Rozprawy doktorskie na temat „Cardiovascular regulation”

Heterologous expression systems such as COS-7 cells have demonstrated the profound effects of KCNAB1-3 or Kvβ1-3 proteins on voltage gated potassium channels (Kv) channels. Indeed, in the presence of these β-subunits transiently expressed Kv channels are often modulated in multiple ways. Kv channel membrane expression is often increased in the presence of β-subunits. In addition, non-inactivating Kv currents suddenly become fast-inactivating and fast-inactivating channels become even faster. While much research has demonstrated the profound effects the β-subunits in particular the Kvβ1 subunit have on transiently expressed Kv currents little to date is known of the physiological role it may play. One study demonstrated that by “knocking out” Kvβ1 cardiomyocyte current changes were noted including a decrease in the Ito,f current. While this novel finding demonstrated a key cardiac physiological role of the Kvβ1 subunit it left many unanswered questions as to determine the cardiovascular regulation the Kvβ1 subunit provides. Indeed, cardiac arrhythmias and other electrical abnormalities within the heart such as long QT present patients with many unfortunate unknowns. Many of these incidences occur often abruptly with cardiac electrical abnormalities. Genetic research has begun to shine light on key cardiovascular genes in particular those coding for ion channels and auxiliary subunits or β-subunits. Kv channels and their β-subunits have gained particular notoriety in their key responsibility in restoring the resting membrane potential known as the repolarization phase. Indeed genetic manipulation and physiological examination of Kv channels and recently their β-subunits has demonstrated profound physiological results including prolonged QT durations within mice altered functional activity during physiological cycles such as estrus. While initial findings of Kvβ1 have demonstrated profound cellular and cardiomyocyte current alterations much still remains unknown. Therefore, this work hypothesizes that the Kvβ1 subunit provides a profound cardiovascular role in regulation and redox sensing at the physiological and pathophysiological level in both males and females. This work identifies a sex-based difference in cardiovascular regulation by Kvβ1 as well as demonstrated a profound redox sensing ability during altered metabolic states seen in pathophysiological conditions.

Abstract Neurogenic factors are known to be important in the development of hypertension. Our current knowledge of the role of autonomic nervous system in chronic hypertension is, however, limited. The purpose of the present study was to evaluate the possible abnormalities in heart rate variability (HRV) and baroreflex sensitivity (BRS) in patients with long standing systemic hypertension compared to subjects without evidence of cardiovascular disease. A particular aim was also to examine whether genetic variation in the renin-angiotensin-aldosterone system (RAS) genes have an influence on cardiovascular autonomic regulation. Case-control studies were carried out on a total of 280 normotensive and 214 hypertensive subjects drawn from a random middle-aged population originally recruited for an epidemiologic study of cardiovascular risk factors. The possible association of BRS with the genetic polymorphisms of renin-angiotensin-aldosterone system genes was studied in a cross-sectional study of 315 healthy controls. Genetic associations were also tested in a younger, independent population sample of 66 subjects. The effects of intensified antihypertensive treatment on autonomic cardiovascular control were evaluated in 33 hypertensive patients with poor blood pressure control. Wide interindividual variation in both HRV and BRS was observed in normotensive as well as hypertensive subjects. Overall HRV and autonomic responses to a change in body posture were blunted in long-standing hypertension. Decreased HRV was mainly related to elevated blood pressure and obesity. For the first time in a population-based study, it was confirmed that BRS is impaired in patients with long-standing hypertension despite adequate antihypertensive treatment. In contrast to HRV, BRS was reduced in hypertensive subjects also after adjustment for blood pressure and obesity. BRS also varied widely both between healthy and hypertensive individuals. The wide interindividual variation in the markers of autonomic cardiovascular regulation was not, however, completely explained by demographic variables, cardiovascular risk factors or lifestyle, suggesting a genetic component contributing to HRV and BRS. The polymorphism in the aldosterone synthase (CYP11B2) gene was found to strongly associate with BRS in two independent random populations of apparently healthy subjects. The association was even stronger in the younger population. On the basis of the observations made in the older population, it seems possible that women are protected against the effect of age and blood pressure on BRS and tend to maintain the genomic influence longer. Intensified antihypertensive combination therapy improved blood pressure control and caused regression of left ventricular hypertrophy, and resulted in significant improvements of HRV and BRS. The present study shows that HRV and BRS are altered in long-standing systemic hypertension. Together with age, blood pressure and obesity, genetic factors seem to be important determinants of BRS. However, abnormal autonomic cardiovascular regulation does not seem to be an irreversible phenomenon, but can be partly restored by modern combination antihypertensive therapy.

Thesis (S.B. and M.Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2000.
Includes bibliographical references (p. 65-67).
by Ming-Hokng Maa.
S.B.and M.Eng.

Abstract The incidence of adverse cardiovascular events is higher among spectators of exciting sports events, particularly in patients with coronary artery disease (CAD), but the mechanistic link between the events is not known. We assessed the hemodynamic, autonomic function, plasma catecholamines, endothelin-1, interleukin-6, and markers of platelet activation and blood coagulation of enthusiastic male ice hockey spectators with CAD (n=55, 60±9 years) and healthy subjects (n=16, 48±6 years) during Finnish national league ice hockey final play-off matches and on a control day. Blood markers were also measured before and after a maximal exercise test with a bicycle ergometer. Systolic and diastolic blood pressure (BP) were significantly higher one hour before, during, and one hour after the match than on the control day. During the match the highest systolic BP was 180±14 vs. 145±15 and diastolic BP was 103±13 vs. 82±11 mmHg (respectively, p<0.001 for both). Heart rate (HR) was higher throughout the match (p<0.05) and remained elevated two hours after the match (p<0001), and measures of HR variability were decreased during the match (p<0.01). Plasma endothelin-1 (ET-1), interleukin-6 (IL-6) and noradrenaline (NOR) increased during the match (p<0.01 for all), but markers of platelet activation and coagulation remained unchanged. ET-1 did not change during exercise but NOR, adrenaline, IL-6, and markers of platelet activation and blood coagulation increased statistically significantly (p<0.0001 for all). A statistically significantly more marked increase in both endothelin-1 and interleukin-6 was observed in CAD patients compared with healthy subjects during the match (time x group interaction p<0.05 for both). The high-frequency power of R-peak-to-R-peak intervals decreased in CAD patients (p<0.001) but did not change in healthy subjects during the match. Maximal metabolic equivalens (METs) were most strongly correlated with ET-1 response during the match (β =-0.45, partial correlation r=-0.43, p=0.002) when age, body mass index, METs, left ventricular ejection fraction, basal ET-1 and subjective experience of excitement were entered into the model as independent variables in a linear stepwise regression analysis. In conclusion, autonomic reactions and vasoconstriction may partly explain the vulnerability to cardiovascular events caused by this type of leisure-time emotional excitement. Emotional excitement causes concomitant increases in markers reflecting vulnerability to atherosclerotic plaque complications, while physical exercise causes more prominent changes in markers of coagulation. Emotional excitement causes more significant increases of markers of vasoconstriction and acute inflammation and withdrawal of cardiac vagal regulation in patients with CAD than in healthy subjects. Exercise capacity may protect against further cardiovascular events in CAD patients because it is associated with reduced ET-1 release during emotional excitement
Tiivistelmä Jännittävän urheilutapahtuman on havaittu lisäävän sydäntapahtumia erityisesti sepelvaltimotautipotilailla. Syyt eivät ole selvillä. Tutkimuksen kohteena oli jääkiekon mestaruussarjan pudotuspelien seuraamisen vaikutus sekä sepelvaltimotautisten (n=55, 60±9 vuotta) että terveiden (n=16, 48±6 vuotta) jääkiekkofanien verenkiertoon, autonomiseen hermostoon, veren katekolamiinien, endoteliini-1:n (ET-1) ja interleukiini-6:n (IL-6) pitoisuuksiin sekä veren hyytymiseen paikan päällä jäähallissa seurattuna. Muuttujat mitattiin jäähallissa ottelun aikana. Ne mitattiin myös ennen ottelua ja eri päivänä sairaalassa ennen kuntopyörällä tehtyä maksimaalista sydämen kuormitustestiä ja heti sen jälkeen. Sepelvaltimotautipotilaiden ylä- ja alaverenpaineet kohosivat tilastollisesti merkitsevästi tuntia ennen jääkiekkopeliä ja sen aikana, ja ne olivat koholla vielä tunnin ajan pelin jälkeen kontrollipäivään verrattuina. Ottelun aikana yläpaineet olivat 180±14 vs. 145±15 ja alapaineet 103±13 vs. 82±11 mmHg (p<0.001 molemmille painetasoille). Sydämen syke oli korkeampi pelin ajan (p<0.05), ja se pysyi koholla kahden tunnin ajan pelin jälkeen (p<0.001). Lisäksi sykevaihtelu heikentyi pelin aikana (p<0.01) kontrollipäivään verrattuna. Veren ET-1-, IL-6- ja noradrenaliinipitoisuudet (p<0.01) nousivat pelin aikana, mutta veren hyytymistä kuvastavat lukemat säilyivät muuttumattomina. ET-1 ei noussut fyysisessä kuormitustestissä, mutta noradrenaliini- ja adrenaliinipitoisuudet sekä IL-6:n ja veren hyytymistä kuvaavat lukemat kasvoivat tilastollisesti merkitsevästi (p<0.0001). Pelin aikana sepelvaltimotautipotilaiden ET-1 ja IL-6 pitoisuudet kohosivat enemmän kuin terveiden vastaavat arvot (p<0.05). Lisäksi ottelun aikana sydämen sykevaihtelu laski sepelvaltimopotilailla (p<0.001), muttei muuttunut terveillä. Polkupyörätestin maksimaalinen suorituskyky (METs) oli voimakkaasti yhteydessä ET-1 vasteeseen pelin aikana (β =-0.45, r=-0.43, p=0.002), kun ikä, painoindeksi, METs, sydämen supistusvireys, ET-1:n lähtötaso ja koehenkilöiden kokema jännitystaso huomioitiin itsenäisinä muuttujina regressiotyyppisessä tilastolaskennassa. Yhteenvetona todetaan itsenäisesti toimivan hermoston muutosten ja verisuonten supistumisen voivan osittain selittää aiemmin havaitun sydäntapahtumien lisääntymisen tutkimuskohteen tyyppisessä vapaa-ajan tunne-elämyksessä. Jääkiekkopelin jännitys aiheuttaa muutoksia sepelvaltimotautialueiden repeämisherkkyyttä kuvaaviin tekijöihin, kun taas fyysinen rasitus vaikuttaa voimakkaammin veren hyytymistä ilmaiseviin lukemiin. Potilailla jännitys lisäsi enemmän suonten supistuvuutta, akuuttia tulehdusreaktiota ja nosti parasympaattisen hermoston vetäytymistä kuvaavia lukemia terveisiin koehenkilöihin verrattuna. Hyvä suorituskyky voi suojata korkean riskin sepelvaltimotautipotilaita sydäntapahtumilta vähentämällä ET-1:n vapautumista jännityksen aikana

Reversible protein phosphorylation is an essential component of metazoan signaling and cardiovascular physiology. Protein kinase activity is required for regulation of cardiac ion channel and membrane receptor function, metabolism, and transcription, and aberrant kinase function is widely observed across disparate cardiac pathologies. In fact, multiple generations of cardiac therapies (eg. beta-adrenergic receptor blockers) have targeted cardiac kinase regulatory cascades. In contrast, essentially nothing is known regarding the mechanisms that regulate cardiac phosphatase activity at baseline or in cardiovascular disease. Protein phosphatase 2A (PP2A) is a key phosphatase with multiple roles in cardiac physiology. Here we demonstrate the surprisingly complex regulatory platforms that control PP2A holoenzyme activity in heart. We present the first full characterization of the expression and regulation of the PP2A family of polypeptides in heart. We identify the expression of seventeen different PP2A genes in human heart and define their differential expression and distribution across species and in different cardiac chambers. We show unique subcellular distributions of PP2A regulatory subunits in myocytes, strongly implicating the regulatory subunit in conferring PP2A target specificity in vivo. We report striking differential regulation of PP2A scaffolding, regulatory, and catalytic subunit expression in multiple models of cardiovascular disease as well as in human heart failure samples. Importantly, we demonstrate that PP2A regulation in disease extends far beyond expression and subcellular location, by identifying and describing differential post-translational modifications of the PP2A holoenzyme in human heart failure. Furthermore, we go to characterize a mechanism for this method of post-translational modification that may represent a pathway capable of being therapeutically manipulated in human heart failure. Lastly we provide evidence that dysregulation of phosphatase activity contributes to the cellular pathology associated with a previously described inheritable human arrhythmia syndrome, highlighting the importance of the PP2A in cardiovascular physiology and disease. Together, our findings provide new insight into the functional complexity of PP2A expression, activity, and regulation in heart and in human cardiovascular disease and identify potentially new and specific gene and subcellular targets for the treatment of human arrhythmia and heart failure.

There is clear evidence that the autonomic nervous system (ANS) is lateralized at both the peripheral as well as the central levels of the nervous system. Both the vagus and the sympathetic ganglia asymmetrically innervate the sino-atrial node and the myocardium of the heart. This lateralization has also been observed in afferent as well as efferent projections to nuclei in the brainstem, hypothalamus, and amygdala. Where laterality has not been as clear is in regions of the frontal lobe dedicated to the regulation of autonomic nervous system responses. This study addressed that issue via the implementation of lateralized autonomic response-evoking tasks. With the use of cardiovascular and electrodermal measures, the present study indexed autonomic responses to lateralized stimuli. This study also explored the role of lateralization within sex as well as in relation to reported gender identity. The findings lend support to the right hemisphere as serving a dominant role in regulating sympathetic nervous system activity, while lending less conclusive support for lateralization of parasympathetic nervous system regulation. Men demonstrated greater lateralization for sympathetic nervous system responses across several different metrics of autonomic indices. The exploration of gender variables in relation to lateralization of autonomic responses was generally not supported.
Master of Science

Nitric oxide is generated by the vascular endothelium from L-arginine by a constitutive, Ca2+-dependent, NO synthase. Analogues of L-arginine were characterised as inhibitors of NO synthase to investigate the biological significance of the L-arginine-NO pathway in the vessel wall and its role in the cardiovascular system. These inhibitors attenuate the endothelium-dependent vasorelaxation and hypotension induced by various agents, produce an increase in vascular tone and an increase in blood pressure. This suggests that NO is involved in endothelium-dependent relaxation and its continuous release maintains a vasodilator tone and plays a fundamental role in the regulation of blood flow and blood pressure. The removal of the NO-dependent vasodilator tone, results in an `upregulation' of its intracellular receptor, the soluble guanylate cyclase and an increased sensitivity to those vasodilators which act by stimulating this enzyme. This phenomenon of `supersensitivity' to nitrovasodilators may be an important component of their therapeutic action in certain cardiovasulcar disorders. Vascular tissue also expresses an inducible, Ca2+-independent, NO-synthase after activation by lipopolysaccharide (LPS) which results in the generation of large quantities of NO, predominantly from the smooth muscle layer, with a consequent loss of vascular tone and a hyporeactivity to the vasoconstrictor action of phenylephrine. Induction of NO synthase in the vasculature may therefore be responsible for the hypotension and hyporesponsiveness to pressor agents characteristic of endotoxin shock. The glucocorticoid, dexamethasone inhibits the expression of this enzyme but not its activity, which may explain why steroids are more effective at preventing rather than treating this condition. These results suggest that in the cardiovascular system, NO can be considered to have both a protective and a pathological role. The release of small amounts of NO from the constitutive, Ca2+-dependent NO synthase, acts as an adaptive mechanism whereby the vascular endothelium responds to changes in its environment and regulates blood flow and blood pressure to maintain organ perfusion. In contrast, following the induction of the Ca2+-independent NO synthase, after immunological stimulation, NO is released in large quantities from vascular tissue, which may result in pathological vasodilation and tissue damage.

Abstract Epilepsy is associated with changes in autonomic cardioregulatory function. Ictally, autonomic disturbances may be evident with significant changes in heart rate (HR), blood pressure (BP) and respiration. However, interictal dysfunction of autonomic cardiovascular system may be subtle and it may be recognized only by delicate tools designed for that purpose. The aim of this study was to evaluate the function of the cardiovascular autonomic regulatory system in patients with epilepsy. Cardiovascular reflex tests were performed on patients with partial or idiopathic generalized epilepsies. Special attention was paid to temporal lobe epilepsy (TLE). An association of refractory and well controlled TLE and hippocampal sclerosis with altered cardioregulation was evaluated by using cardiovascular reflex tests and an analysis of spectral and non-linear analysis of heart rate variation (HRV). Cardiovascular reflexes were altered both in patients with partial and idiopathic generalized epilepsies who had been treated for epilepsy with antiepileptic drugs (AEDs), whereas patients with newly, untreated epilepsy did not differ from the control subjects. Diminished cardiovascular reflexes also seemed to be associated with carbamazepine (CBZ) treatment. Various parameters of cardiovascular reflex tests and analysis of spectral and dynamic measures of HRV were diminished in patients with TLE compared to the control subejcts. These results indicate that epilepsy, especially TLE, is associated with interictal changes of autonomic cardioregulation. Although these changes seem to be evident in patients with severe form of TLE, patients with well controlled TLE and patients without hippocampal sclerosis also have altered autonomic cardioregulatory function. These results suggest that dysfunction of the cardioregulatory system is rather associated with functional than structural changes of the inner temporal lobe in patients with TLE.

Leptin acts within the brain to increase resting metabolic rate (RMR) and blood pressure (BP). The renin-angiotensin system (RAS) elicits similar effects in the brain, as reviewed in chapter 1, and it has previously been shown that central angiotensin II type 1 (AT1) receptors are required for leptin-mediated inductions in sympathetic nerve activity to the brown adipose tissue. Thus, we hypothesize that the brain RAS mediates the metabolic effects of leptin. To investigate the interaction between the RAS and leptin, we generated the AT1ALepR-KO mouse which lacks the AT1A receptor in leptin-sensitive cells. In chapter 2, we demonstrated that stimulation of RMR by DOCA-salt and high fat diet requires AT1A receptors in leptin receptor-expressing cells and that these cells expressing both AT1A and the leptin receptor appear to be agouti related-peptide (AgRP) neurons. In chapter 3, we investigated the role of AT1A specifically in AgRP neurons by utilizing AT1AAgRP-KO mice. Similar to AT1ALepR-KO mice, AT1AAgRP-KO mice exhibited deficits in BAT SNA responses to leptin and induction of RMR by alpha melanocyte stimulating hormone. In chapter 4, we utilized a novel transgenic mouse model to demonstrate that microglia do not express the AT1A receptor under chow or high fat diet fed conditions. Taken together, we conclude that a subset of AgRP neurons, which express both the leptin receptor and the AT1A receptor, are critical for the control of sympathetic nerve activity and ultimately RMR.

Circulation and breathing movements that are essential for life are regulated by neurons in the hypothalamus and lower brainstem. Activity of these neurons is regulated by peripheral afferent and higher order inputs that release a diverse array of amino acids, amines and peptides. In this thesis we investigated the role of the neurotransmitter acetylcholine (ACh) and its receptors in regulation of cardiorespiratory homeostasis. Secondly, we determined whether or not genetic disturbances in regulation of acetylcholine receptor sensitivity affect central control of circulation, body temperature or respiration. The findings presented in Chapter 3 reveal a novel functional role of ACh and G-protein coupled muscarinic receptor (mAChR) activation in the rostral ventrolateral medulla (RVLM). We showed for the first time that some non-C1 RVLM neurons express mRNA for the M2 or M3 receptor; however, both C1 and enkephalinergic RVLM neurons were closely apposed by c holinergic terminals positive for the vesicular acetylcholine transporter (vAChT). Physiological studies demonstrated that activation of mAChR within the RVLM in anaesthetised rats increases arterial pressure and sympathetic nerve activity and has differential effects on major cardiorespiratory reflexes: RVLM mAChR activation resets the sympathetic baroreflex to higher arterial pressures and increases its gain and, concomitantly, attenuates excitatory reflexes evoked by peripheral chemoreceptor or somatic afferent stimulation. Retrograde tracing from the RVLM combined with vAChT immunoreactivity showed that neurons in the pedunculopontine tegmental nucleus (PPT) are the sole source of cholinergic input to the RVLM. The PPT-RVLM pathway appears to be part of a central command circuit concerned with adjusting circulatory function appropriate to increased muscle activity. These data support the notion that activation of specific neurotransmitter receptors in the RVLM encodes fu nctional specificity in control of sympathetic outflow and r! eflex fu nction. The extent to which genetic variations in central mAChR sensitivity influence autonomic function is unknown. Flinders Sensitive Line (FSL) rats were bred from Sprague Dawley (SD) rats for exaggerated behavioural and hypothermic responses to cholinesterase inhibitors and direct-acting mAChR agonists. A control genetic counterpart, the Flinders Resistant Line (FRL), was also bred in parallel for reduced responses to cholinergic agonists. The findings of Chapter 5 showed for the first time that FSL rats exhibit an increase in M2 and reduction in M3 receptor expression in the rostral medulla, suggesting that cholinergic signalling in this region may be altered. However, alterations of mAChR expression specific to FSL rats were restricted to this area and there were no changes in cerebellar expression of mAChR in any strain. Physiological studies showed that conscious or anaesthetised FSL rats were more sensitive to thermoregulatory responses to central mAChR a ctivation (ie hypothermia and increase in cutaneous blood flow); whereas pressor responses were reduced compared to SD and FRL rats. The increase in sympathetic activity and depression of respiration evoked by central mAChR activation was unchanged and attenuated, respectively, in FSL rats compared to control strains. These findings indicate that mAChR involved in control of different autonomic functions are regulated independently at the genetic and / or post-transcriptional level. The findings of Chapters 4 and 6 reveal a novel effect of breeding for cholinergic hypersensitivity in FSL rats on control of vagal and sympathetic outflow. Spectral analysis of blood pressure recordings in conscious FSL rats showed a reduction in total and high frequency power of heart rate variability (HRV), an increase in the LF/HF ratio and reduction in baroreflex sensitivity (BRS) compared to controls. These changes reflect a reduction in reflex vagal input and relative predominan ce of sympathetic input to the sinus node in FSL rats. Under! urethan e anaesthesia, FSL rats had a higher heart rate and exhibited lower gain of baroreflex control of splanchnic sympathetic nerve activity (SNA). Moreover, FSL rats were more susceptible to ventricular arrhythmias during infusion of the cardiac glycoside ouabain under anaesthesia compared to controls. These data indicate that FSL rats exhibit impaired reflex regulation of vagal and sympathetic outflow that could underlie increased vulnerability to arrhythmia seen in this strain. The precise brain regions and neurotransmitters that underlie autonomic disturbances seen in FSL rats are unclear. As well as muscarinic hypersensitivity, FSL rats also exhibit increased sensitivity to nicotine, serotonin and dopamine. Multiple chemical sensitivities in FSL rats may arise from functional interactions with mAChR or changes in common intracellular regulatory or signalling pathways. FSL rats exhibit a number of behavioural and somatic abnormalities consistent with clinical depre ssion, including reduced motivated behaviour and sleep and psychomotor disturbances. These symptoms are also alleviated by treatment with antidepressants, suggesting that similar neurochemical abnormalities may underlie behavioural disturbances seen in FSL rats and human depression. Symptoms of depression are an emerging risk factor in the development of cardiovascular disease and are associated with increased risk of dying from a cardiac-related event. A reduction in HRV and BRS in depressed patients has been widely reported and is considered to be a key substrate predisposing to arrhythmia in this patient group. In this thesis we demonstrate for the first time that FSL rats exhibit similar autonomic abnormalities to those reported in human depression and are more vulnerable to ouabain-induced ventricular arrhythmias. These findings suggest that biological factors predisposing to autonomic dysfunction and arrhythmia in FSL rats could also operate in human depression. This m ay involve altered neurotransmission in cardiovascular brain! regions , or inappropriate regulation of cardiovascular function by arousal or motor control pathways. Overall, this thesis provides novel insights into cholinergic mechanisms that regulate cardiorespiratory homeostasis. ACh is important in physiological regulation of circulation via activation of G-protein coupled mAChR in the RVLM. Selective breeding for cholinergic hypersensitivity in FSL and FRL rats results in region- and subtype-specific changes in mAChR expression in the lower brainstem and differentially influences muscarinic control of circulation and breathing. Variations in central mAChR sensitivity may contribute to impaired reflex control of vagal and sympathetic outflow and could hence predispose to cardiac complications including arrhythmias. Future studies may aim to further understand the relationship between endogenous sensitivity of metabotropic neurotransmitter receptors in the CNS and cardiovascular disturbances associated with depression.

Human cardiovascular adaptations to microgravity include decreased plasma volume, exercise capacity, baroreflex function as well as decreased orthostatic tolerance upon return to a gravity environment. Several countermeasures have been proposed and tested, although currently none have been developed to prevent post-spaceflight orthostatic intolerance (OI). Artificial gravity (AG) generated by short-radius centrifugation (SRC) has been proposed as a countermeasure to OI as well as other cardiovascular alterations. Methods: Fifteen men and fourteen women underwent three weeks of daily (5 days a week) exposure to intermittent (1.0 to 2.5 Gz) artificial gravity on a 1.9m human powered centrifuge (HPC) at the NASA Ames Research Center. Half the subjects exercised (active) to power the HPC while half rode passively (passive). A combination head-up tilt (HUT) and lower body negative pressure (LBNP) test was used to determine orthostatic tolerance before and after training. Oscillatory LBNP (OLBNP) was used at seven frequencies (0.01 to 0.15 Hz) for two minutes each to assess the dynamic responses of the cardiovascular system to orthostatic stress, before and after AG training. Results: Training improved overall tolerance in the group of subjects by 13% (pandlt;0.05); men were more tolerant than were women (pandlt;0.05); and active subjects were more improved than passive subjects (pandlt;0.05). Mechanisms of improvement appear to be through decreased total peripheral resistance (TPR) and increased stroke volume after training, and increased responsiveness of TPR to fluid shifts (faster changes in TPR to changes in calfcircumference [CC] and OLBNP after training). There was no change in spontaneous baroreflex sensitivity (BRS, calculated by sequence method) or number of sequences per number of heart beats (NNS), although BRS analysis did indicate that stimulation to the cardiac baroreceptors during 1.0 Gz and 2.5 Gz centrifugation was no different than supine control and 70?? HUT, respectively. Taken together, these results suggest that AG training improved tolerance through training of local mechanisms in the peripheral vasculature, or extrinsic control of peripheral vascular resistance, rather than through changes of autonomic control of heart rate.

This thesis comprises of four experiments from which related but independent analyses were undertaken. The interventions employed were designed to investigate the effect of cardiovascular adaptation, both in the short and long term on the cardiovascular responses to orthostatic stress. The first study, described in Chapter 3, tested the hypothesis that the cardiovascular system (CVS) could adapt to repeated orthostatic challenges in a single session. 14 subjects were exposed to ten +75° head-up tilts (HUT) over 70 mins. Each tilt involved a 5 min supine period (SUPINE) followed by 2 min HUT (TILT). Various indices of cardiovascular function were determined non-invasively. Cardiovascular responses to HUT10 for the final 30s of SUPINE and the first 30s of TILT were compared with those of HUT1. Integrated cardiac baroreflex sensitivity (BRS) was assessed using the Valsalva Manoeuvre (VM). Results showed MAP and DBP increased in both SUPINE (MAP p=0.009, DBP p=0.002) and TILT (MAP p=0.003, DBP p=0.009) for HUT10 compared with HUT1. TPR increased during TILT only (p=0.001) during HUT10 compared with HUT1. CO and SV were decreased during SUPINE at HUT10 relative to HUT1, however, there were no differences in TILT at HUT10 for either CO or SV. There was no change in the response of BRS, HR or SBP from HUT1 to HUT10. This study indicated that 10 repetitive HUTs can elicit changes in the cardiovascular responses to orthostasis, reflected by an increased TPR. The second study, described in Chapter 4, investigated the effect of the repeated HUT protocol outlined above on the cardiovascular responses to the squat-stand test (SST). 16 subjects were randomly allocated into either a tilting group that underwent ten +75° HUTs in 70 min (TILTING) or a control group that underwent 70 min of rest (CONTROL). Before and after the 70 min of either HUT or rest, subjects performed a SST (SST1 and SST2 respectively). The same cardiovascular parameters as those used in Chapter 3 were determined during both SSTs. The final 30s of SQUAT and the first 30s of STAND (divided into three 10-sec blocks termed STAND10, STAND20 and STAND30) were compared between SST1 and SST2, results were as follows. TILTING: during the SQUAT phase of SST2, SBP, MAP, DBP and TPR were significantly elevated (p less than 0.05) and HR was significantly decreased (p=0.032) compared with SST1; at STAND10, DBP and MAP were significantly increased (p less than 0.05); at STAND20, SBP was increased (p=0.03); and, at STAND30, DBP, SBP and MAP (p less than 0.05) were increased. There were no differences observed between SST1 and SST2 in the CONTROL group. Results indicated that ten consecutive +75° HUTs can improve the CVS responses to the SST. This is predominantly due to an increase in DBP, indicative of a change in vascular resistance. The third study, outlined in Chapter 5, investigated the effect of lower limb unilateral and bilateral resistance exercise on the blood pressure (BP) and HR responses in young males. 12 normotensive, sedentary young males were divided into 2 groups; one group exercised unilaterally and the other bilaterally. Thirty seconds of resting data were collected before subjects performed 4 SETs of 10-12 reps on a seated leg press. SET 1 was performed at 50% of 10-12RM, SET 2 was performed at 75% and SET 3 and SET 4 were performed at 10- 12RM. Bilateral resistance exercise elicited greater increases in SBP than unilateral exercise at SETs 2, 3 and 4 (p less than 0.05). DBP was only greater with bilateral exercise relative to unilateral exercise at SET 2 (p=0.036). There were no differences between the groups for the HR response. This study demonstrated that the BP response to bilateral lower limb resistance exercise was significantly greater than that of unilateral exercise in young sedentary males. This information could be beneficial to many populations for whom lower BP responses to exercise would be an advantage. Following on from this, to investigate long term improvements in cardiovascular responses to orthostasis the study outlined in Chapter 6, investigated the effect of acute (10 weeks) and chronic (more than 4 years) resistance training (RT) on the cardiovascular responses to both HUT and SST. 22 young males were allocated into three groups. The UNILATERAL (N=7) and the BILATERAL (N=7) groups performed baseline testing followed by 10 weeks of lower limb RT (performed unilaterally or bilaterally), followed by repeats of the tests performed at baseline. The CONTROL group (N=8) followed the same protocol except they were asked to perform no resistance training during the 10 weeks between testing sessions. An additional 7 subjects were allocated to a CHRONIC group consisting of individuals who had been training for more than 4 years. These subjects only performed the baseline testing. Baseline testing consisted of a number of cardiovascular tests, ultrasound for vein diameter, BRS via VM, and tests for calf ejection fraction and venous elasticity. Results demonstrated that neither unilateral nor bilateral RT caused an alteration in the cardiovascular response to the HUT or SST. There were no changes in any cardiovascular variable in response to acute RT relative to the control group. The CHRONIC group had a decreased cardiovascular response to both orthostatic challenges, with a decrease in SV in response to HUT being greater in the chronic group relative to the other groups (p less than 0.05) and the TPR response to SST being significantly less than the control group (p less than 0.05). The CHRONIC group also had a smaller elastic modulus for the right leg in comparison to the other groups (p less than 0.05). Results indicate that heavy resistance exercise may cause a decreased cardiovascular response to orthostatic stress and that these decreases may be controlled by a decreased venous elasticity. Collectively, these results demonstrate that the CVS is highly adaptable to repeated orthostatic stress and the dominant underlying feature of this protective adaptation is increased vascular resistance. Following the repeated HUT the CVS is in a more protected state and has become better able to defend itself against the adverse consequences of rapidly applied hydrostatic force. However lower limb RT performed bilaterally (with large increases in BP) or unilaterally (with lower increases in BP) does not improve CVS response to orthostatic stress, in fact chronic RT (more than 4 yrs) appears to impair the CVS response to orthostasis, potentially due to decreased venous elasticity.

Chronic kidney disease is common and associated with an elevated cardiovascular risk, as well as the long-term risk of renal failure. At present, therapeutic approaches to managing chronic kidney disease (CKD) do not fully reverse these risks. This has led to study of the determinants of pathological outcomes in these patients, with the hope of further therapeutic interventions to reduce these risks. Mineralocorticoids, predominantly aldosterone, are produced by the adrenal cortex and have a vital role in maintaining sodium status and blood pressure. However, high levels of aldosterone in humans are known to produce an adverse phenotype of hypertension and a disproportionately elevated cardiovascular risk. Furthermore, in animal models of renal failure, elevated aldosterone levels stimulate renal damage, in the presence of a high sodium milieu. These laboratory findings have been translated to provide a basis for several short-term follow-up clinical trials looking at the impact of non-genomic non-natriuretic doses of mineralocorticoid receptor inhibition in patients with chronic kidney disease. These studies have shown a reduction in proteinuria, often independent of decline in blood pressure. However, there is a paucity of baseline physiological data relating to the normal regulation of mineralocorticoid synthesis and action in chronic kidney disease. The response of the adrenal cortex to renal failure is not understood. Is mineralocorticoid synthesis regulated in the usual way? Are the stimulators of mineralocorticoid production and release affected by uraemia? Is dietary sodium intake associated with steroid status and adverse outcomes in humans? The hypothesis of this thesis was that the renin-angiotensin-aldosterone system is inappropriately activated in patients with chronic kidney disease. Secondly, that high levels of mineralocorticoids are associated with adverse end-organ damage including proteinuria excretion, left ventricular hypertrophy, endothelial dysfunction, elevated pulse wave velocity and markers of renal fibrosis. Furthermore, that these deleterious effects are associated with sodium status and that an elevated dietary sodium intake is independently associated with increased renal and cardiovascular risk. In order to test these hypotheses, 70 patients with CKD and 30 patients with essential hypertension (EH) were recruited and underwent detailed clinical and biochemical phenotyping. This included 24 hour urinary steroid metabolite analysis, plasma renin and aldosterone measurement, cardiac magnetic resonance imaging, carotid-femoral pulse wave velocity and assessment of endothelial function. 20 It was shown that levels of the main mineralocorticoids (MC) (aldosterone and deoxycorticosterone) are not elevated in patients with CKD, as compared with patients with essential hypertension (EH). However, the determinants of levels of MC excretion differed between the two conditions. In CKD, excretion of MC metabolites was directly proportional to excretion of urinary sodium. A high urinary sodium (a marker of dietary sodium intake) was associated with a higher excretion of tetrahydroaldosterone (THALDO - the main aldosterone metabolite). In patients with EH, no relationship was seen between urinary steroid excretion and urinary sodium excretion. This is a novel relationship between the kidney and adrenal gland which questions the conventional wisdom that the adrenal cortex is unaffected by uraemia and prompts further study into the regulation of steroid synthesis in CKD. Furthermore, it was shown for the first time that 24h excretion of tetrahydrodeoxycorticosterone (THDOC) is an independent predictor of left ventricular mass index and that THALDO is an independent predictor of proteinuria excretion – demonstrating a relationship between mineralocorticoids and two of the main predictors of mortality in CKD. An interaction between sodium, MCs and these two features was also demonstrated. No association between levels of mineralocorticoids and vascular function was seen. Urinary 24 hour excretion of sodium was significantly associated with endothelial dysfunction in patients with CKD and pulse wave velocity in patients with essential hypertension. Retrospective data analysis further confirmed an association between a high dietary sodium intake and adverse outcomes. In a study of 498 patients with CKD and a median follow-up of 7 years, an elevated 24h urinary sodium to creatinine ratio was shown to be associated with an increased risk of death. There was however no independent association with renal progression or requirement for renal replacement therapy. This is the first time that sodium intake has been clearly linked to adverse outcomes in patients with CKD. Lastly, laboratory work demonstrated that steroid stimulation (aldosterone or cortisol) of human proximal tubular cells resulted in increased collagen 1 gene expression, but only in the context of a high sodium environment. Collagen 1 is deposited in renal interstitial fibrosis. This effect was inhibited by MR blockade, further expanding on the potential role 21 of steroids in the progression of CKD and again confirming the relationship between salt and steroids. In conclusion, in this thesis it has been demonstrated that production of MCs in patients with CKD is closely associated with urinary sodium excretion (a surrogate for dietary sodium intake). This relationship is novel and not seen in patients with essential hypertension. It suggests that the response of the adrenal cortex in the context of uraemia is altered. Moreover, levels of mineralocorticoids are independently associated with left ventricular mass index and proteinuria excretion, both significant predictors of mortality, in patients with CKD. Dietary sodium intake has been shown to be an independent predictor of mortality and laboratory studies have demonstrated that mineralocorticoid receptor binding in a high sodium environment is associated with collagen 1 gene upreguation. These findings have important implications for the role of adequate renin-angiotensin-aldosterone blockade in patients with CKD and suggest that the addition of a mineralocorticoid receptor blocker and dietary sodium restriction should be advocated.

The central effect of nicotine on cardiovascular regulation has been extensively studied. However, due to its unselective nature for nicotinic acetylcholine receptors (nAChR) the involvement of specific nAChRs at sites in the brain, in central nervous cardiovascular regulation remains unclear. The effects of intracerebroventricular (i.c.v.) and intracisternal (i.e.) injections of the a7 selective agonist, PSAB-OFP, and the a4p2 selective agonist, TC-2559, were investigated on blood pressure (BP), heart rate (HR) and renal sympathetic nerve activity (RSNA) compared with nicotine, in the anaesthetised rats. PSAB-OFP and TC-2559 i.c.v. caused a delayed dose-related increase in BP and RSNA. When given i.e. the action was similar except the rise in BP was more immediate. The possibility that the pressor response was partly due to the agonists causing the release of the vasoconstrictor vasopressin into the circulation was tested by repeating the i.c.v. and i.e. injections of the agonists in the presence of a selective vasopressin Via antagonist. In the presence of Vi antagonist (i.v.), PSAB-OFP and TC-2559 (i.c.v.) now induced no change in BP or RSNA however i.e., the increase in BP and RSNA was delayed with TC-2559, while PSAB-OFP caused a decrease in BP and no change in RSNA. The cardiovascular effects of i.c.v. PSAB-OFP and TC-2559 in the presence of Vi receptor antagonist (i.c.v.) were also completely blocked. PSAB-OFP and TC-2559 (i.e.) in rats pre-treated with Vi antagonist (i.e.), no longer produced an increase in BP and RSNA. However, the delayed fall in BP caused by PSAB-OFP was potentiated. Nicotine i.c.v. caused a dose-related increase in BP and renal sympathoinhibition while i.e. the rise in BP was larger and now associated with a bradycardia. In the presence of Vj antagonist (i.v.), nicotine's (i.c.v.) cardiovascular effects were blocked however nicotine i.e. caused a decrease in BP, RSNA and HR. In the presence of Vi antagonist (i.c.v.), nicotine caused no change in RSNA, but BP still increased. In the presence of Vi antagonist (i.e.), nicotine i.e. induced a decrease in RSNA and HR, with no change in BP. This study indicates that activation of a4p2 and