Sympathoexcitation In Heart Failure Research Articles

Stellate Ganglia and Cardiac Sympathetic Overactivation in Heart Failure.

Heart failure (HF) is a major public health problem worldwide, especially coronary heart disease (myocardial infarction)-induced HF with reduced ejection fraction (HFrEF), which accounts for over 50% of all HF cases. An estimated 6 million American adults have HF. As a major feature of HF, cardiac sympathetic overactivation triggers arrhythmias and sudden cardiac death, which accounts for nearly 50-60% of mortality in HF patients. Regulation of cardiac sympathetic activation is highly integrated by the regulatory circuitry at multiple levels, including afferent, central, and efferent components of the sympathetic nervous system. Much evidence, from other investigators and us, has confirmed the afferent and central neural mechanisms causing sympathoexcitation in HF. The stellate ganglion is a peripheral sympathetic ganglion formed by the fusion of the 7th cervical and 1st thoracic sympathetic ganglion. As the efferent component of the sympathetic nervous system, cardiac postganglionic sympathetic neurons located in stellate ganglia provide local neural coordination independent of higher brain centers. Structural and functional impairments of cardiac postganglionic sympathetic neurons can be involved in cardiac sympathetic overactivation in HF because normally, many effects of the cardiac sympathetic nervous system on cardiac function are mediated via neurotransmitters (e.g., norepinephrine) released from cardiac postganglionic sympathetic neurons innervating the heart. This review provides an overview of cardiac sympathetic remodeling in stellate ganglia and potential mechanisms and the role of cardiac sympathetic remodeling in cardiac sympathetic overactivation and arrhythmias in HF. Targeting cardiac sympathetic remodeling in stellate ganglia could be a therapeutic strategy against malignant cardiac arrhythmias in HF.

Role of the Renal Nerves in Regulating SGLT2 inhibitor‐induced Diuresis and Natriuresis in rats with Heart Failure

Sodium‐glucose cotransporter 2 (SGLT2) inhibitors promoting glucose excretion are widely used to treat type 2 diabetes. Recently, the clinical trial in both diabetic and non‐diabetic heart failure (HF) patients with reduced ejection fraction demonstrated that SGLT2 inhibitor prevents worsening HF. However, the underlying mechanisms have not been fully elucidated. The present study was conducted to assess whether the effects of SGLT2 inhibitor on urine flow, sodium and glucose excretions are changed in HF. To address the underlying mechanisms the mRNA and protein levels of renal SGLT2 are investigated. HF was induced in rats by left coronary artery ligation. Further, to assess the contribution of renal nerves in the regulation of renal SGLT2, four weeks after ligation surgery, surgical bilateral renal denervation (RDN) was performed. Acute experiments were performed one week after RDN (five weeks after coronary ligation). Urine flow, sodium and glucose excretion responses to SGLT2 inhibitor dapagliflozin (0.5 mg/kg, i.v.) were greater in HF than Sham (Urine flow 15.8 ± 1.8 vs. 8.3 ± 1.1 μl/min/gkw, Sodium excretion 2.23 ± 0.35 vs. 1.13 ± 0.18 μEq/min/gkw, Glucose excretion 0.84 ± 0.06 vs. 0.52 ± 0.08 mg/min/gkw at 120 min, P<0.05, n=5–7). RDN significantly attenuated these responses to dapagliflozin in HF (Urine flow 9.8 ± 1.2 vs. 15.8 ± 1.8 μl/min/gkw, Sodium excretion 1.31 ± 0.17 vs. 2.23 ± 0.35 μEq/min/gkw, Glucose excretion 0.66 ± 0.04 vs. 0.84 ± 0.06 mg/min/gkw at 120 min, P<0.05, n=5–7). Western blot analysis indicated that SGLT2 protein expressions in the renal cortex were higher in HF than Sham (SGLT2/GAPDH 0.83 ± 0.06 vs. 0.58 ± 0.05, P<0.05, n=6). RDN significantly reduced enhanced protein levels of SGLT2 in the renal cortex of rats with HF (SGLT2/GAPDH 0.60 ± 0.07 vs. 0.83 ± 0.06, P<0.05, n=6). In contrast, RT‐PCR analysis indicated that RDN increased mRNA levels of SGLT2 in the renal cortex of rats with HF (SGLT2/18sRNA 1.08 ± 0.28 vs. 0.23 ± 0.06, P<0.05, n=6), possibly a compensatory change to SGLT2 protein expressions. Immunohistochemistry of renal sections confirmed the enhanced staining for SGLT2 in HF. These findings suggest that increases in urine flow, sodium and glucose excretion responses to SGLT2 inhibitor are enhanced in HF due to the upregulation of renal SGLT2. Renal sympathoexcitation in HF might enhance the expression and functional activity of renal SGLT2, thereby contribute to subsequent pathophysiology of renal sodium and water retention associated with HF.Support or Funding InformationSupported by Japan Heart Foundation and NIH grants DK 114663 and HL62222.

Neurocognitive Disorders in Heart Failure: Novel Pathophysiological Mechanisms Underpinning Memory Loss and Learning Impairment.

Heart failure (HF) is a major public health issue affecting more than 26 million people worldwide. HF is the most common cardiovascular disease in elder population; and it is associated with neurocognitive function decline, which represent underlying brain pathology diminishing learning and memory faculties. Both HF and neurocognitive impairment are associated with recurrent hospitalization episodes and increased mortality rate in older people, but particularly when they occur simultaneously. Overall, the published studies seem to confirm that HF patients display functional impairments relating to attention, memory, concentration, learning, and executive functioning compared with age-matched controls. However, little is known about the molecular mechanisms underpinning neurocognitive decline in HF. The present review round step recent evidence related to the possible molecular mechanism involved in the establishment of neurocognitive disorders during HF. We will make a special focus on cerebral ischemia, neuroinflammation and oxidative stress, Wnt signaling, and mitochondrial DNA alterations as possible mechanisms associated with cognitive decline in HF. Also, we provide an integrative mechanism linking pathophysiological hallmarks of altered cardiorespiratory control and the development of cognitive dysfunction in HF patients. Graphical Abstract Main molecular mechanisms involved in the establishment of cognitive impairment during heart failure. Heart failure is characterized by chronic activation of brain areas responsible for increasing cardiac sympathetic load. In addition, HF patients also show neurocognitive impairment, suggesting that the overall mechanisms that underpin cardiac sympathoexcitation may be related to the development of cognitive disorders in HF. In low cardiac output, HF cerebral infarction due to cardiac mural emboli and cerebral ischemia due to chronic or intermittent cerebral hypoperfusion has been described as a major mechanism related to the development of CI. In addition, while acute norepinephrine (NE) release may be relevant to induce neural plasticity in the hippocampus, chronic or tonic release of NE may exert the opposite effects due to desensitization of the adrenergic signaling pathway due to receptor internalization. Enhanced chemoreflex drive is a major source of sympathoexcitation in HF, and this phenomenon elevates brain ROS levels and induces neuroinflammation through breathing instability. Importantly, both oxidative stress and neuroinflammation can induce mitochondrial dysfunction and vice versa. Then, this ROS inflammatory pathway may propagate within the brain and potentially contribute to the development of cognitive impairment in HF through the activation/inhibition of key molecular pathways involved in neurocognitive decline such as the Wnt signaling pathway.

Abstract P290: Central Angiotensin II and Interleukin-1©¬ Upregulate Brain Tumor Necrosis Factor-¥å Converting Enzyme in the Rat

Tumor necrosis factor-α (TNF-α) converting enzyme (TACE/ADAM17) proteolytically cleaves the extracellular domain of transmembrane TNF-α to release the soluble form of TNF-α that contributes to augmented sympathetic nerve activity in heart failure (HF) and hypertension (HTN). Our previous study indicated that TACE is upregulated in the subfornical organ (SFO) and hypothalamic paraventricular nucleus (PVN), two key cardiovascular and autonomic brain centers, in rats with ischemia-induced HF, and is associated with TNF-α –induced sympathetic excitation in that setting. However, the mechanisms regulating TACE activity in the brain remain a mystery. The present study sought to determine whether angiotensin II (ANG II) or interleukin-1β (IL-1β), which increase in SFO and PVN in HF, upregulate TACE expression. Urethane anesthetized male SD rats underwent a 4- hour intracerebroventricular (ICV) infusion of artificial cerebrospinal fluid (aCSF), ANG II (100 ng/hr) or IL-1β (50 ng/hr). Some rats were euthanized to collect SFO and PVN tissues to measure TACE mRNA and protein; others were transcardially perfused with 4% paraformaldehyde to immunostain for TACE in SFO and PVN. ICV infusion of ANG II (n=6) or IL-1β (n=6) significantly (*p<0.05) increased TACE mRNA level (fold change) in SFO (2.54 ± 0.24* and 2.36 ± 0.21*, respectively) and PVN (2.39* ± 0.25 and 2.23 ± 0.20*, respectively) compared with ICV aCSF infusion. Western blot analysis also revealed a significant increase in the TACE protein (normalized to β-actin) in ANG II or IL-1β infused rats in SFO (0.31±0.06* and 0.26±0.05* respectively) and PVN (0.27 ± 0.04*, 0.24 ± 0.03*, respectively) compared with ICV aCSF-infused rats (SFO: 0.12±0.05; PVN: 0.09±0.04). Confocal images exhibited that TACE-like immunoreactivity was markedly higher in all four subdivisions of PVN and in SFO in rats treated with ICV ANG II or IL-1β, compared with aCSF-infused rats. These data indicate that ANG II and IL-1β upregulate TACE expression in SFO and PVN, suggesting that activation of the renin-angiotensin system and augmented inflammation may upregulate TACE expression in the SFO and PVN in HF and HTN. TACE-mediated ectodomain shedding in SFO and PVN may contribute to ANG II- and cytokine-driven sympathoexcitation in HF and HTN.

Disruption of Central Antioxidant Property of Nuclear Factor Erythroid 2-Related Factor 2 Worsens Circulatory Homeostasis with Baroreflex Dysfunction in Heart Failure.

Heart failure is defined as a disruption of circulatory homeostasis. We have demonstrated that baroreflex dysfunction strikingly disrupts circulatory homeostasis. Moreover, previous many reports have suggested that central excess oxidative stress causes sympathoexcitation in heart failure. However, the central mechanisms of baroreflex dysfunction with oxidative stress has not been fully clarified. Our hypothesis was that the impairment of central antioxidant property would worsen circulatory homeostasis with baroreflex dysfunction in heart failure. As the major antioxidant property in the brain, we focused on nuclear factor erythroid 2-related factor 2 (Nrf2; cytoprotective transcription factor). Hemodynamic and baroreflex function in conscious state were assessed by the radio-telemetry system. In the heart failure treated with intracerebroventricular (ICV) infusion of angiotensin II type 1 receptor blocker (ARB), sympathetic activation and brain oxidative stress were significantly lower, and baroreflex sensitivity and volume tolerance were significantly higher than in heart failure treated with vehicle. ICV infusion of Nrf2 activator decreased sympathetic activation and brain oxidative stress, and increased baroreflex sensitivity and volume tolerance to a greater extent than ARB. In conclusion, the disruption of central antioxidant property of Nrf2 worsened circulatory homeostasis with baroreflex dysfunction in heart failure.

Renal denervation improves cardiac function in rats with chronic heart failure: Effects on expression of β-adrenoceptors.

Chronic activation of the sympathetic drive contributes to cardiac remodeling and dysfunction during chronic heart failure (HF). The present study was undertaken to assess whether renal denervation (RDN) would abrogate the sympathoexcitation in HF and ameliorate the adrenergic dysfunction and cardiac damage. Ligation of the left coronary artery was used to induce HF in Sprague-Dawley rats. Four weeks after surgery, RDN was performed, 1 wk before the final measurements. At the end of the protocol, cardiac function was assessed by measuring ventricular hemodynamics. Rats with HF had an average infarct area >30% of the left ventricle and left ventricular end-diastolic pressure (LVEDP) >20 mmHg. β1- and β2-adrenoceptor proteins in the left ventricle were reduced by 37 and 49%, respectively, in the rats with HF. RDN lowered elevated levels of urinary excretion of norepinephrine and brain natriuretic peptide levels in the hearts of rats with HF. RDN also decreased LVEDP to 10 mmHg and improved basal dP/dt to within the normal range in rats with HF. RDN blunted loss of β1-adrenoceptor (by 47%) and β2-adrenoceptor (by 100%) protein expression and improved isoproterenol (0.5 μg/kg)-induced increase in +dP/dt (by 71%) and -dP/dt (by 62%) in rats with HF. RDN also attenuated the increase in collagen 1 expression in the left ventricles of rats with HF. These findings demonstrate that RDN initiated in chronic HF condition improves cardiac function mediated by adrenergic agonist and blunts β-adrenoceptor expression loss, providing mechanistic insights for RDN-induced improvements in cardiac function in the HF condition.

Infusion of Losartan into the 4th Ventricle Reduced Cardiac Sympathoexcitation in Heart Failure

Background and AimsA key feature of heart failure (HF) is an increase in cardiac sympathetic nerve activity (CSNA). We have found that the area postrema (AP), a brainstem circumventricular organ, plays an important role in controlling CSNA and in determining the increase in CSNA in heart failure. We hypothesized that in sheep with HF, 4th ventricular infusions of losartan (angiotensin II type 1 receptor antagonist) will reduce CSNA to a greater extent than infusion into the cisterna magna.MethodsIn sheep (n=6), when ejection fraction (EF) had fallen to ~50%, cannulae were implanted for infusion into the 4th ventricle and cisterna magna. Blood pressure, heart rate, CSNA & renal SNA were recorded when EF had fallen to <40%. Losartan (1.0 mg/h) or artificial cerebrospinal fluid (aCSF) (1.0 mL/h) were infused into the 4th ventricle and cisterna magna for 5 h, at two days after nerve recording electrodes were surgically implanted.ResultsIn sheep with HF, there was a significant decrease in EF (from 81 ± 3 % to 37 ± 1 %, P <0.001). During 4th ventricle infusion of losartan, there was a significant decrease in CSNA (89 ± 3 to 48 ± 8 bursts/100 heartbeats, P<0.01). Infusion of losartan into the cisterna magna caused a smaller decrease in CSNA (85 ± 2 to 74 ± 4 bursts/100 heartbeats, P<0.05). Infusion of losartan into the 4th ventricle caused no significant changes in renal SNA or in other parameters. Infusion of aCSF into the 4th ventricle or cistrena magna had no effects.ConclusionsInfusion of losartan into the 4th ventricle reduced the elevated CSNA in sheep with HF. The findings suggest that angiotensin type 1 receptors in the brainstem have an important role in determining the increased CSNA in heart failure.

Heart Failure as a Disruption of Dynamic Circulatory Homeostasis Mediated by the Brain.

Circulatory homeostasis is associated with interactions between multiple organs, and the disruption of dynamic circulatory homeostasis could be considered as heart failure. The brain is the central unit integrating neural and neurohormonal information from peripheral organs and controlling peripheral organs using the autonomic nervous system. Heart failure is worsened by abnormal sympathoexcitation associated with baroreflex failure and/or chemoreflex activation, and by vagal withdrawal, and autonomic modulation therapies have benefits for heart failure. Recently, we showed that baroreflex failure induces striking volume intolerance independent of left ventricular dysfunction. Many studies have indicated that an overactive renin-angiotensin system, excess oxidative stress and excess inflammation, and/or decreased nitric oxide in the brain cause sympathoexcitation in heart failure. We have demonstrated that angiotensin II type 1 receptor (AT1R)-induced oxidative stress in the rostral ventrolateral medulla (RVLM), which is known as a vasomotor center, causes prominent sympathoexcitation in heart failure model rats. Interestingly, systemic infusion of angiotensin II directly affects brain AT1R with sympathoexcitation and left ventricular diastolic dysfunction. Moreover, we have demonstrated that targeted deletion of AT1R in astrocytes strikingly improved survival with prevention of left ventricular remodeling and sympathoinhibition in myocardial infarction-induced heart failure. From these results, we believe it is possible that AT1R in astrocytes, not in neurons, have a key role in the pathophysiology of heart failure. We would like to propose a novel concept that the brain works as a central processing unit integrating neural and hormonal input, and that the disruption of dynamic circulatory homeostasis mediated by the brain causes heart failure.

Interaction between interleukin-1 beta and angiotensin II receptor 1 in hypothalamic paraventricular nucleus contributes to progression of heart failure.

The central mechanisms by which interleukin-1 beta (IL-1β) and angiotension II receptor 1 (AT1-R) contribute to sympathoexcitation in heart failure (HF) are unclear. In this study, we determined whether an interaction between IL-1β and AT1-R in the paraventricular nucleus (PVN) contributes to progression of HF. Rats were implanted with bilateral PVN cannulae and subjected to coronary artery ligation or sham surgery (Sham). Subsequently, animals were treated for 4 weeks through PVN infusion with either vehicle, losartan (LOS, 200 μg/day), IL-1β (IL, 1 μg/day), or IL-1β along with LOS (LOS+IL). HF rats had higher levels of corticotropin-releasing hormone (CRH), norepinephrine (NE), and glutamate (Glu); lower levels of gamma-aminobutyric acid (GABA); and more positive fra-like activity in PVN when compared with Sham rats. HF rats also had higher levels of NE, epinephrine (EPI), and IL-1β in plasma. PVN infusion of LOS attenuated the decreases in GABA and the increases in CRH, NE, and Glu in the PVN of HF rats. IL-1β could further increase the expression of CRH, NE, Glu, EPI, and IL-1β and decrease GABA expression. Treatment with IL-1β along with LOS could eliminate the effects of IL-1β. These findings suggest that an interaction between AT1-R and IL-1β in the PVN contributes to progression in HF.

Central exogenous nitric oxide decreases cardiac sympathetic drive and improves baroreflex control of heart rate in ovine heart failure.

Heart failure (HF) is associated with increased cardiac and renal sympathetic drive, which are both independent predictors of poor prognosis. A candidate mechanism for the centrally mediated sympathoexcitation in HF is reduced synthesis of the inhibitory neuromodulator nitric oxide (NO), resulting from downregulation of neuronal NO synthase (nNOS). Therefore, we investigated the effects of increasing the levels of NO in the brain, or selectively in the paraventricular nucleus of the hypothalamus (PVN), on cardiac sympathetic nerve activity (CSNA) and baroreflex control of CSNA and heart rate in ovine pacing-induced HF. The resting level of CSNA was significantly higher in the HF than in the normal group, but the resting level of RSNA was unchanged. Intracerebroventricular infusion of the NO donor sodium nitroprusside (SNP; 500 μg · ml(-1)· h(-1)) in conscious normal sheep and sheep in HF inhibited CSNA and restored baroreflex control of heart rate, but there was no change in RSNA. Microinjection of SNP into the PVN did not cause a similar cardiac sympathoinhibition in either group, although the number of nNOS-positive cells was decreased in the PVN of sheep in HF. Reduction of endogenous NO with intracerebroventricular infusion of N(ω)-nitro-l-arginine methyl ester decreased CSNA in normal but not in HF sheep and caused no change in RSNA in either group. These findings indicate that endogenous NO in the brain provides tonic excitatory drive to increase resting CSNA in the normal state, but not in HF. In contrast, exogenously administered NO inhibited CSNA in both the normal and HF groups via an action on sites other than the PVN.

Central neuregulin-1/ErbB signaling modulates cardiac function via sympathetic activity in pressure overload-induced heart failure

Neuregulin-1 (NRG-1)/ErbB signaling in the heart is reported to have a crucial role in heart failure. We recently demonstrated that NRG-1 signaling has sympathoinhibitory effects in the brain cardiovascular control center. How this central signaling impacts sympathoexcitation in heart failure, however, is unknown. Here we examined the role of central NRG-1/ErbB signaling in modulating the sympathetic nervous system in pressure overload-induced heart failure. Pressure overload-induced heart failure was induced in Wistar-Kyoto rats by banding the abdominal aorta. Rats were followed up for 15 weeks. Compared to sham-operated rats, aortic-banded rats showed left ventricle (LV) hypertrophy, LV dilation, and LV dysfunction [reducing fractional shortening (%fractional shortening), increased LV end-diastolic pressure, decreased positive and negative pressure differential (±dp/dt(max))], and increased urinary norepinephrine excretion. Aortic banding led to reduced expression of NRG-1 in the brainstem at 10 weeks after banding and reduced expression of ErbB2 at 5 weeks, but did not affect ErbB4. Central administration of recombinant NRG-1β at 5 weeks for 2 weeks attenuated LV hypertrophy, improved LV dilatation, prevented LV dysfunction (improvement of %fractional shortening and ±dp/dt(max), and reduction of LV end-diastolic pressure), and lowered urinary norepinephrine excretion at 10 weeks, and these effects were still observed at 15 weeks. NRG-1/ErbB signaling in the brainstem is impaired during the progression of pressure overload-induced heart failure. Activation of central NRG-1 signaling improves cardiac function through sympathoinhibition. These findings provide a new treatment concept and support the benefit of NRG-1 treatment in heart failure.

HIF‐1α increases sympathoexcitation via upregulation of NMDA receptors in the PVN during heart failure (1130.16)

Increased sympathetic outflow is a prominent feature of chronic heart failure (HF) associated with higher mortality. Multiple studies from our lab have reported that higher glutamatergic tone (increase in N‐methyl‐D‐aspartate (NMDA)‐type 1 (NR1) receptors expression) within the paraventricular nucleus (PVN) increase the sympathetic drive in HF. Further, HF (coronary artery ligation‐induced) augmented the expression of hypoxia‐inducible‐factor (HIF)‐1α both at mRNA (9 fold) and protein (2.5 fold) levels in the PVN which, led us to hypothesized that increased levels of HIF‐1α may contribute to exaggerated sympathetic drive via increasing NR1 expression in the PVN of rats with HF. Neuronal cell line (NG108‐15) exposed to hypoxia (2% O₂, 5% CO₂, 93% N₂) showed 2‐fold increase in HIF‐1α (12h) expression with concomitant increases in NR1 at transcription and protein levels after 4h (6.5 fold) and 12h (40%) respectively. Live cell imaging also showed marked increase in intracellular calcium in response to glutamate under hypoxic conditions. Mechanistically, hypoxia promotes the direct binding of HIF‐1α (3.2 fold) at NR1 promoter in neurons exposed to hypoxia as demonstrated by chromatin immunoprecipitation analysis. Furthermore, silencing of HIF‐1α by using HIF‐1α ‐targeted small interfering RNA in neurons led to 2.9 fold decrease in the expression of NR1. Validating our in vitro data, HIF‐1α knockdown by HIF‐1α‐siRNA in the PVN of rats with HF ameliorated the increased sympathoexcitation to NMDA (57±5% vs. 27±1% of basal value). Taken together, our study suggests a contribution of HIF‐1α in the regulation of NR1 expression within the PVN in HF, and provides a novel mechanism for the modulation of sympathoexcitation in HF. Supported by NIH HL62222.Grant Funding Source: NIH HL62222.

Interaction Between AT1 Receptor and NF-κB in Hypothalamic Paraventricular Nucleus Contributes to Oxidative Stress and Sympathoexcitation by Modulating Neurotransmitters in Heart Failure

Angiotensin II type 1 receptor (AT1-R) and nuclear factor-kappaB (NF-κB) in the paraventricular nucleus (PVN) play important roles in heart failure (HF); however, the central mechanisms by which AT1-R and NF-κB contribute to sympathoexcitation in HF are yet unclear. In this study, we determined whether interaction between AT1-R and NF-κB in the PVN modulates neurotransmitters and contributes to NAD(P)H oxidase-dependent oxidative stress and sympathoexcitation in HF. Rats were implanted with bilateral PVN cannulae and subjected to coronary artery ligation or sham surgery (SHAM). Subsequently, animals were treated for 4 weeks through bilateral PVN infusion with either vehicle or losartan (LOS, 10μg/h), an AT1-R antagonist; or pyrrolidine dithiocarbamate (PDTC, 5μg/h), a NF-κB inhibitor via osmotic minipump. Myocardial infarction (MI) rats had higher levels of glutamate (Glu), norepinephrine (NE) and NF-κB p65 activity, lower levels of gamma-aminobutyric acid (GABA), and more positive neurons for phosphorylated IKKβ and gp91(phox) (a subunit of NAD(P)H oxidase) in the PVN when compared to SHAM rats. MI rats also had higher levels of renal sympathetic nerve activity (RSNA) and plasma proinflammatory cytokines (PICs), NE and epinephrine. PVN infusions of LOS or PDTC attenuated the decreases in GABA and the increases in gp91(phox), NF-κB activity, Glu and NE, in the PVN of HF rats. PVN infusions of LOS or PDTC also attenuated the increases in RSNA and plasma PICs, NE and epinephrine in MI rats. These findings suggest that interaction between AT1 receptor and NF-κB in the PVN contributes to oxidative stress and sympathoexcitation by modulating neurotransmitters in heart failure.

Neural control of the circulation during exercise in health and disease

EDITORIAL article Front. Physiol., 26 August 2013Sec. Exercise Physiology https://doi.org/10.3389/fphys.2013.00224

The hypothalamic paraventricular nucleus may not be at the heart of sympathetic outflow

Heart failure (HF) is associated with activation of various neurohumoral factors including the renin–angiotensin–aldosterone and sympathetic nervous systems. In HF patients, elevated sympathetic nerve activity (SNA) is reflected by increased whole body, as well as regional (e.g. cardiac and renal) noradrenaline spillover (Kaye et al. 1994; Petersson et al. 2005), and increased sympathetic nerve discharge (Leimbach et al. 1986). Importantly, the degree of sympathoexcitation predicts mortality in HF patients (Petersson et al. 2005). Consequently, an immense amount of research effort has been directed towards the identification of mechanisms and circuitry underlying elevated SNA in HF. Neurons of the hypothalamic paraventricular nucleus (PVH) regulate SNA in a variety of physiological conditions and pathophysiological states through mono- and polysynaptic projections to the medulla and spinal cord (Guyenet, 2006). Evidence from studies, largely conducted in anaesthetized rodents, suggests HF activates PVH neurons through a reduction in GABAergic function (Patel, 2000). A critical question is the extent to which PVH neurons contribute to elevated SNA in HF. In this issue of The Journal of Physiology, Ramchandra and colleagues (2013) provide novel data utilizing chronic SNA recordings in conscious sheep to address this important question. Interruption of PVH neurotransmission by radiofrequency ablation or neuronal inhibition by microinjection of glycine or the GABAA agonist muscimol failed to lower cardiac and/or renal SNA in both control and HF sheep. Furthermore, blockade of PVH GABAA receptors with injection of bicuculline increased cardiac SNA, mean arterial blood pressure and heart rate in control but not HF sheep. The absence of sympathetic-cardiovascular responses to GABAA receptor activation or blockade in HF versus control sheep confirms a reduced GABAergic function in the PVH. More importantly, these findings challenge the general notion that PVH neurons contribute to sympathoexcitation in HF. Several issues may explain the discrepancies between the present and past studies: (1) differences between anaesthetized versus conscious animals, (2) differences in the central nervous system circuitry/mechanisms between HF models (i.e. coronary ligation versus ventricular pacing), and (3) the possibility that PVH neurons contribute to the development, but not maintenance, of elevated SNA in HF. A second intriguing finding is the differential contribution of PVH neurons to cardiac and renal sympathoinhibitory responses to volume expansion. In conscious sheep, PVH inhibition with injection of the GABAA agonist muscimol reversed the renal, but not the cardiac, sympathoinhibition during intravenous infusion of gelofusine. At least two critical questions arise from these findings. First, PVH neurons abundantly express the vesicular glutamate transporter but are not GABAergic (e.g. GAD67 positive) (Stocker et al. 2006). If volume expansion reduces the discharge of spinally projecting PVH neurons (Lovick & Coote, 1988), why does further inhibition using muscimol reverse the sympathoinhibition? Second, how do PVH neurons differentially regulate SNA to various end organs? The notion that PVH neurons can selectively increase SNA to one organ but not to another has been reported previously (Deering & Coote, 2000; Ward et al. 2011). Therefore, are there distinct populations of PVH neurons that regulate renal versus cardiac versus muscle SNA? Do these neurons receive different anatomical and neurochemical inputs? Previous studies have utilized transneuronal viruses to map the neuronal circuitry associated with a specific end-organ, but limited data exist to demonstrate whether PVH and other central nuclei contain overlapping or distinct populations of neurons to permit differential regulation of SNA. The findings of Ramchandra and colleagues (2013) provide evidence against a role of PVH neurons in elevating SNA in HF but emphasize the ability of PVH neurons to differentially control sympathetic outflow to distinct end-organs. The present findings highlight our limited understanding of how many CNS structures are anatomically and neurochemically connected to coordinate sympathetic outflow to a variety of organs.

Abstract 9763: Brain-targeted Intranasal Administration of Viral Inhibition Peptide of Toll-like Receptor 4 Improves Survival and Prevents Left Ventricular Remodeling Via Sympathoinhibition in Ischemia-induced Heart Failure

[Backgrounds] Abnormal sympathoexcitation causes left ventricular (LV) remodeling and worsen the prognosis of ischemia-induced heart failure (HF). Recent studies have suggested that inflammation in the brain induces sympathoexcitation in HF. We previously demonstrated that brain inflammatory cascade mediated by Toll-like receptor 4 (TLR4) is activated in HF associated with sympathoexcitation. However, brain-specific inhibitory agent of TLR4 has not been available. The aim of the present study was to investigate whether intranasal administration of viral inhibition peptide of TLR4 (VIPER) could inhibit brain-specific TLR4 or not, and whether the brain-targeted inhibition of TLR4 could improve survival rate and prevent LV remodeling via sympathoinhibition in ischemia-induced HF or not. [Methods and Results] Sprague-Dawley rats with HF by coronary artery ligation were initiated the treatment with a dairy intranasal administration of VIPER (VIP), dairy intraperitoneal administration of VIPER (IP) or vehicle (Veh) just after the operation. At day 1, the expressions of TLR4, MyD88 (second messenger of TLR4), and nuclear factor κB (NFκB) in the brain were already significantly lower in VIP than in IP and Veh. These effects in VIP group were confirmed continuously in terms of the treatments. At day 7, urinary norepinephrine excretion (UNE; parameter of sympathoexcitation) was significantly lower and LV end-systolic dimension (LVESD) were significantly smaller in VIP than in Veh (uNE; 1.6±0.2 μg/day vs. 2.5±0.2 μg/day, LVESD; 2.9±0.3 mm vs. 4.8±0.2 mm, n=15 for each, p<0.05 for each). At day 30, the survival rate was significantly higher in VIP than in Veh (84 % vs 61 %, P<0.05). All of these beneficial results in VIP group were not obtained in IP group. [Conclusion] Intranasal administration of viral inhibition peptide of TLR4 is able to inhibit brain-specific TLR4, and improves survival rate and prevents LV remodeling via sympathoinhibition in ischemia-induced HF. This method has a potential to be a novel treatment for ischemia-induced HF with sympathoinhibition.

Exercise training suppresses central command‐evoked sympathoexcitation in rats with heart failure

Sympathoexcitation evoked by central command, a parallel activation of the locomotor and autonomic neural circuits in the brain, has been shown to become exaggerated in heart failure (HF). In the present study, we tested whether exercise training (ET) in HF normalizes central command‐evoked sympathoexcitation. HF was induced in rats > 6 wks after coronary artery ligation. A subset of the HF rats was treadmill trained (20 m/min, 5% grade, 60 min/day, 5 days/wk, 8–14 wks) (HF+ET). Central command was activated by fictive locomotion in decerebrate rats. Fictive locomotion induced by 30‐s electrical stimulation at 35 μA of the mesencephalic locomotor region evoked a larger (P<0.05) increase in renal sympathetic nerve activity in HF rats [269 ± 45 arbitrary unit (AU), fractional shortening (FS) = 20 ± 3%, N12] than that in HF+ET (121 ± 33 AU, FS = 20 ± 2%, N10) and sham (111 ± 37 AU, FS=46 ± 3%, N6) rats. The sympathoexcitation in the HF rats was significantly reduced by bilateral injection into the rostral ventrolateral medulla of Tempol (10 mM, 100 nl), a superoxide dismutase mimetic. In the HF+ET and sham rats, Tempol had no effect on the response. These results suggest that ET has a therapeutic effect to suppress sympathoexcitation evoked by central command in HF. Further, the role played by central superoxide in amplifying central command‐evoked sympathoexcitation in HF may be altered by ET. Supported by JSPS Kaken 22790226 (SK).

Baroreflex Sensitivity Assessment—Latest Advances and Strategies

The baroreflex mechanism has been recognised as a key part of cardiovascular regulation. Alterations in the baroreceptor-heart rate reflex (baroreflex sensitivity [BRS]) contribute to sympathetic–parasympathetic imbalance, playing a major role in the development and progression of many cardiovascular disorders. Therefore, the measurement of the baroreflex is a source of valuable information in the clinical management of cardiac disease patients. This article reviews the most relevant advances for the measurement of BRS and their clinical and prognostic implications. Novel therapeutic strategies, exploring the use of electrical stimulation of the carotid sinus, have been evaluated recently in experimental and preliminary clinical studies to lower blood pressure and to reduce the level of baroreflex-mediated sympathoexcitation in heart failure. A recent study has also shown that the implementation of an artificial baroreflex system to regulate sympathetic vasomotor tone automatically is feasible.

NF-κB in the paraventricular nucleus modulates neurotransmitters and contributes to sympathoexcitation in heart failure.

Findings from our laboratory indicate that proinflammatory cytokines and their transcription factor, nuclear factor-kappaB (NF-κB), are increased in the hypothalamic paraventricular nucleus (PVN) and contribute towards the progression of heart failure. In this study, we determined whether NF-κB activation within the PVN contributes to sympathoexcitation via interaction with neurotransmitters in the PVN during the pathogenesis of heart failure. Heart failure was induced in rats by left anterior descending coronary artery ligation. Sham-operated control (SHAM) or heart failure rats were treated for 4weeks through bilateral PVN infusion with SN50, SN50M or vehicle via osmotic minipump. Rats with heart failure treated with PVN vehicle or SN50M (inactive peptide for SN50) had increased levels of glutamate, norepinephrine (NE), tyrosine hydroxylase (TH), superoxide, gp91(phox) (a subunit of NAD(P)H oxidase), phosphorylated IKKβ and NF-κB p65 activity, and lower levels of gamma-aminobutyric acid (GABA) and the 67-kDa isoform of glutamate decarboxylase (GAD67) in the PVN compared with those of SHAM rats. Plasma levels of cytokines, norepinephrine, epinephrine and angiotensin II, and renal sympathetic nerve activity (RSNA) were increased in heart failure rats. Bilateral PVN infusion of SN50 prevented the decreases in PVN GABA and GAD67, and the increases in RSNA and PVN glutamate, norepinephrine, TH, superoxide, gp91(phox), phosphorylated IKKβ and NF-κB p65 activity observed in vehicle or SN50M-treated heart failure rats. A same dose of SN50 given intraperitoneally did not affect neurotransmitters concentration in the PVN and was similar to vehicle-treated heart failure rats. These findings suggest that NF-κB activation in the PVN modulates neurotransmitters and contributes to sympathoexcitation in rats with ischemia-induced heart failure.

Baroreflex Sensitivity Assessment – Latest Advances and Strategies

The baroreflex mechanism has been recognised as a key part of cardiovascular regulation. Alterations in the baroreceptor-heart rate reflex (baroreflex sensitivity [BRS]) contribute to sympathetic–parasympathetic imbalance, playing a major role in the development and progression of many cardiovascular disorders. Therefore, the measurement of the baroreflex is a source of valuable information in the clinical management of cardiac disease patients. This article reviews the most relevant advances for the measurement of BRS and their clinical and prognostic implications. Novel therapeutic strategies, exploring the use of electrical stimulation of the carotid sinus, have been evaluated recently in experimental and preliminary clinical studies to lower blood pressure and to reduce the level of baroreflex-mediated sympathoexcitation in heart failure. A recent study has also shown that the implementation of an artificial baroreflex system to regulate sympathetic vasomotor tone automatically is feasible.