Background: Myocardial infarction (MI) causes pathological remodeling of the autonomic nervous system, which exacerbates heart failure and predisposes to ventricular arrhythmias. These changes, characterized by sympathetic activation and parasympathetic dysfunction (reduced vagal tone), act in concert to increase risk of death. The primary reasons and mechanisms for vagal withdrawal in this setting are currently unknown.
Methods: MI was induced percutaneously in pigs. Six-weeks post-MI (n=11) or age-matched normal animals (n=11) underwent functional nodose ganglia neuronal recordings using linear microarray electrodes in-vivo. After median sternotomy neuronal firing in response to changes in preload/afterload and application of epicardial mechanical or nociceptive stimuli (capsaicin, bradykinin, or vertradine) was assessed by spike sorting. In a different set of normal (n=22) and infarcted animals (n=31), nodose ganglia were rapidly excised for comparison of immunohistological changes.
Results: Functional recordings of cardiac chemosensitive neurons in normal animals showed expected increased firing rates in response to nociceptive stimuli. Paradoxically, greater numbers of nociceptive neurons and sensitivity of these neurons (defined as absolute changes in firing rates), infarcted animals demonstrated significant decreases in extracellular neuronal firing in response to nociceptive stimuli. Immunohistochemical analysis revealed increased calcitonin gene-related peptide (CGRP) expression, a surrogate for nociceptive neurons, similar to neural recordings. Both CGRP-positive and CGRP-negative neurons demonstrated increased expression of neuromodulators including glial activation and nitric oxide synthase post-MI. However, only CGRP-positive neurons showed inhibitory neurotransmission as indicated by increased expression of GABA and its enzymes.
Conclusions: Our results, for the first time, indicate significant changes in vagal cardiac afferent neurotransmission post-MII. Nociceptive neurotransmission is decreased, potentially through increased autoreceptor mediated inhibition by GABA. As nociceptive signaling through the vagal ganglia is known to increase vagal tone, decreased nociceptive neurotransmission post-MI may play an important role in occurrence of parasympathetic dysfunction.
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