referred to as metabolic syndrome. Renal denervation (RDNx) lowers arterial pressure (AP) and improves glucose metabolism in drug-resistant hypertensive patients with high body mass index. In addition, RDNx has been shown to reduce renal inflammation in the mouse model of angiotensin II hypertension. The present study tested the hypothesis that RDNx reduces AP and renal inflammation and improves glucose metabolism in obesity-induced hypertension. Eight-week-old C57BL/6J mice were fed either a low-fat diet (10 kcal%) or a high-fat diet (45 kcal%) for 10 weeks. Body weight, food intake, fasting blood glucose, and glucose metabolism (glucose tolerance test) were measured. In a parallel study, radiotelemeters were implanted in mice for AP measurement. High fat-fed C57BL/6J mice exhibited an inflammatory and metabolic syndrome phenotype, including increased fat mass, increased AP, and hyperglycemia compared with low-fat diet mice. RDNx, but not Sham surgery, normalized AP in high-fat diet mice (115.8±1.5 mm Hg in sham versus 96.6±6.7 mm Hg in RDNx). RDNx had no significant effect on AP in low-fat diet mice. Also, RDNx had no significant effect on glucose metabolism or renal inflammation as measured by the number of CD8, CD4, and T helper cells or levels of inflammatory cytokines in the kidneys. These results indicate that although renal nerves play a role in obesity-induced hypertension, they do not contribute to impaired glucose metabolism or renal inflammation in this model.
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Affiliation(s)
- Ninitha Asirvatham-Jeyaraj
- From the Department of Integrative Biology and Physiology (N.A.-J., R.H., J.F., C.T.B., M.R., A.B., J.W.O.), Laboratory Medicine and Pathology (J.K.F., B.J.B., Y.S.), and Pediatrics (A.P.-M.), University of Minnesota, Minneapolis
| | - Jessica K Fiege
- From the Department of Integrative Biology and Physiology (N.A.-J., R.H., J.F., C.T.B., M.R., A.B., J.W.O.), Laboratory Medicine and Pathology (J.K.F., B.J.B., Y.S.), and Pediatrics (A.P.-M.), University of Minnesota, Minneapolis
| | - Ruijun Han
- From the Department of Integrative Biology and Physiology (N.A.-J., R.H., J.F., C.T.B., M.R., A.B., J.W.O.), Laboratory Medicine and Pathology (J.K.F., B.J.B., Y.S.), and Pediatrics (A.P.-M.), University of Minnesota, Minneapolis
| | - Jason Foss
- From the Department of Integrative Biology and Physiology (N.A.-J., R.H., J.F., C.T.B., M.R., A.B., J.W.O.), Laboratory Medicine and Pathology (J.K.F., B.J.B., Y.S.), and Pediatrics (A.P.-M.), University of Minnesota, Minneapolis
| | - Christopher T Banek
- From the Department of Integrative Biology and Physiology (N.A.-J., R.H., J.F., C.T.B., M.R., A.B., J.W.O.), Laboratory Medicine and Pathology (J.K.F., B.J.B., Y.S.), and Pediatrics (A.P.-M.), University of Minnesota, Minneapolis
| | - Brandon J Burbach
- From the Department of Integrative Biology and Physiology (N.A.-J., R.H., J.F., C.T.B., M.R., A.B., J.W.O.), Laboratory Medicine and Pathology (J.K.F., B.J.B., Y.S.), and Pediatrics (A.P.-M.), University of Minnesota, Minneapolis
| | - Maria Razzoli
- From the Department of Integrative Biology and Physiology (N.A.-J., R.H., J.F., C.T.B., M.R., A.B., J.W.O.), Laboratory Medicine and Pathology (J.K.F., B.J.B., Y.S.), and Pediatrics (A.P.-M.), University of Minnesota, Minneapolis
| | - Alessandro Bartolomucci
- From the Department of Integrative Biology and Physiology (N.A.-J., R.H., J.F., C.T.B., M.R., A.B., J.W.O.), Laboratory Medicine and Pathology (J.K.F., B.J.B., Y.S.), and Pediatrics (A.P.-M.), University of Minnesota, Minneapolis
| | - Yoji Shimizu
- From the Department of Integrative Biology and Physiology (N.A.-J., R.H., J.F., C.T.B., M.R., A.B., J.W.O.), Laboratory Medicine and Pathology (J.K.F., B.J.B., Y.S.), and Pediatrics (A.P.-M.), University of Minnesota, Minneapolis
| | - Angela Panoskaltsis-Mortari
- From the Department of Integrative Biology and Physiology (N.A.-J., R.H., J.F., C.T.B., M.R., A.B., J.W.O.), Laboratory Medicine and Pathology (J.K.F., B.J.B., Y.S.), and Pediatrics (A.P.-M.), University of Minnesota, Minneapolis
| | - John W Osborn
- From the Department of Integrative Biology and Physiology (N.A.-J., R.H., J.F., C.T.B., M.R., A.B., J.W.O.), Laboratory Medicine and Pathology (J.K.F., B.J.B., Y.S.), and Pediatrics (A.P.-M.), University of Minnesota, Minneapolis.
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Sakakura K, Roth A, Ladich E, Shen K, Coleman L, Joner M, Virmani R. Controlled circumferential renal sympathetic denervation with preservation of the renal arterial wall using intraluminal ultrasound: a next-generation approach for treating sympathetic overactivity. EUROINTERVENTION 2015; 10:1230-8. [PMID: 25349043 DOI: 10.4244/eijy14m10_14] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIMS The Paradise Ultrasound Renal Denervation System is a next-generation catheter-based device which was used to investigate whether the target ablation area can be controlled by changing ultrasound energy and duration to optimise nerve injury while preventing damage to the arterial wall. METHODS AND RESULTS Five ultrasound doses were tested in a thermal gel model. Catheter-based ultrasound denervation was performed in 15 swine (29 renal arteries) to evaluate five different doses in vivo, and animals were euthanised at seven days for histopathologic assessment. In the gel model, the peak temperature was highest in the low power-long duration (LP-LD) dose, followed by the mid-low power-mid duration (MLP-MD) dose and the mid-high power-short duration (MHP-SD) dose, and lowest in the mid power-short duration (MP-SD) dose and the high power-ultra short duration (HP-USD) dose. In the animal study, total ablation area was significantly greater in the LP-LD group, followed by the MLP-MD group, and it was least in the HP-USD, MP-SD and MHP-SD groups (p=0.02). Maximum distance was significantly greater in the LP-LD group, followed by the MLP-MD group, the MHP-SD group, and the HP-USD group, and shortest in the MP-SD group (p=0.007). The short spare distance was not different among the five groups (p=0.38). Renal artery damage was minimal, while preserving significant nerve damage in all groups. CONCLUSIONS The Paradise Ultrasound Renal Denervation System is a controllable system where total ablation area and depth of ablation can be optimised by changing ultrasound power and duration while sparing renal arterial tissue damage but allowing sufficient peri-arterial nerve damage.
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Ewen S, Ukena C, Pöss J, Linz D, Böhm M, Mahfoud F. [Interventional hypertension therapy in diabetes mellitus. Effects on blood pressure and glucose metabolism?]. Herz 2014; 39:325-30. [PMID: 24671666 DOI: 10.1007/s00059-014-4088-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hypertension is the most common chronic cardiovascular disease with increasing prevalence all over the world. Despite the availability of many effective antihypertensive drugs, blood pressure control to target values remains low. In the pathophysiology of therapy resistant hypertension, increased activity of the sympathetic nervous system with an imbalance between sympathetic and parasympathetic activity has been identified as a main contributor to the development and maintenance of hypertension. Catheter-based denervation of the renal sympathetic nerves has been described as reducing blood pressure and decreasing sympathetic activity in patients with resistant hypertension. Supplementary beneficial effects on common cardiovascular comorbidities, such as diabetes type 2, have been reported. The present review aims to give an overview about percutaneous renal denervation for treatment of hypertension and potential new therapeutic options to improve glycemic control.
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Affiliation(s)
- S Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str., Geb. 40, 66421, Homburg/Saar, Deutschland
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Linz D, Mahfoud F, Ewen S, Schirmer SH, Reil J, Ukena C, Böhm M. Application in Hypertension of Renal Sympathetic Denervation - A Review. Interv Cardiol 2013; 8:124-126. [PMID: 29588764 DOI: 10.15420/icr.2013.8.2.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Afferent and efferent sympathetic nerves of the kidney located in the adventitia of the renal artery are involved in the regulation of blood pressure and play a pathophysiological role in the progression and maintenance of hypertension. Renal sympathetic denervation is a potent and safe catheter-based therapeutic approach for the treatment of patients with resistant hypertension. Clinical trials of renal sympathetic denervation have shown significant reduction in blood pressure, which was associated with a reduction in local renal norepinephrine spillover as well as a reduction of whole body sympathetic activation in resistant hypertensive patients.
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Affiliation(s)
- Dominik Linz
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Felix Mahfoud
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Sebastian Ewen
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Stephan H Schirmer
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Jan Reil
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Christian Ukena
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
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