Effects Of Carotid Body Denervation Research Articles

Effect of Carotid Body Denervation on Systemic Endothelial Function in a Diabetic Animal Model.

Endothelial dysfunction is an essential intermediary for development of cardiovascular diseases associated with diabetes and hypertension (HT). The carotid body (CB) dysfunction contributes to dysmetabolic states, and the resection of carotid sinus nerve (CSN) prevents and reverts dysmetabolism and HT. Herein, we investigated if CSN denervation ameliorates systemic endothelial dysfunction in an animal model of type 2 diabetes mellitus (T2DM).We used Wistar male rats submitted to HFHSu diet during 25weeks and the correspondent age-matched controls fed with a standard diet. CSN resection was performed in half of the groups after 14weeks of diet. In vivo insulin sensitivity, glucose tolerance and blood pressure, ex vivo aortic artery contraction and relaxation and nitric oxide (NO) levels in plasma and aorta, aorta nitric oxide synthase (NOS) isoforms, and PGF2αR levels were evaluated.We demonstrated that, alongside to dysmetabolism and HT reversion, CSN resection restores endothelial function in the aorta and decreases the NO levels in plasma and aorta at the same time that restores normal levels of iNOS in aorta without changing eNOS or PGF2αR levels.These results suggest that the modulation of CB activity can be important for the treatment of HT and endothelial dysfunction related with T2DM.

Respiratory rhythm irregularity after carotid body denervation in rats

Respiratory activity is controlled by inputs from the peripheral and central chemoreceptors. Since overactivity of the carotid bodies, the main peripheral chemoreceptors, is linked to the pathophysiology of disparate metabolic and cardiovascular diseases, carotid body denervation (CBD) has been proposed as a potential treatment. However, long-term effects of CBD on the respiratory rhythm and regularity of breathing remain unknown. Here, we show that five weeks after bilateral CBD in rats, the respiratory rhythm was slower and less regular. Ten weeks after bilateral CBD, the respiratory frequency was not different from the sham-operated group, but the regularity of the respiratory rhythm was still reduced. Increased frequency of randomly occurring apneas is likely to be responsible for the irregular breathing pattern after CBD. These results should be taken into consideration since any treatment that reduces the stability of the respiratory rhythm might exacerbate the cardio-respiratory instability and worsen the cardiovascular outcomes.

Increased Ca2+ permeable ampa receptor expression following carotid body denervation in goats (713.2)

The mechanisms which contribute to the time‐dependent recovery of resting ventilation and the ventilatory CO2 chemoreflex after carotid body denervation (CBD) are poorly understood. The initiation of neuronal plasticity often involves changes in Ca2+ permeability. Therefore, we tested the hypothesis that during recovery from the acute effects of CBD in goats, there is an increase in Ca2+ permeable GluA1R and GluN1R and/or a decrease in Ca2+ impermeable GluA2R expression at brainstem sites that contribute to respiratory control. We tested this hypothesis via optical densitometric (OD) quantification of medullary neurons immunostained with antibodies targeting GluA1R, GluA2R, and GluN1R at 5‐13 days or 30 days after bilateral CBD. CBD resulted in hypoventilation and a reduced CO2 chemoreflex, which both recovered significantly over 30 days post‐CBD. At 5‐13 days post‐CBD, GluA1 OD was unchanged from control goats, but GluA2 and GluN1 OD were reduced 15‐30% within 6 of medullary respiratory nuclei measured. However, at 30 days post‐CBD GluA1 OD remained unchanged, but GluA2 and GluN1 OD returned to control levels. We conclude that a shift toward Ca2+ permeable glutamate receptors 5‐13 days post‐CBD may initiate the recovery of ventilation after CBD. Furthermore, at 30 days post‐CBD the partial recovery of ventilation is maintained by relatively normal glutamate receptor expression.Grant Funding Source: Supported by National Heart, Lung, and Blood Institute Grants HL25739 and HL007852 and by VA

Is carotid body denervation the silver bullet for heart failure?

The carotid body chemoreceptors are traditionally viewed as the body's primary oxygen sensors. Activation of the carotid body chemoreceptors in response to a fall in arterial oxygen levels results in reflex increases in both ventilation and sympathetic nervous system activity. Additionally, a growing body of experimental evidence in both animals and humans supports a role for the carotid body chemoreceptors in the pathophysiology of several sympathoexcitatory conditions such as hypertension, sleep apnoea and congestive heart failure (CHF). Consistent with this idea, in a recent issue of The Journal Physiology, Marcus and colleagues (Marcus et al. 2013) confirmed that the carotid body chemoreceptors play a central role in CHF pathophysiology. Expanding on their previous experiments in rats (Del Rio et al. 2013), Marcus et al. induced CHF in a group of rabbits through ventricular pacing and examined the effect of carotid body denervation on ventilation, autonomic nervous system activity and markers of cardiac function. Remarkably, only 9 days after denervation, a number of ventilatory, autonomic and cardiac function variables commonly impaired in CHF were improved. These results raise several important questions regarding the contribution of the carotid body chemoreceptors to CHF pathophysiology: how does carotid body denervation initiate improvements in CHF; what is the link between the carotid body chemoreceptors and cardiac function in CHF; could carotid body denervation replace traditional therapeutic strategies for CHF?

Acute and chronic effects of carotid body denervation on ventilation and chemoreflexes in three rat strains

Brown Norway (BN) rats have a relatively specific deficit in CO2 sensitivity. This deficit could be due to an abnormally weak carotid body contribution to CO2 sensitivity. Accordingly, we tested the hypothesis that CBD would have less of an effect on eupnoeic breathing and CO2 sensitivity in the BN rats compared to other rat strains.We measured ventilation and blood gases at rest (eupnoea) and during hypoxia (FIO2 =0.12) or hypercapnia (FICO2 =0.07) before and up to 23 days after bilateral or Sham CBD in BN, Sprague–Dawley (SD) and Dahl Salt-Sensitive (SS) rats. In all three rat strains, CBD elicited eupnoeic hypoventilation (PaCO2 +8.7–11.0 mmHg) 1–2 days post-CBD (P <0.05), and attenuated ventilatory responses to hypoxia (P <0.05) and venous sodium cyanide (NaCN; P<0.05), while sham CBD had no effect on resting breathing, blood gases or chemoreflexes (P >0.05). In contrast, CBD had no effect on CO2 sensitivity (˙VE/PaCO2) in all strains (P>0.05). Eupnoeic PaCO2 returned to pre-CBD values within 15–23 days post-CBD. Thus, the effects of CBD in rats (1) further support an important role for the carotid bodies in eupnoeic blood gas regulation, (2) suggest that the carotid bodies are not a major determinant of CO2 sensitivity in rats, and (3) may not support the concept of an interaction among the peripheral and central chemoreceptors in rats.

Respiratory neuroplasticity following carotid body denervation: Central and peripheral adaptations.

Historically, the role of the carotid bodies in ventilatory control has been understated, but the current view suggests that the carotid bodies (1) provide a tonic, facilitory input to the respiratory network, (2) serve as the major site of peripheral O2 chemoreception and minor contributor to CO2/H+ chemoreception, and (3) are required for ventilatory adaptation to high altitude. Each of these roles has been demonstrated in studies of ventilation in mammals after carotid body denervation. Following carotid body denervation, many of the compromised ventilatory “functions” show a time-dependent recovery plasticity that varies in the degree of recovery and time required for recovery. Respiratory plasticity following carotid body denervation is also dependent on species, with contributions from peripheral and central sites/mechanisms driving the respiratory plasticity. The purpose of this review is to provide a summary of the data pointing to peripheral and central mechanisms of plasticity following carotid body denervation. We speculate that after carotid body denervation there are altered excitatory and/or inhibitory neuromodulator mechanisms that contribute to the initial respiratory depression and the subsequent respiratory plasticity, and further suggest that the continued exploration of central effects of carotid body denervation might provide useful information regarding the capacity of the respiratory network for plasticity following neurologic injury in humans.

Effect of Carotid Body Denervation (CBD) on Breathing and Central Neuromodulation

After CBD, goats hypoventilate and exhibit reduced CO2 sensitivity followed by a partial recovery in the weeks following (Pan et al, 1998). Currently, the contribution of central mechanisms in these changes is unknown; however, perturbations involving the carotid bodies have been show to affect central neuromodulator/neurotransmitter (NM/NT) levels within the respiratory network (Goiny et al, 1991; Hoop at al, 1999). Here, we tested the hypothesis that the time‐dependent changes in breathing following CBD are associated with altered central NM/NT levels within the pre‐Bötzinger Complex (pre‐BötC). In 6 awake adult goats, on several days pre‐ and post‐CBD we assessed resting PaCO2, CO2 sensitivity, and the NM/NT content of mock cerebrospinal fluid (mCSF) dialyzed into the pre‐BötC. From days 0–15 post‐CBD, we observed hypoventilation and reduced CO2 sensitivity, with a concomitant increase in GABA and Glycine and a decrease in serotonin and Substance‐P in the dialyzed mCSF. From days 16–30 post‐CBD, we observed a partial recovery of resting PaCO2, but little recovery of CO2 sensitivity or NMs/NTs. In conclusion, a shift in the balance of NMs/NTs toward net inhibition at the pre‐BötC may contribute to the hypoventilation and reduced CO2 sensitivity following CBD. Supported by NIH 25739 and Veterans Association

Carotid body denervation alters ventilatory responses to ibotenic acid injections or focal acidosis in the medullary raphe

Our aim was to determine the effects of carotid body denervation (CBD) on the ventilatory responses to focal acidosis and ibotenic acid (IA) injections into the medullary raphe area of awake, adult goats. Multiple microtubules were chronically implanted into the midline raphe area nuclei either before or after CBD. For up to 15 days after bilateral CBD, arterial PCO2 (PaCO2) (13.3 +/- 1.9 Torr) was increased (P < 0.001), and CO2 sensitivity (-53.0 +/- 6.4%) was decreased (P <0.001). Thereafter, resting PaCO2 and CO2 sensitivity returned (P <0.01) toward control, but PaCO2 remained elevated (4.8 +/- 1.9 Torr) and CO2 sensitivity reduced (-24.7 +/- 6.0%) > or =40 days after CBD. Focal acidosis (FA) at multiple medullary raphe area sites 23-44 days post-CBD with 50 or 80% CO(2) increased inspiratory flow (Vi), tidal volume (Vt), metabolic rate (VO2), and heart rate (HR) (P <0.05). The effects of FA with 50% CO2 after CBD did not differ from intact goats. However, CBD attenuated (P <0.05) the increase in Vi, Vt, and HR with 80% CO2, but it had no effect on the increase in VO2. Rostral but not caudal raphe area IA injections increased Vi, BP, and HR (P < 0.05), and these responses were accentuated (P <0.001) after CBD. CO2 sensitivity was attenuated (-20%; P <0.05) <7 days after IA injection, but thereafter it returned to prelesion values in CBD goats. We conclude the following: 1) the attenuated response to FA after CBD provides further evidence that the carotid bodies provide a tonic facilitory input into respiratory control centers, 2) the plasticity after CBD is not due to increased raphe chemoreceptor sensitivity, and 3) the "error-sensing" function of the carotid body blunts the effect of strong stimulation of the raphe.

Role of the carotid bodies in chemosensory ventilatory responses in the anesthetized mouse.

We examined the effects of carotid body denervation on ventilatory responses to normoxia (21% O2 in N2 for 240 s), hypoxic hypoxia (10 and 15% O2 in N2 for 90 and 120 s, respectively), and hyperoxic hypercapnia (5% CO2 in O2 for 240 s) in the spontaneously breathing urethane-anesthetized mouse. Respiratory measurements were made with a whole body, single-chamber plethysmograph before and after cutting both carotid sinus nerves. Baseline measurements in air showed that carotid body denervation was accompanied by lower minute ventilation with a reduction in respiratory frequency. On the basis of measurements with an open-circuit system, no significant differences in O2 consumption or CO2 production before and after chemodenervation were found. During both levels of hypoxia, animals with intact sinus nerves had increased respiratory frequency, tidal volume, and minute ventilation; however, after chemodenervation, animals experienced a drop in respiratory frequency and ventilatory depression. Tidal volume responses during 15% hypoxia were similar before and after carotid body denervation; during 10% hypoxia in chemodenervated animals, there was a sudden increase in tidal volume with an increase in the rate of inspiration, suggesting that gasping occurred. During hyperoxic hypercapnia, ventilatory responses were lower with a smaller tidal volume after chemodenervation than before. We conclude that the carotid bodies are essential for maintaining ventilation during eupnea, hypoxia, and hypercapnia in the anesthetized mouse.

Mortality after carotid body denervation in rats.

Carotid body denervation (CBD) in neonatal goats and piglets results in minimal irregular breathing and no fatalities. Redundancy and/or plasticity of peripheral chemosensitivity and a relatively mature ventilatory control system at birth may contribute to the paucity of CBD effects in these species. In the present study, we tested the hypothesis that CBD mortality would be greater in neonates of a less mature species such as the rat. We found that the mortality in rats denervated at 2-3 and 7-8 days of age was significantly higher (P < 0.05) than in sham-CBD rats. In all surviving rats, pulmonary ventilation during hypoxia was lower in CBD than in sham operated rats 2 days after denervation. In surviving rats denervated during the 7th and 8th postnatal days, there was also reduced weight gain and pulmonary ventilation during eupnea, including apneas up to 20 s in duration. However, the effects of CBD were compensated within 3 wk after denervation. Local injections of NaCN indicated that aortic chemoreceptors might have been one of the sites of recovery of peripheral chemosensitivity. We concluded that CBD has higher mortality in newborn rats than in other mammals, possibly because of the relative immaturity of these animals at birth. Nonetheless, in survivors there was enough redundancy and plasticity in the control of breathing to eventually compensate for the consequences of CBD.

Effect of carotid body denervation on breathing in neonatal goats.

The objective of the present study was to determine in goats whether carotid body denervation (CBD) at 1-3 days of age causes permanent changes in breathing greater than those that occur after CBD in adult goats. Goats underwent CBD (n = 6) or sham CBD (n = 3) surgery at 1-3 days of age. In addition, one unoperated control animal was studied. Bolus intravenous injections of NaCN 2 days postsurgery verified successful CBD surgery. However, at 3, 11, and 18 mo of age, the CBD goats had regained a NaCN response that did not differ (P > 0.10) from that of intact goats. Intracarotid NaCN injections elicited a hyperpnea in the sham CBD but not the CBD goats. Only one animal exhibited highly irregular breathing [characterized by prolonged (>9-s) apneas] after CBD, and the irregularity disappeared by 3 mo of age. One CBD goat died at 35 days of age, and autopsy revealed that death was associated with pneumonia. After 3 mo of age, there were no statistically significant differences (P > 0.10) between sham and CBD goats in eupneic breathing, hypoxia and CO(2) sensitivity, and the exercise hyperpnea. It is, therefore, concluded that CBD at 1-3 days of age in goats does not appear to affect selected aspects of respiratory control after 3 mo of age, conceivably because of the emergence of other functional chemoreceptors that compensate for the loss of the carotid chemoreceptor.

Prolonged apnea and impaired survival in piglets after sinus and aortic nerve section

We examined the effects of carotid body denervation (CX, n = 9), CX + aortic nerve section (CAX, n = 9), and sham surgery (SHAM, n = 7) on cardiorespiratory and metabolic function in young piglets (less than 9 days). For comparison, 1-mo-old pigs were also studied. Studies were performed 1 day after surgery, during which time ventilation (barometric plethysmography), heart rate, blood pressure, arterial blood gases, and electroencephalogram were recorded under normoxia. CX and CAX piglets hypoventilated (arterial PCO2 = 47.1 +/- 2.6 and 45.4 +/- 3.1 Torr, respectively) compared with SHAM piglets (arterial PCO2 = 36.4 +/- 1.5 Torr). CX piglets had an average of 8.0 +/- 3.0 apneas/h, lasting, on average, 26 +/- 3 s. CAX piglets averaged 17.2 +/- 7.9 apneas/h, lasting 30 +/- 5 s. Such long apneas were never observed in SHAM animals. Mean heart rate and blood pressure in denervated piglets were not significantly different from those in SHAM piglets. In animals followed up poststudy, significantly high mortality was observed in CX (5 of 9) and CAX (6 of 9) piglets by 7 days after surgery but not in SHAM animals (0 of 7) despite identical environmental and feed conditions (P less than 0.05; chi 2). One-month-old denervated animals showed periodic breathing and hypoventilation, but none died. These results suggest that in the newborn piglet 1) peripheral chemoreceptors have an active role in maintaining normal ventilation and avoidance of prolonged apnea and 2) survivability in early life is critically dependent on peripheral chemoreceptors.

Effect of carotid body denervation on arousal response to hypoxia in sleeping dogs.

We studied the arousal and ventilatory responses to hypoxia during sleep in three trained dogs, before and 1-4 wk after carotid body denervation (CBD). During the studies the dogs breathed through a cuffed endotracheal tube inserted via a chronic tracheostomy. Eucapnic progressive hypoxia was induced by a rebreathing technique, and arterial O2 saturation (Sao2) was measured with an ear oximeter. Sleep stage was determined by electroencephalographic and behavioral criteria. Following CBD, all dogs exhibited hypoventilation under resting conditions; hypoxic ventilatory responses during wakefulness, slow-wave sleep (SWS), and rapid-eye-movement (REM) sleep were less than 10% of control. Prior to CBD, hypoxic arousal occurred at Sao2 of 83.2 +/- 4.6% (mean +/- Se) during SWS and 70.6 +/-2.2% in REM sleep. Following CBD, arousal failed to occur during progressive desaturation to 60% in SWS and 50% in REM sleep, at which levels hypoxia was arbitrarily terminated. In a few studies following CBD where rebreathing was allowed to continue, the dogs occasionally failed to arouse at all and require active resuscitation. The results indicate a critical role for the carotid chemoreceptors in mediating the arousal response to hypoxia.

Effects of carotid body denervation on respiratory pattern of awake cats.

Eight awake cats have been studied before and after carotid denervation during air and oxygen breathing, and during hypercapnia. Analysis of the variables that characterize the spirogram shows that carotid denervation consistently results in a decrease of the mean inspiratory flow (VT/TI), causing a decrease in tidal volume (VT) and ventilation with a relative alveolar hypercapnia. In carotid-denervated animals, inhalation of oxygen results in an increase in ventilation due to an augmentation of VT/TI and VT and a relative hypocapnia. TI does not significantly change in the different conditions whereas TE is significantly affected. TE seems therefore to be more closely related to the rate of rise of inspiratory activity than to inspiratory duration.

The effect of carotid body denervation upon the respiratory response to hypoxia and hypercapnia in the duck.

1. Respiratory responses to altered P(a, O2) at constant P(a, CO2) and altered P(a, CO2) at constant P(a, O2) were measured in fourteen unanaesthetized ducks 5-9 weeks old.2. All the ducks responded to the inhalation of a few breaths of 100% O(2) with a fall in V(E) of between 11 and 17% of control, and to the reduction in P(a, O2) from control levels (93-101 mm Hg) to 38-47 mm Hg with an average increase in V(E) of 190% of control which was potentiated by raising the level of CO(2).3. Ventilation approximately doubled when P(a, CO2) was raised to 55 mm Hg, the greatest sensitivity to changes in P(a, CO2) being over the range 40-45 mm Hg.4. Carotid body denervation was carried out in nine ducks and the respiratory responses were modified. The fall in V(E) with inhalation of 100% O(2) was abolished in all ducks and the rise in V(E) with hypoxia was abolished in six. The increase in V(E) as P(a, CO2) was altered in steps was unaffected but the rate at which V(E) increased in response to 4% CO(2) was markedly reduced.5. It is concluded that the chemoreceptor regulation of respiration in ducks is similar to that observed in non-diving animals.