Melatonin and the Brain–Heart Crosstalk in Neurocritically Ill Patients—From Molecular Action to Clinical Practice

Abstract

Brain injury, especially traumatic brain injury (TBI), may induce severe dysfunction of extracerebral organs. Cardiac dysfunction associated with TBI is common and well known as the brain–heart crosstalk, which broadly refers to different cardiac disorders such as cardiac arrhythmias, ischemia, hemodynamic insufficiency, and sudden cardiac death, which corresponds to acute disorders of brain function. TBI-related cardiac dysfunction can both worsen the brain damage and increase the risk of death. TBI-related cardiac disorders have been mainly treated symptomatically. However, the analysis of pathomechanisms of TBI-related cardiac dysfunction has highlighted an important role of melatonin in the prevention and treatment of such disorders. Melatonin is a neurohormone released by the pineal gland. It plays a crucial role in the coordination of the circadian rhythm. Additionally, melatonin possesses strong anti-inflammatory, antioxidative, and antiapoptotic properties and can modulate sympathetic and parasympathetic activities. Melatonin has a protective effect not only on the brain, by attenuating its injury, but on extracranial organs, including the heart. The aim of this study was to analyze the molecular activity of melatonin in terms of TBI-related cardiac disorders. Our article describes the benefits resulting from using melatonin as an adjuvant in protection and treatment of brain injury-induced cardiac dysfunction.

Depression as a cardiovascular disorder: central-autonomic network, brain-heart axis, and vagal perspectives of low mood

“…Considering the swiftly growing body of scientific evidence highlighting dysfunctional BHI dynamics in a range of pathological conditions ( Taggart et al, 2011 ; Tahsili-Fahadan et al, 2017 ; Joyner, 2019 ; Riching et al, 2019 ; Riganello et al, 2019 ; Liu et al, 2020 ; Méloux et al, 2020 ; Costagliola et al, 2021 ; Nowroozpoor et al, 2021 ; Tumati et al, 2021 ; Vaccarino et al, 2021 ; Bekała et al, 2022 ; Grassi et al, 2022 ; Kumral et al, 2022 ; Lazaridi et al, 2022 ; Liu et al, 2022 ; Seligowski et al, 2022 ; Wang and Peng, 2022 ; Xue et al, 2022 ), it is possible that cardiologists will run EEG/psychometric/emotional assessments before their standard clinical evaluation. Likewise, psychiatrists and clinical psychologists may need to conduct EEG/MRI scans and 24-h cardiac holter monitoring to consider depression as a neurocardiovascular disorder.”…”

The role of circadian clock in regulating cell functions: implications for diseases

“…The rhythmicity is transmitted from the central to peripheral clocks via neural or hormonal signals 4 . Intertissue communications, exemplified by the gut–brain axis, brain–heart axis, and gut–liver axis, are instrumental in maintaining circadian rhythms in gene expressions and physiological processes 5–9 . For example, the intestinal clock orchestrates the hepatic rhythmic transcriptome and diurnal metabolism, thereby underpinning hepatic metabolic homeostasis 10 .…”

Blast Exposure Dysregulates Nighttime Melatonin Synthesis and Signaling in the Pineal Gland: A Potential Mechanism of Blast-Induced Sleep Disruptions

“…The disruption of the melatonin synthesis pathway by TBI can also cause the dysfunction of extracerebral organs such as the heart. Furthermore, TBI-related cardiac dysfunction can worsen the brain damage and delay the functional recovery [ 26 ]. Nevertheless, no prior studies have investigated the effect of bTBI on genes involved in the melatonin synthesis pathway in the pineal gland.…”