Emerging evidence suggests an associative link between gut dysbiosis, the autonomic nervous system (ANS) and the immune system in pathophysiology of neurogenic hypertension (HTN). However, the close interplay between these three systems presents us with difficulties in deciphering the cause-effect relationship in disease. The present study utilized beta 1 and 2 adrenergic receptor knock out (AdrB1tm1BkkAdrB2tm1Bkk/J KO) mice to isolate the effects of reduced overall sympathetic drive on gut microbiota and systemic immune system. We observed the following: (i) Diminished beta adrenergic signaling mainly reflects in shifts in the Firmicutes phyla, with a significant increase in abundance of largely beneficial Bacilli Lactobacillales in the KO mice; (ii) This was associated with increased colonic production of beneficial short chain fatty acids (SCFAs) butyrate, acetate and propionate, confirming functional microbiota shifts in the KO mice; (iii) Dampened systemic immune responses in the KO mice reflected in reduction on circulating CD4+.IL17+ T cells and increase in young neutrophils, both previously associated with shifts in the gut microbiota. Taken together, these observations demonstrate that reduced expression of beta adrenergic receptors may lead to beneficial shifts in the gut microbiota and dampened systemic immune responses. Considering the role of both in hypertension, this suggests that dietary intervention may be a viable option for manipulation of blood pressure via correcting gut dysbiosis.

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preoperative functionality of the affected limb than those not screened by this protocol, 2.7 versus 5.4 (P ¼ .0082). Postoperative functionality reported by the two groups was similar, 8.0 versus 8.1 (P ¼ .45). Approximately half of survey respondents reported some degree of symptom recurrence after surgery, with an average time to recurrence of 2 months (range, 1-96 months). There was no difference in symptom recurrence (P ¼ .74) or need for reintervention 4 of 49 cases (P ¼ .80) between block and nonblock groups. Patients operated on following positive response to muscle block reported a lower long-term postoperative pain rating (2.9 vs 3.3), as well as more relief from nTOS symptoms (8.0 vs 7.7), though neither of these differences reached significance.Conclusions: The majority of patients undergoing surgical decompression for relief of nTOS symptoms report improvement in pain and related symptomatology, though some degree of recurrence continues to occur in nearly half of patients. The institution of a preoperative screening protocol involving temporary muscle block selects a patient population with more severe preoperative symptoms. While block protocols may provide another data point to guide patient selection, this study does not demonstrate a statistically significant difference in clinical outcomes in an initial patient group following protocol institution. Further study as additional patients are accrued under the protocol is ongoing.