Cardiac autonomic neuropathy (CAN) is an early cardiovascular complication of diabetes occurring before metabolic derangement is evident. The cause of CAN remains elusive and cannot be directly linked to hyperglycemia. Recent clinical data report cardioprotective effects of some antidiabetic drugs independent of their hypoglycemic action. Here, we used a rat model receiving limited daily increase in calories from fat (HC diet) to assess whether mild metabolic challenge led to CAN in absence of interfering effects of hyperglycemia, glucose intolerance, or obesity. Rats receiving HC diet for 12 weeks showed reduction in baroreceptor sensitivity and heart rate variability despite lack of change in baseline hemodynamic and cardiovascular structural parameters. Impairment of cardiac autonomic control was accompanied with perivascular adipose inflammation observed as an increased inflammatory cytokine expression, together with increased cardiac oxidative stress, and signaling derangement characteristic of diabetic cardiomyopathy. Two-week treatment with metformin or pioglitazone rectified the autonomic derangement and corrected the molecular changes. Switching rats to normal chow but not to isocaloric amounts of HC for two weeks reversed CAN. As such, we conclude that adipose inflammation due to increased fat intake might underlie development of CAN and, hence, the beneficial effects of metformin and pioglitazone.

Cardiac autonomic neuropathy (CAN) is an early cardiovascular manifestation of type 2 diabetes (T2D) that constitutes an independent risk factor for cardiovascular mortality and morbidity. Nevertheless, its underlying pathophysiology remains poorly understood. We recently showed that localized perivascular adipose tissue (PVAT) inflammation underlies the incidence of parasympathetic CAN in prediabetes. Here, we extend our investigation to provide a mechanistic framework for the evolution of autonomic impairment as the metabolic insult worsens. Early metabolic dysfunction was induced in rats fed a mild hypercaloric diet. Two low-dose streptozotocin injections were used to evoke a state of late decompensated T2D. Cardiac autonomic function was assessed by invasive measurement of baroreflex sensitivity using the vasoactive method. Progression into T2D was associated with aggravation of CAN to include both sympathetic and parasympathetic arms. Unlike prediabetic rats, T2D rats showed markers of brainstem neuronal injury and inflammation as well as increased serum levels of IL-1b. Experiments on PC12 cells differentiated into sympathetic-like neurons demonstrated that brainstem injury observed in T2D rats resulted from exposure to possible pro-inflammatory mediators in rat serum rather than a direct effect of the altered metabolic profile. CAN and the associated cardiovascular damage in T2D only responded to combined treatment with insulin to manage hyperglycemia in addition to a non-hypoglycemic dose of metformin or pioglitazone providing an anti-inflammatory effect, coincident with the effect of these combinations on serum IL-1b. Our present results indicate that CAN worsening upon progression to T2D involves brainstem inflammatory changes likely triggered by systemic inflammation.

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The risk of cardiovascular complications in type 2 diabetes increases as early as in the prediabetic stage. Our previous studies showed that perivascular adipose tissue inflammation contributes to vascular and cardiac autonomic dysfunction in prediabetic rats. Intermittent fasting has been extensively studied in the management of metabolic diseases. Here, we aim to examine the impact of therapeutic fasting (TF) on the metabolic and cardiovascular stress among prediabetic rats. Male SD rats (4–5weeks) were randomly allocated into 3 dietary groups; control diet (C), high‐calorie (HC) diet and HC‐diet with TF, for 24 weeks. Rats were fed ad libitum in the first 12 weeks. Afterwards, the TF group was subjected to daily fasting from 7.00pm – 7.00am (during the dark period) for 12 weeks with free access to water, and to HC‐diet during the light phase. Daily food intake, body weight (BW), blood glucose (fasting FBG and random RBG), body composition (BC) (using NMR), HbA1c, serum insulin levels, echocardiographic parameters, and noninvasive blood pressure were measured. At week 24; rats were catheterized for invasive hemodynamic examination. Cardiac autonomic neuropathy (CAN) was assessed by measuring baroreceptor sensitivity (BRS) using the vasoactive method. After sacrifice, aortic contractility and endothelial function were assessed using organ bath experiments. Daily calorie intake was higher in the HC group compared to control with no difference in body weight, blood glucose level, HbA1c, and glucose tolerance. Similar to our previous observations, HC feeding led to an increased fat/lean ratio, increased serum insulin level, insulin resistance, increased vascular reactivity, and reduced endothelium‐dependent relaxation. Despite a lack of effect on daily calorie intake, the previous parameters were reversed by TF. As well, SBP was higher in the HC‐fed rats (137.7 vs. 119 mm Hg), which was reversed in TF rats. This could be explained based on the observed increase in vascular sensitivity to phenylephrine‐induced contraction (pEC50 5.95 vs. 5.53) and a reduced acetylcholine mediated endothelium‐dependent relaxation in HC rats. Both observations were normalized in TF rats. Moreover, HC‐fed rats showed parasympathetic CAN manifesting as reduced BRS (DMAP vs. DHR slope decreased to −0.15 from −0.4) that was reversed in TF. Our results indicate that HC feeding induced vascular and cardiac autonomic dysfunction secondary to perivascular adipose inflammation. TF reverses signs of cardiovascular impairment. Future studies will be conducted to assess the effect of TF on PVAT inflammation. Support or Funding Information Funded by AUB‐FM MPP grant #320148

Background The complexity of the interaction between metabolic dysfunction and cardiovascular complications has long been recognized to extend beyond simple perturbations of blood glucose levels. Yet, structured interventions targeting the root pathologies are not forthcoming. Growing evidence implicates the inflammatory changes occurring in perivascular adipose tissue (PVAT) as early instigators of cardiovascular deterioration. Methods and Results We used a nonobese prediabetic rat model with localized PVAT inflammation induced by hypercaloric diet feeding, which dilutes inorganic phosphorus (Pi) to energy ratio by 50%, to investigate whether Pi supplementation ameliorates the early metabolic impairment. A 12‐week Pi supplementation at concentrations equivalent to and twice as much as that in the control diet was performed. The localized PVAT inflammation was reversed in a dose‐dependent manner. The increased expression of UCP1 (uncoupling protein1), HIF‐1α (hypoxia inducible factor‐1α), and IL‐1β (interleukin‐1β), representing the hallmark of PVAT inflammation in this rat model, were reversed, with normalization of PVAT macrophage polarization. Pi supplementation restored the metabolic efficiency consistent with its putative role as an UCP1 inhibitor. Alongside, parasympathetic autonomic and cerebrovascular dysfunction function observed in the prediabetic model was reversed, together with the mitigation of multiple molecular and histological cardiovascular damage markers. Significantly, a Pi‐deficient control diet neither induced PVAT inflammation nor cardiovascular dysfunction, whereas Pi reinstatement in the diet after a 10‐week exposure to a hypercaloric low‐Pi diet ameliorated the dysfunction. Conclusions Our present results propose Pi supplementation as a simple intervention to reverse PVAT inflammation and its early cardiovascular consequences, possibly through the interference with hypercaloric‐induced increase in UCP1 expression/activity.