The enhanced cardiac sympathetic afferent reflex (CSAR) contributes to the exaggerated sympatho-excitation in chronic heart failure (CHF). Increased sympatho-excitation is positively related to mortality in CHF patients. However, the potential beneficial effects of chronic CSAR deletion on cardiac and autonomic function in CHF have not been previously explored. Here we determined the effects of chronic CSAR deletion on cardiac remodeling and autonomic dysfunction in CHF. In order to selectively delete the transient receptor potential vanilloid 1 receptor (TRPV1) -expressing CSAR afferents, epicardial application of resiniferatoxin (RTX, 50 μg/ml), an ultrapotent analogue of capsaicin, was performed during myocardium infarction (MI) surgery in rats. This procedure largely abolished the enhanced CSAR, prevented the exaggerated renal and cardiac sympathetic nerve activity and improved baroreflex sensitivity in CHF rats. Most importantly, we found that epicardial application of RTX largely prevented the elevated LVEDP, lung edema and cardiac hypertrophy, partially reduced left ventricular dimensions in the failing heart and increased cardiac contractile reserve in response to β-adrenergic receptor stimulation with isoproterenol in CHF rats. Molecular evidence showed that RTX attenuated cardiac fibrosis and apoptosis and reduced expression of fibrotic markers and TGF β-receptor I in CHF rats. Pressure - volume loop analysis showed that RTX reduced the end diastolic pressure volume relations in CHF rats indicating improved cardiac compliance. In summary, cardiac sympathetic afferent deletion exhibits protective effects against deleterious cardiac remodeling and autonomic dysfunction in CHF. These data suggest a potential new paradigm and therapeutic potential in the management of CHF.

Chronic heart failure is often associated with sympathoexcitation and blunted arterial baroreflex function. These phenomena have been causally linked to elevated central ANG II mechanisms. Recent studies have shown that NAD(P)H oxidase-derived reactive oxygen species (ROS) are important mediators of ANG II signaling and therefore might play an essential role in these interactions. The aims of this study were to determine whether central subchronic infusion of ANG II in normal animals has effects on O2- production and expression of NAD(P)H oxidase subunits as well as ANG II type 1 (AT1) receptors in the rostral ventrolateral medulla (RVLM). Twenty-four male New Zealand White rabbits were divided into four groups and separately received a subchronic intracerebroventricular infusion of saline alone, ANG II alone, ANG II with losartan, and losartan alone for 1 wk. On day 7 of intracerebroventricular infusion, mean arterial pressure (MAP), heart rate (HR), and renal sympathetic nerve activity (RSNA) values were recorded, and arterial baroreflex sensitivity was evaluated while animals were in the conscious state. We found that ANG II significantly increased baseline RSNA (161.9%; P< 0.05), mRNA and protein expression of AT1 receptors (mRNA, 66.7%; P < 0.05; protein, 85.1%; P < 0.05), NAD(P)H oxidase subunits (mRNA, 120.0-200.0%; P < 0.05; protein, 90.9-197.0%; P < 0.05), and O2- production (83.2%; P < 0.05) in the RVLM. In addition, impaired baroreflex control of HR (Gain(max) reduced by 48.2%; P < 0.05) and RSNA (Gain(max) reduced by 53.6%; P < 0.05) by ANG II was completely abolished by losartan. Losartan significantly decreased baseline RSNA (-49.5%; P < 0.05) and increased baroreflex control of HR (Gain(max) increased by 64.8%; P < 0.05) and RSNA (Gain(max) increased by 67.9%; P < 0.05), but had no significant effects on mRNA and protein expression of AT1 receptor and NAD(P)H oxidase subunits and O2- production in the RVLM. These data suggest that in normal rabbits, NAD(P)H oxidase-derived ROS play an important role in the modulation of sympathetic activity and arterial baroreflex function by subchronic central treatment of exogenous ANG II via AT1 receptors.

A novel influenza A (H7N9) virus of avian origin emerged in eastern China in the spring of 2013. This virus causes severe disease in humans, including acute and often lethal respiratory failure. As of January 2014, 275 cases of H7N9-infected patients had been reported, highlighting the urgency of identifying biomarkers for predicting disease severity and fatal outcomes. Here, we show that plasma levels of angiotensin II, a major regulatory peptide of the renin-angiotensin system, are markedly elevated in H7N9 patients and are associated with disease progression. Moreover, the sustained high levels of angiotensin II in these patients are strongly correlated with mortality. The predictive value of angiotensin II is higher than that of C-reactive protein and some clinical parameters such as the PaO 2 /FiO 2 ratio (partial pressure of arterial oxygen to the fraction of inspired oxygen). Our findings indicate that angiotensin II is a biomarker for lethality in flu infections.

Background-In a previous study, we showed that simvastatin (SIM) therapy normalized sympathetic outflow and cardiovascular reflex regulation in chronic heart failure (CHF). However, the precise neural and cellular pathways for these effects are unknown. We hypothesized that SIM exerts its beneficial effect on autonomic function in CHF by downregulating central angiotensin II (Ang II) and superoxide mechanisms. Methods and Results-Experiments were carried out on 36 male New Zealand White rabbits, 13 normal and 23 CHF. All rabbits were identically instrumented to record mean arterial pressure, heart rate, and renal sympathetic nerve activity (RSNA

A previous study from this laboratory has shown that cardiac sympathetic afferent stimulation by epicardial application of bradykinin (BK) and capsaicin was significantly enhanced in the dog with experimental heart failure (HF). The present study determined whether activity from cardiac sympathetic chemosensitive afferent endings is enhanced in HF. Rapid ventricular pacing was induced in six dogs. Five sham dogs served as controls. At the time of the acute experiment, the dogs were anesthetized with pentobarbital sodium (30 mg/kg iv). A thoracotomy was performed in the second intercostal space, and single afferent fiber discharge from the left cardiac sympathetic nerve was recorded. Baseline cardiac sympathetic afferent discharge rate (spikes/s) and its responses to intra-atrial injection of BK were compared between sham and HF groups. Baseline cardiac sympathetic afferent discharge rate in the HF group was significantly elevated compared with the sham group (4.3 ± 0.5 vs. 2.2 ± 0.6 spikes/s, P < 0.05). In addition, cardiac sympathetic afferent responses to left intra-atrial injection of bradykinin (2 and 5 μg/kg) and capsaicin (5 and 10 μg/kg) were also significantly augmented. The sensitized cardiac sympathetic afferent responses to BK (2 and 5 μg/kg, left intra-atrial injection) in the HF group were significantly reduced by the cyclooxygenase inhibitor indomethacin (5 mg/kg iv). The sensitized cardiac sympathetic afferent response to capsaicin (5 and 10 μg/kg, left intra-atrial injection) in the HF group was preserved. It is suggested that the cardiac sympathetic chemosensitive afferent sensitivity is significantly enhanced in dogs with HF even though the baseline cardiac sympathetic afferent discharge is elevated.

Chronic obstructive pulmonary disease (COPD) is a progressive condition of chronic bronchitis, small airway obstruction, and emphysema that represents a leading cause of death worldwide. While inflammation, fibrosis, mucus hypersecretion, and metaplastic epithelial lesions are hallmarks of this disease, their origins and dependent relationships remain unclear. Here we apply single-cell cloning technologies to lung tissue of patients with and without COPD. Unlike control lungs, which were dominated by normal distal airway progenitor cells, COPD lungs were inundated by three variant progenitors epigenetically committed to distinct metaplastic lesions. When transplanted to immunodeficient mice, these variant clones induced pathology akin to the mucous and squamous metaplasia, neutrophilic inflammation, and fibrosis seen in COPD. Remarkably, similar variants pre-exist as minor constituents of control and fetal lung and conceivably act in normal processes of immune surveillance. However, these same variants likely catalyze the pathologic and progressive features of COPD when expanded to high numbers.

Angiotensin type 1 receptors (AT(1)Rs) play a critical role in a variety of physiological functions and pathophysiological states. They have been strongly implicated in the modulation of sympathetic outflow in the brain. An understanding of the mechanisms by which AT(1)Rs are regulated in a variety of disease states that are characterized by sympathoexcitation is pivotal in development of new strategies for the treatment of these disorders. This review concentrates on several aspects of AT(1)R regulation in the setting of chronic heart failure (CHF). There is now good evidence that AT(1)R expression in neurons is mediated by activation of the transcription factor activator protein 1 (AP-1). This transcription factor and its component proteins are upregulated in the rostral ventrolateral medulla of animals with CHF. Because the increase in AT(1)R expression and transcription factor activation can be blocked by the AT(1)R antagonist losartan, a positive feedback mechanism of AT(1)R expression in CHF is suggested. Oxidative stress has also been implicated in the regulation of receptor expression. Recent data suggest that the newly discovered catabolic enzyme angiotensin-converting enzyme 2 (ACE2) may play a role in the modulation of AT(1)R expression by altering the balance between the octapeptide ANG II and ANG- (1-7). Finally, exercise training reduces both central oxidative stress and AT(1)R expression in animals with CHF. These data strongly suggest that multiple central and peripheral influences dynamically alter AT(1)R expression in CHF.

Abstract-It has been established that the baroreflex is markedly decreased in chronic heart failure (CHF). Our recent study has indicated that activation of the cardiac sympathetic afferent reflex (CSAR) inhibits the baroreflex in normal rats, and in the rats with CHF the CSAR is significantly enhanced, which is related to augmented central angiotensin II (Ang II) mechanism. Therefore, the hypothesis is that the augmented CSAR in the CHF state tonically inhibits the baroreflex via central AT 1 receptor. To test the hypothesis, the rats with myocardial infarction-induced CHF or sham surgery were anesthetized with ␣-chloralose and urethane, vagotomized, and recordings were made of the mean arterial pressure (MAP) and renal sympathetic nerve activity (RSNA). We found: (1) Key Words: baroreflex Ⅲ cardiac function Ⅲ heart failure Ⅲ reflex Ⅲ renal nerves Ⅲ sympathetic nervous system C hronic heart failure (CHF) has long been known to be associated with a blunted arterial baroreflex sensitivity. [1][2][3][4][5] This is a clinically important phenomenon not only because it contributes to altered moment to moment cardiovascular homeostatic adjustments in the CHF patient but also because it has been directly implicated in an enhanced risk of sudden cardiac death 6 and total cardiovascular mortality. 7 However, the mechanisms by which the baroreflex is impaired in this disease remain incompletely understood.In a previous study, we showed that in the CHF state, the cardiac sympathetic afferent reflex (CSAR) was augmented in dogs with CHF 8 -10 and in rats with CHF. 11 The sites at which this reflex is enhanced reside at both the afferent endings 10 and in the central nervous system. 12 Evidence from this laboratory also suggests that the enhanced gain of the cardiac sympathetic afferent reflex in CHF is related to an enhanced central angiotensin II (Ang II) mechanism. 11,13 However, cardiac sympathetic afferent can inhibit baroreflex sensitivity 14 and our recent study also demonstrated that in normal rats, electrical and chemical stimulation of the CSAR inhibited the arterial baroreflex control of renal sympathetic nerve activity (RSNA), and that central blockade of AT 1 receptors prevented this inhibition. 15 We thus reasoned that in the CHF state, the enhanced CSAR might contribute to impairment of arterial baroreceptor reflex function via central Ang II mechanism. In the present study, we examined the effects of blocking CSAR on this reflex function in the rats with chronic myocardial infarction-induced CHF and explored the role of central Ang II mechanism in this process. MethodsMale Sprague-Dawley rats weighing 180 to 200 grams were used in these experiments. All experiments were approved by the Institutional Animal Care and Use Committee of the University of Nebraska Medical Center and were performed under the guidelines of the American Physiological Society and the National Institutes of Health Guide for the Care and Use of Laboratory Animals. Model of Chronic Heart FailureCHF was produced by coronary artery ligati...