Cardiac Ganglia Research Articles

Abstract Mo135: Correlation of Leptin Resistance With Attenuation of Cardiac Vagal Activation in Type 2 Diabetes

Type 2 diabetes mellitus (T2DM) is one of the most prominent diseases impacting individuals worldwide. A leading cause of death for T2DM patients is MI-related ventricular arrhythmia, which is associated with cardiac vagal nerve dysfunction. As T2DM patients exhibit leptin resistance, and leptin signaling has been implicated in heart rate regulation, we set out to characterize changes in cardiac vagal ganglionic neuron activity during development of T2DM and determine leptin signaling’s role in cardiac vagal dysfunction. In this study, T2DM was induced in Sprague-Dawley rats by feeding a high fat diet (HFD) plus a low dose streptozotocin injection. To characterize cardiac dysfunction, we measured arterial baroreflex sensitivity and found that 12 wks post-T2DM induction, rats experienced a diminished baroreflex response (gain max 0.62 ± 0.04 bpm/mm Hg T2DM vs. 2.21 ± 0.14 bpm/mm Hg sham). To determine if the change in baroreflex sensitivity is due to altered cardiac vagal nerve activity, we measured nAChR currents and cell excitability in intracardiac ganglion (ICG) neurons and found that T2DM rat cardiac vagal neurons exhibited reduced nAChR current density (213.9 ± 25.6 pA/pF T2DM vs. 375.5 ± 44.3 pA/pF sham) and action potential frequency (9.1 ± 0.5 spikes/s T2DM vs. 19.9 ± 1.4 spikes/s sham). Furthermore, acetylcholine release from cardiac vagal nerve terminals was attenuated in T2DM rats (0.4 ± 0.16 nM T2DM vs. 1.07 ± 0.12 nM sham). To determine the role of leptin signaling in the decrease of cardiac vagal nerve activity, we examined leptin and leptin receptor levels in ICG at 4, 8, and 12 wks post-T2DM induction. Western blots revealed elevated ICG leptin levels at 4, 8, and 12 wks post-T2DM induction (8.9 ± 0.7, 9.1 ± 1.3, and 11.7 ± 2.1 times sham level, respectively). qRT-PCR revealed reduced levels of leptin receptor transcript at 12 wks post-T2DM induction (48 ± 12% of sham). A reduction of leptin receptor protein in ICG neurons at 12 wks post-T2DM induction was observed using IF microscopy. These data demonstrate that T2DM reduces cardiac vagal nerve activity resulting in diminished control of cardiac functions such as the baroreflex. Furthermore, leptin resistance may play a role in this diminished cardiac function through reductions in leptin receptor levels.

Sulfonylurea receptor coupled conductances alter the performace of two central pattern generating circuits in Cancer borealis.

Neuronal activity and energy supply must maintain a fine balance for neuronal fitness. Various channels of communication between the two could impact network output in different ways. Sulfonylurea receptors (SURs) are a modification of ATP-binding cassette proteins (ABCs) that confer ATP-dependent gating on their associated ion channels. They are widely expressed and link metabolic states directly to neuronal activity. The role they play varies in different circuits, both enabling bursting and inhibiting activity in pathological conditions. The crab, Cancer borealis, has central patterns generators (CPGs) that fire in rhythmic bursts nearly constantly and it is unknown how energy availability influences these networks. The pyloric network of the stomatogastric ganglion (STG) and cardiac ganglion (GC) control rhythmic contractions of the foregut and heart respectively. Pharmacological manipulation of SURs results in opposite effects in the two CPGs. Neuronal firing completely stops in the STG when SUR-associated channels are open, and firing increases when the channels are closed. This results from a decrease in the excitability of pyloric dilator (PD) neurons, which are a part of the pacemaker kernel. The neurons of the CG, paradoxically, increase firing within bursts when SUR-associated channels are opened, and bursting slows when SUR-associated channels are closed. The channel permeability and sensitivities analyses present novel SUR-conductance biophysics, which nevertheless change activity in ways reminiscent of the predominantly studied mammalian receptor/channels. We suggest that SUR-associated conductances allow different neurons to respond to energy states in different ways through a common mechanism.

Restoration of C-type natriuretic peptide and glial fibrillary acidic protein expression in fear centers and intrinsic cardiac ganglia by theta frequency sound during chronic stress in mice

BackgroundC-type natriuretic peptide (CNP) can be altered during stress and has protective effects in both the heart and brain; the functions of both organs can be positively affected by CNP modulation. Low arousal sounds can modulate heart–brain communication and improve stress responses. Here, we aimed to explore the modulation of CNP and glial fibrillary acidic protein (GFAP) and neuroprotective effects of low arousal theta frequency sound (TFS). MethodsChronic stress was induced in mice (n > 4) using four different stressors on alternate days for 15 days, followed by TFS therapy on alternate days. Open field and elevated plus maze tests were administered for the behavioral analysis, and enzyme-linked immunosorbent assay was used to analyze corticosterone, dopamine, and serotonin levels. Hematoxylin and eosin and cresyl violet staining were used for the morphological analysis of brain and heart sections, and immunohistochemistry for GFAP and CNP was performed. ResultsTFS significantly increased the time spent in the open arms during the elevated plus maze (p< 0.05) and improved exploration in the open field test (p < 0.05). In both tests, decision-making times were significantly reduced by TFS. Nuclear morphology and GFAP expression demonstrated significantly reduced gliosis in fear pathways after TFS therapy x. CNP levels were restored in fear pathways but not intrinsic cardiac ganglia (responsible for heart–brain communication) in TFS-treated mice. Brain corticosterone and dopamine levels increased after TFS therapy, reflecting restored motivational behaviors. ConclusionsLow arousal TFS is a potential neuromodulator for treating stress and related complications.

Cardioneuroablation guided by extracardiac vagal stimulation for cardioinhibitory vasovagal syncope

Abstract Introduction Vasovagal Syncope (VVS) is often linked to abnormal autonomic reflexes, with hypervagotonia identified as a key mechanism, especially in cases with pronounced cardioinhibition. Cardioneuroablation (CNA), which involves radiofrequency ablation of cardiac vagal ganglia, targets parasympathetic hyperactivity, offering a promising treatment for recurrent VVS. This study evaluates the effectiveness and safety of anatomically guided CNA, which may provide an alternative treatment option to pacemaker implantation for younger patients with severe cardioinhibitory VVS. Methods Consecutive patients between January 2019 and October 2023 who underwent CNA at two cardiology centers were enrolled. All patients had a history of recurrent syncope, predominantly cardioinhibitory and unresponsive to conventional treatments. Patients showed no signs of conduction system disease, evidenced by normal rate responses in treadmill stress tests and 24-hour Holter monitoring. Electroanatomic mapping of the left atrium and pulmonary veins was performed. Extracardiac vagal stimulation (ECVS) through the right internal jugular vein, with or without atrial pacing, was utilized to assess baseline responses of the sinus and atrioventricular (AV) nodes. The ablation strategy was tailored based on rhythm disturbances triggered by ECVS, using sequential and anatomically guided ablation of ganglionated parasympathetic plexuses. Radiofrequency ablation, conducted with an irrigated catheter, was guided by the ablation index. Acute success was defined as the absence or significant reduction of cardiac parasympathetic response to ECVS, indicated by the elimination of asystole, severe bradycardia, or AV block. The primary endpoint was syncope recurrence during follow-up. Results The study included 25 patients (16 males; mean age 36 ± 12 years). All had documented cardioinhibition, identified through ECG monitoring (N=12), implantable loop recorders (N=5), or head-up tilt tests (N=8). The average number of syncopal episodes per patient in the year preceding ablation was 2.7, ranging from 1 to 10. Ablation was acutely successful in all cases. Post-ablation, there were no immediate complications related to the procedure, except for one convulsion deemed unrelated. Over a mean follow-up of 17 ± 14 months, 23 patients remained syncope-free. Two patients experienced syncope recurrence; despite undergoing a repeat ablation, they eventually required pacemaker implantation. Conclusion The results of this study suggest that CNA guided by ECVS, may offer a promising treatment for patients with refractory cardioinhibitory VVS. While the procedure showed a high rate of acute success and a notable reduction in syncope recurrence, further research is warranted to fully establish its role as an alternative to pacemaker implantation.

Evaluation of heart rate variability at 1-month after pulsed field ablation of atrial fibrillation and comparison with radiofrequency ablation

Abstract Background Pulsed Field Ablation (PFA) of atrial fibrillation (AF) is a nonthermal novel ablative modality in which high-voltage electric pulses are delivered to generate a high myocardial tissue-specific cellular death, with negligible consequences on surrounding structures including ganglionated plexi. The impairment of the cardiac autonomic ganglia after AF ablation with radiofrequency (RF) has been associated with an increase in mean heart rate (HR) and a reduction in heart rate variability (HRV) and might influence the long-term success of AF ablation. Little data is available on the effect of PFA on cardiac autonomic nervous function. Purpose The aim of this study is to investigate whether PFA ablation could lead to different values of HR and HRV compared to RF at 1-month post-ablation 24-hour Holter monitoring. Methods Between January to September 2023, we included consecutive patients undergoing AF ablation with PFA. According to our clinical practice, all patients performed a routine 24-hour Holter monitoring at 1-month post-ablation. Consecutive AF patients treated with RF were used as controls. Patients in treatment with antiarrhythmics or with documented recurrences of AF at 1-month post-ablation Holter monitoring were excluded. Results 22 consecutive PFA patients were compared to 22 consecutive RF controls. There were no differences in demographic, clinical and echocardiographic data between the 2 groups (Table 1). At 1-month post-ablation Holter monitoring (Table 2), PFA patients had significant higher values of VarIndex (2.18±0.9 vs 1.47±0.7, p=0.01), ASDNN/5min (52.37±15.93 vs 37.17±12.96, p&amp;lt;0.01), SDANN/5min (116.50±27.97 vs 96.03±28.38, p=0.04), and SD (128.95±31.31 vs 106.30±29.56, p=0.04). There was no difference in minimum HR (47.00±6.59 vs 50.29±10.25, p=0.21), mean HR (67.77±6.63 vs 69.24±9.71, p=0.56), and maximal HR (115.41±18.12 vs 110.81±16.44, p=0.39). Conclusions PFA leads to higher values of HRV parameters (i.e., VarIndex, ASDNN/5min, SDANN/5min, and SD) at 1-month post-ablation compared to RF. These data suggest a higher preservation of cardiac autonomic function with PFA, in contrast to RF. Whether the preservation of cardiac autonomic function with PFA might lead to higher rate of long-term AF recurrences remains to be determined.Table 1Table 2

Identification of Spinal Afferent Innervation in the Rat Heart: Atria and Ventricles: Anterograde Tracing

The spinal afferent innervation of the heart regulates cardiac functions by sending sensory information from the dorsal root ganglia (DRG) to the brain. However, the distribution and morphology of spinal afferents in the whole heart are not well characterized. The challenges here are: 1) diffculty in surgically accessing the upper thoracic DRG to label only cardiac spinal afferents. 2) handling flat-mounts of whole atria and ventricles (thickness ~850 μm) without using sections or partial tissues that could disrupt the continuity of axonal structures. To overcome these challenges, we injected anterograde tracer dextran biotin (DB) into the left DRG (C8-T3) of male SD rats (3-5 months) and allowed them to recover for 14 days for tracer transportation. Flat-mounts of the left and right atria and ventricles were prepared, and DAB (3,3′-Diaminobenzidine) stained, followed by imaging, tracing, and digitization using the Neurolucida system. Our findings are: In the atria, the DB-labeled axons entered the atria potentially through the left precaval vein (LPCV), with predominant innervation of the left side of the atrial wall and extended their projection towards the auricles, middle region of the atrium, and pulmonary veins. Most of the spinal afferent axons were present in the myocardial layer. Varicose DB-labeled axons were also observed on cardiac targets at different regions, and distinct morphological structures were found. In the cardiac muscle, DB-labeled axons ran mainly in the direction of muscle fibers. Also, varicose axons ran along the small vasculature on the atria. Spinal afferents formed varicose contacts with individual principal neurons within some intrinsic cardiac ganglia (ICG). In the ventricles, DB-labeled axons were present in the left and right ventricles, which ramified and expressed spherical-like varicosities on the cardiac muscle. In both the atria and ventricles, spinal afferent axons formed simple, branching, and complex terminal structures. Thus, our work, for the first time, successfully labeled, traced, and digitized the spinal cardiac afferents in the flat-mounts of whole atria and ventricles, which will provide a foundation for specific labeling of cardiac spinal afferent fibers. In addition, it will lead to the future study of topographical cardiac spinal afferent innervation, functional studies, and their remodeling in pathological conditions. This study was supported by NIH HEAL/SPARC U01 NS113867-01, NIH R15 R15HL137143-01A1, and UCF dissertation completion Fellowships. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Chronic Expression of Interleukin-10 Transgene Modulates Cardiac Sympathetic Ganglion Resulting in Reduced Ventricular Arrhythmia.

The cardiac autonomic nervous system (CANS) is intimately connected to the regulation of electrophysiology and arrhythmogenesis in cardiac systems. This work aimed at investigating whether interleukin-10 (IL-10) could effectively modulate CANS and suppress ischemia-induced ventricular arrhythmia (VA) through chronically acting on the cardiac sympathetic ganglion (CSG). Using an adeno-associated virus (AAV), we achieved local chronic overproduction of IL-10 in the CSG, left stellate ganglion (LSG). As a result, in the IL-10 group, we observed a decreased number of tyrosine hydroxylase-positive (TH+) cells in the LSG. IL-10 markedly downregulated the nerve growth factor, synaptophysin, as well as growth-associated protein 43 expression. In vivo, results from ambulatory electrocardiography showed that IL-10 overexpression significantly inhibited the cardiac sympathetic nervous system activity and improved heart rate variability. Meanwhile, we observed decreased LSG function as well as prolonged ventricular effective refractory period and suppressed VA after myocardial infarction (MI) in the IL-10 group. In addition, IL-10 overexpression attenuated inflammation and decreased norepinephrine levels in the myocardium after acute MI. In conclusion, our data suggest that chronic IL-10 overexpression modulates cardiac sympathetic nerve remodeling and suppresses VA induced by MI. Neuromodulation through AAV-mediated IL-10 overexpression may have the characteristics of and advantages as a potential neuroimmunotherapy for preventing MI-induced VAs.

Cardioneuroablation: the known and the unknown.

Cardioneuroablation (CNA) is a novel interventional procedure for the treatment of recurrent vasovagal syncope (VVS) and advanced atrioventricular block secondary to hyperactivation of vagal tone in young patients. By damaging the cardiac parasympathetic ganglia, CNA seems to be able to mitigate and/or abolish the excessive vagal activity and improve patients' outcome. This review is intended to give a detailed and comprehensive overview of the current evidences regarding (1) the clinical applications of CNA (2) the identification of ablation targets and procedural endpoints (3) the medium-long term effect of the procedure and its future perspectives. However, clinical data are still limited, and expert consensus or recommendations in the guidelines regarding this technique are still lacking.

Chronic intermittent hypoxia remodels catecholaminergic nerve innervation in mouse atria.

Chronic intermittent hypoxia (CIH, a model for sleep apnoea) is a major risk factor for several cardiovascular diseases. Autonomic imbalance (sympathetic overactivity and parasympathetic withdrawal) has emerged as a causal contributor of CIH-induced cardiovascular disease. Previously, we showed that CIH remodels the parasympathetic pathway. However, whether CIH induces remodelling of the cardiac sympathetic innervation remains unknown. Mice (male, C57BL/6J, 2-3months) were exposed to either room air (RA, 21% O2 ) or CIH (alternating 21% and 5.7% O2 , every 6min, 10 hday-1 ) for 8-10weeks. Flat-mounts of their left and right atria were immunohistochemically labelled for tyrosine hydroxylase (TH, a sympathetic marker). Using a confocal microscope (or fluorescence microscope) and Neurlocudia 360digitization and tracing system, we scanned both the left and right atria and quantitatively analysed the sympathetic axon density in both groups. The segmentation data was mapped onto a 3D mouse heart scaffold. Our findings indicated that CIH significantly remodelled the TH immunoreactive (-IR) innervation of the atria by increasing its density at the sinoatrial node, the auricles and the major veins attached to the atria (P < 0.05, n=7). Additionally, CIH increased the branching points of TH-IR axons and decreased the distance between varicosities. Abnormal patterns of TH-IR axons around intrinsic cardiac ganglia were also found following CIH. We postulate that the increased sympathetic innervation may further amplify the effects of enhanced CIH-induced central sympathetic drive to the heart. Our work provides an anatomical foundation for the understanding of CIH-induced autonomic imbalance. KEY POINTS: Chronic intermittent hypoxia (CIH, a model for sleep apnoea) causes sympathetic overactivity, cardiovascular remodelling and hypertension. We determined the effect of CIH on sympathetic innervation of the mouse atria. In vivo CIH for 8-10weeks resulted in an aberrant axonal pattern around the principal neurons within intrinsic cardiac ganglia and an increase in the density, branching point, tortuosity of catecholaminergic axons and atrial wall thickness. Utilizing mapping tool available from NIH (SPARC) Program, the topographical distribution of the catecholaminergic innervation of the atria were integrated into a novel 3D heart scaffold for precise anatomical distribution and holistic quantitative comparison between normal and CIH mice. This work provides a unique neuroanatomical understanding of the pathophysiology of CIH-induced autonomic remodelling.

Pathways and morphologic pattern of blood supply of epicardial ganglionated nerve plexus

Detailed cardiac neuroanatomy is critical for understanding cardiac function and its pathology. However, there remains a significant gap in knowledge regarding the blood supply to the intrinsic cardiac ganglionated plexus (GP). This study addresses this by mapping the routes and morphological pattern of blood supply to the epicardial GP in a large-animal pig model (Sus scrofa domesticus). Twenty-five domestic pigs were used in the study. We demonstrate that the epicardial ganglionated nerves receive blood from both coronary and extra-cardiac arteries. The coronary arterial branches supply blood to all five subplexuses constituting the epicardial GP. In contrast, the branches of extra-cardiac arteries supply blood to target heart areas: 1) the venous part of the heart hilum on the left atrium, 2) the walls of the sinuses of the right cranial (superior cava) and 3) pulmonary veins. Uniformly, epicardial nerves and ganglia are supplied with blood via a sole epineurial arteriole which, in most cases, is the fifth/sixth-order branch of the coronary arteries. The extra-cardiac arteries supplying blood to the epicardial GP accompanied the mediastinal nerves entering the epicardium within the limits of the heart hilum. Together, the dual and triple blood supply of the epicardial nerves and ganglia suggests a protective role from an ischemic event and/or ischemic heart disease. Stuctured abstractThis study details the anatomy of the blood supply of epicardial ganglionated nerve plexus, from which nerve fibres extend to the myocardium, heart conduction system, coronary vessels, and endocardium, in the most popular animal model of experimental cardiology and cardiac surgery - the domestic pig. Our observations demonstrate that the epicardial nerves and ganglia receive blood from both coronary and extra-cardiac arteries. The multi-source blood supply to the cardiac nerves and ganglia may offer protection against myocardial infarction ant other ischemic heart disorders.

Abstract 13269: Clinical and Electrophysiological Features of New Onset Ventricular Arrythmias Following Catheter Ablation of Atrial Fibrillation

Introduction: Data on new onset ventricular arrhythmias (VAs) following catheter ablation of atrial fibrillation (AF) is sparse. Hypothesis: We aimed to assess the incidence of new onset VA post AF RFA. Methods: We conducted a retrospective study of all patients at our institution that underwent AF ablation who also developed symptomatic high burden premature ventricular complexes (PVCs) requiring catheter ablation within 1 year of the index AF ablation procedure. All patients underwent post AF ablation monitoring with either 48 hr Holter monitors or implantable cardiac monitors. New onset VA was defined as symptomatic new onset PVC with &gt;5% burden. Data on PVC morphology and successful ablation sites was analyzed. Results: Out of 175 patients that underwent AF ablation during the study period, 2.8 % (n=5) patients developed new onset high burden PVCs requiring catheter ablation therapy within 1 year of AF ablation. Mean age was 68.6 + 11 years and all patients were male. Mean baseline LVEF was 56 + 9.6% and mean PVC burden was 10.3 + 8.8 %. A total of 9 PVCs were mapped in 5 patients. The number of VA morphology was 1 in 2 (40%) patients, 2 in 2 (40%) and 3 in 1 (20%) patient. Site of origin for the PVCs was in the left ventricle in all patients, with majority (55%) localizing to the LV outflow tract and summit region (table). Average time from AF RFA to PVC ablation was 4 + 2.9 months. PVC ablation was successful in all patients except one where ablation was deferred due to proximity to the conduction system. Conclusions: New onset VAs following catheter ablation of AF tend to localize to the LV outflow tract and areas of bipolar voltage abnormality. Potential mechanisms of new onset PVCs could include altered sympathetic tone due to ablation of cardiac ganglia, unmasking of PVCs due to regularization of ventricular rate and withdrawal of anti-arrhythmic medications. Further prospective studies are needed to understand true incidence of new onset VAs following AF ablation.

Distribution and morphology of calcitonin gene-related peptide (CGRP) innervation in flat mounts of whole rat atria and ventricles

Calcitonin gene-related peptide (CGRP) is widely used as a marker for nociceptive afferent axons. However, the distribution of CGRP-IR axons has not been fully determined in the whole rat heart. Immunohistochemically labeled flat-mounts of the right and left atria and ventricles, and the interventricular septum (IVS) in rats for CGRP were assessed with a Zeiss imager to generate complete montages of the entire atria, ventricles, and septum, and a confocal microscope was used to acquire detailed images of selected regions. We found that 1) CGRP-IR axons extensively innervated all regions of the atrial walls including the sinoatrial node region, auricles, atrioventricular node region, superior/inferior vena cava, left pre-caval vein, and pulmonary veins. 2) CGRP-IR axons formed varicose terminals around individual neurons in some cardiac ganglia but passed through other ganglia without making appositions with cardiac neurons. 3) Varicose CGRP-IR axons innervated the walls of blood vessels. 4) CGRP-IR axons extensively innervated the right/left ventricular walls and IVS. Our data shows the rather ubiquitous distribution of CGRP-IR axons in the whole rat heart at single-cell/axon/varicosity resolution for the first time. This study lays the foundation for future studies to quantify the differences in CGRP-IR axon innervation between sexes, disease models, and species.

Abstract 060: Conditional Deletion Of Renin In The Mouse Brain Results In Cardiovascular And Respiratory Abnormalities In Response To Hypoxia Or Autonomic Blockade

Previously, we reported the existence of renin-expressing neurons in the nucleus ambiguus (NuAm), a major autonomic and respiratory center in the brainstem. Within the NuAm, renin is expressed in choline acetyltransferase (ChAT)-positive cardioinhibitory vagal neurons projecting to the cardiac ganglion. Based on this, we hypothesized that ablation of renin specifically in ChAT-positive neurons disrupts normal cardiorespiratory function. Cardiorespiratory function in control (WT) vs. mice lacking renin in cholinergic neurons (Ren-a ChAT-null ) was compared using an integrated radiotelemetry/whole-body plethysmography system. We measured parameters at baseline and upon acute respiratory or pharmacological challenge in males. Using in situ mRNA hybridization, we confirmed that Ren-a ChAT-null exhibit lower expression of renin in the NuAm compared to the WT (Ren-a ChAT-null : 0.7±0.3 vs. WT: 3.9±0.9 arbitrary units, p&lt;0.05, n=4-5). At baseline, there were no major differences in cardiorespiratory function between groups. Therefore, mice were subjected to acute cardiorespiratory challenges. During acute hypoxia (12% O 2 for 10 minutes), Ren-a ChAT-null displayed lower hypoxic ventilatory response compared to WT (1.53±0.04 vs. 1.94±0.10 fold change compared to baseline, p&lt;0.05, n=4). Additionally, Ren-a ChAT-null exhibited exacerbated tachycardia (640±19 vs. 564±11 bpm, p&lt;0.05, n=3-4). Subsequently, when subjected to sympathetic blockade with propranolol (5 mg/kg, ip), Ren-a ChAT-null exhibited an exacerbated bradycardic and hypotensive effect compared to WT (14427±293 vs 15722±498 AUC bpm*min, p&lt;0.05, n=7-9 and 3661±90 vs 3988±78 AUC mmHg*min, p&lt;0.05, n=7-9, respectively). In response to parasympathetic blockade with methyl atropine (2 mg/kg, ip), Ren-a ChAT-null exhibited a lower systolic blood pressure elevation compared to WT (4001±112 vs. 4324±84 AUC mmHg*min, p&lt;0.05; n=7-9). These data suggest that renin in cholinergic neurons exerts a functional physiological role and contributes to maintaining an appropriate cardiorespiratory response to acute stressors. Ongoing studies are currently underway to investigate 1) sex differences and 2) the phenotype of Ren-a ChAT-null mice in chronic conditions such as hypertension.

Molecular and Functional Relevance of NaV1.8-Induced Atrial Arrhythmogenic Triggers in a Human SCN10A Knock-Out Stem Cell Model.

In heart failure and atrial fibrillation, a persistent Na+ current (INaL) exerts detrimental effects on cellular electrophysiology and can induce arrhythmias. We have recently shown that NaV1.8 contributes to arrhythmogenesis by inducing a INaL. Genome-wide association studies indicate that mutations in the SCN10A gene (NaV1.8) are associated with increased risk for arrhythmias, Brugada syndrome, and sudden cardiac death. However, the mediation of these NaV1.8-related effects, whether through cardiac ganglia or cardiomyocytes, is still a subject of controversial discussion. We used CRISPR/Cas9 technology to generate homozygous atrial SCN10A-KO-iPSC-CMs. Ruptured-patch whole-cell patch-clamp was used to measure the INaL and action potential duration. Ca2+ measurements (Fluo 4-AM) were performed to analyze proarrhythmogenic diastolic SR Ca2+ leak. The INaL was significantly reduced in atrial SCN10A KO CMs as well as after specific pharmacological inhibition of NaV1.8. No effects on atrial APD90 were detected in any groups. Both SCN10A KO and specific blockers of NaV1.8 led to decreased Ca2+ spark frequency and a significant reduction of arrhythmogenic Ca2+ waves. Our experiments demonstrate that NaV1.8 contributes to INaL formation in human atrial CMs and that NaV1.8 inhibition modulates proarrhythmogenic triggers in human atrial CMs and therefore NaV1.8 could be a new target for antiarrhythmic strategies.

ARTERIAL BAROREFLEX FUNCTION IS IMPAIRED DURING THE RECOVERY FROM ACUTE LUNG INJURY IN A BLEOMYCIN-INDUCED RAT LUNG INJURY MODEL

Objective: Acute lung injury (ALI) and its clinical correlate, the acute respiratory distress syndrome (ARDS), results due, in part, to disruption of the normal capillary endothelial barrier and invokes perturbations of ventilatory control. ALI is associated with autonomic dysfunction and cardiac arrhythmias. In a recent study we suggested that rats were susceptible to cardiac arrhythmia even during the recovery from ALI, in part, due to abnormalities in cardiac sympathetic ganglia. On the other hand, if arterial baroreflex function is altered during the recovery of ALI remains unknown. The primary goal of this study was to examine baroreflex function during the recovery stage from ALI in a bleomycin (Bleo)-induced rat ALI model. Design and method: ALI was induced in male SD rats (200-250g) using a single intra-tracheal injection of Bleo (2.5 mg/kg). 4 weeks post Bleo (n = 7) or saline (sham, n = 6), rats were anesthetized with urethane (800 mg/kg ip) and alpha-chloralose (40 mg/kg ip) to measure baroreflex sensitivity. Baroreflex curves were generated by measuring the heart rate (HR) and renal sympathetic nerve activity (RSNA) responses to decreases and increases in mean blood pressure (MAP) by intravenous administration of nitroglycerin (25 μg) followed by phenylephrine (10 μg). Differences between sham and Bleo rats were determined by one-way ANOVA followed by the Tukey post hoc test. Results: Compared to sham rats, there was a significant decrease in the RSNA (117.4±11.6 vs. 77.5±8.9 %baseline, P = 0.018) or HR (147.5±9.7 vs. 75.1±11.3 bpm, P&lt;0.001) range in Bleo rats. Minimum RSNA or HR was also decreased in bleo rats compared to sham rats. There was no significant difference in either the slope coefficient or the blood pressure at the midpoint of the range (BP50) between the two groups. There was a significant decrease in peak slope [or maximum gain (Gainmax) in Bleo rats (MAP-RSNA Gainmax: 3.11±0.27 vs. 1.74±0.31, p = 0.017; MAP-HR Gainmax: 3.57±0.31 vs. 1.21±0.14, p&lt;0.001). Conclusions: Our data demonstrate impaired baroreflex function during the recovery state from ALI. Autonomic dysfunction may also contribute to increased cardiovascular risk during the recovery stage from ALI.

Cardioneuroablation for severe neurocardiogenic syncope

Introduction and objectivesCardioneuroablation (CNA), a technique based on radiofrequency ablation of cardiac vagal ganglia, was developed to treat recurrent vasovagal syncope (VVS) with a predominant cardioinhibitory component, as an alternative to pacemaker implantation. The aim of our study was to evaluate the safety and success rate of CNA guided by extracardiac vagal stimulation in patients with highly symptomatic cardioinhibitory VVS. MethodsProspective study of patients who underwent anatomically guided CNA at two cardiology centers. All patients had a history of recurrent syncope with a predominant cardioinhibitory component and refractory to conventional measures. Acute success was determined by the absence or significant reduction of cardiac parasympathetic response to extracardiac vagal stimulation. The primary endpoint was the recurrence of syncope during follow-up. ResultsIn total, 19 patients (13 males; mean age 37.8±12.9 years) were included. Ablation was acutely successful in all patients. One patient had a convulsive episode after the procedure, which was deemed unrelated to the ablation, requiring admission to intensive care but without sequelae. No other complications occurred. At a mean follow-up of 21.0±13.2 months (range 3–42 months), 17 patients remained free of syncope. The remaining two patients had recurrence of syncope and, despite undergoing a new ablation procedure, required pacemaker implantation during follow-up. ConclusionCardioneuroablation, confirmed by extracardiac vagal stimulation, appears to be an effective and safe treatment option for highly symptomatic patients with refractory VVS with a predominant cardioinhibitory component, providing a new potential approach as an alternative to pacemaker implantation.

Divergent electrophysiology between two cardiac vagal motor populations despite similar chronotropic effects

Cardiac vagal motor output is generated by brainstem cardiac vagal motorneurons (CVNs) that send axonal projections, through the vagus nerve, to cardiac ganglia. CVNs have a well-established cardioinhibitory influence through reductions in heart rate (HR) and studies using vagotomy confirm cardiac vagal drive originates in CVNs. CVNs can be found in two brainstem regions: nucleus ambiguus (NA) and dorsal motor nucleus of the vagus (DMV). Although the cardioinhibitory role of CVNs in NA (CVN NA ) is widely accepted, effects of CVNs in DMV (CVN DMV ) on HR regulation is controversial. The present study aims to provide evidence of CVN DMV existence and identify the unique role DMV plays in HR regulation. We hypothesized that CVN DMV cause robust bradycardias and associate with unique electrophysiological properties making them hyperexcitable compared to CVN NA . Experiments were performed on adult (9-11 week old) male mice. Using a transgenic mouse line where light activated channelrhodopsin (ChR) is expressed in choline acetyltransferase neurons, activation of ChR in DMV using fiber optic probes resulted in a 359±43 bpm bradycardia (n=8) in awake behaving animals. DMV-mediated ChR-dependent bradycardia remained after i.p. administration of atenolol (256±31 bpm). However, i.p. scopolamine-methyl nitrate abolished the ability of ChR activation of DMV to impact HR (12±2 bpm, p=0.0002). ChR stimulation of NA resulted in a similar bradycardia (447±6 bpm; p&lt;0.0001) that was also blocked by scopolamine-methyl nitrate (9±7 bpm, p=0.005). Retrograde tracing from cardiac tissue using rhodamine and cholera-toxin B (CTB) confirmed CVNs in DMV (50±15 labeled neurons, n=6; CTB: 12±4 labeled neurons, n=8). However, the number of CVN DMV was significantly lower than CVN NA (rhodamine: 116±24 labeled neurons, n=6; CTB: 83.33±9.548 labeled neurons, n=6, p&lt;0.0001 for both). Unilateral vagotomy eliminated tracer presence in DMV ipsilateral (2±1 neurons) compared to contralateral (32±8 neurons; n=4; p=0.048). Using whole cell patch clamp, CVN DMV demonstrated spontaneous action potential firing in vitro (0.7±0.3 Hz, n=14 neurons/10 mice) whereas CVN NA were devoid of spontaneous firing (0.0±0.0 Hz, n=10 neurons/9 mice). CVN DMV (-58.6±2.7 Hz, n=14 neurons/10 mice) and CVN NA (-62.2±1.8 mV, n=10 neurons/9 mice, p=0.3) demonstrated similar resting membrane potential. However, CVN DMV (492.0±22.0 MΩ, n=14 neurons/10 mice) had higher input resistance compared to CVN NA (158.2±10.6 MΩ, n=10 neurons/9 mice, p&lt;0.0001). Taken together, these data support the hypothesis that DMV contains a population of CVNs capable of producing cardioinhibitory actions with unique hyperexcitability compared to CVN NA . Future studies will examine both intracellular mechanism(s) of these differences, but also unique microcircuit pathways which utilize CVN DMV , and not CVN NA . NIH T32 HL007446 for MS; NIH R01HL157366 to CRB This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Topographical mapping of catecholaminergic axon innervation in the flat-mounts of the mouse atria: a quantitative analysis

The sympathetic nervous system is crucial for controlling multiple cardiac functions. However, a comprehensive, detailed neuroanatomical map of the sympathetic innervation of the heart is unavailable. Here, we used a combination of state-of-the-art techniques, including flat-mount tissue processing, immunohistochemistry for tyrosine hydroxylase (TH, a sympathetic marker), confocal microscopy and Neurolucida 360 software to trace, digitize, and quantitatively map the topographical distribution of the sympathetic postganglionic innervation in whole atria of C57Bl/6 J mice. We found that (1) 4–5 major extrinsic TH-IR nerve bundles entered the atria at the superior vena cava, right atrium (RA), left precaval vein and the root of the pulmonary veins (PVs) in the left atrium (LA). Although these bundles projected to different areas of the atria, their projection fields partially overlapped. (2) TH-IR axon and terminal density varied considerably between different sites of the atria with the greatest density of innervation near the sinoatrial node region (P < 0.05, n = 6). (3) TH-IR axons also innervated blood vessels and adipocytes. (4) Many principal neurons in intrinsic cardiac ganglia and small intensely fluorescent cells were also strongly TH-IR. Our work provides a comprehensive topographical map of the catecholaminergic efferent axon morphology, innervation, and distribution in the whole atria at single cell/axon/varicosity scale that may be used in future studies to create a cardiac sympathetic-brain atlas.

The role of feedback and modulation in determining temperature resiliency in the lobster cardiac nervous system.

Changes in ambient temperature affect all biological processes. However, these effects are process specific and often vary non-linearly. It is thus a non-trivial problem for neuronal circuits to maintain coordinated, functional output across a range of temperatures. The cardiac nervous systems in two species of decapod crustaceans, Homarus americanus and Cancer borealis, can maintain function across a wide but physiologically relevant temperature range. However, the processes that underlie temperature resilience in neuronal circuits and muscle systems are not fully understood. Here, we demonstrate that the non-isolated cardiac nervous system (i.e., the whole heart: neurons, effector organs, intrinsic feedback systems) in the American lobster, H. americanus, is more sensitive to warm temperatures than the isolated cardiac ganglion (CG) that controls the heartbeat. This was surprising as modulatory processes known to stabilize the output from the CG are absent when the ganglion is isolated. One source of inhibitory feedback in the intact cardiac neuromuscular system is nitric oxide (NO), which is released in response to heart contractions. We hypothesized that the greater temperature tolerance observed in the isolated CG is due to the absence of NO feedback. Here, we demonstrate that applying an NO donor to the isolated CG reduces its temperature tolerance. Similarly, we show that the NO synthase inhibitor L-nitroarginine (LNA) increases the temperature tolerance of the non-isolated nervous system. This is sufficient to explain differences in temperature tolerance between the isolated CG and the whole heart. However, in an intact lobster, the heart and CG are modulated by an array of endogenous peptides and hormones, many of which are positive regulators of the heartbeat. Many studies have demonstrated that excitatory modulators increase temperature resilience. However, this neuromuscular system is regulated by both excitatory and inhibitory peptide modulators. Perfusing SGRNFLRFamide, a FLRFamide-like peptide, through the heart increases the non-isolated nervous system's tolerance to high temperatures. In contrast, perfusing myosuppressin, a peptide that negatively regulates the heartbeat frequency, decreases the temperature tolerance. Our data suggest that, in this nervous system, positive regulators of neural output increase temperature tolerance of the neuromuscular system, while modulators that decrease neural output decrease temperature tolerance.

Innervation of the heart: Anatomical study with application to better understanding pathologies of the cardiac autonomics.

Current advances in management of the cardiac neuroaxis in different cardiovascular diseases require a deeper knowledge of cardiac neuroanatomy. The aim of the study was to increase knowledge of the human fetal extrinsic cardiac nervous system. We achieved this by systematizing the origin and formation of the cardiac nerves, branches, and ganglia and their sympathetic/parasympathetic connections. Thirty human fetuses (60 sides) were subjected to detailed sub-macroscopic dissection of the cervical and thoracic regions. Cardiac accessory ganglia lying on a cardiac nerve or in conjunction with two or more (up to four) nerves before entering the mediastinal cardiac plexus were observed in 13 sides. Except for the superior cardiac nerve, the sympathetic cardiac nerves were individually variable and inconstant. In contrast, the cardiac branches of the vagus nerve appeared grossly more constant and invariable, although the individual cardiac branches varied in number and position of origin. Each cervical cardiac nerve or cardiac branch of the vagus nerve could be singular or multiple (up to six) and originated from the sympathetic trunk or the vagus nerve by one, two, or three roots. Sympathetic nerves arose from the cervical-thoracic ganglia or the interganglionic segment of the sympathetic trunk. Connections were found outside the cardiac plexus. Some cardiac nerves were connected to non-cardiac nerves, while others were connected to each other. Common sympathetic/parasympathetic cardiac nerve trunks were more frequent on right (70%) versus left sides (20%). The origin, frequency, and connections of the cardiac nerves and branches are highly variable in the fetus. Detailed knowledge of the normal neuroanatomy of the heart could be useful during cardiac neuromodulation procedures and in better understanding nervous pathologies of the heart.