Autonomic Regulation of Cardiovascular Function and Implications for Future Therapeutic Approaches

Cardiovascular disease contributes to symptom expression, reduced quality of life and premature death. Normally, the cardiovascular system function is effectively regulated by the unconscious nervous system (autonomic nervous system) under a variety of environment conditions that repeatedly stress the system. However, following acute or chronic cardiovascular insult (e.g. myocardial infarction), autonomic regulatory function becomes deranged and promotes progression of cardiovascular failure. Current, guideline-directed therapeutic approaches operate through targeted alteration of biological processes facilitated by interactions with exogenous molecules circulating in blood. New therapeutic approaches use exogenous bioelectric neuromodulation to exert potentially beneficial biological effects.  

The cardiovascular system distributes blood throughout the body to sustain life via delivery of oxygen and nutrients and its function and performance are neurologically regulated. Traditional forms of therapy involve periodic delivery of drug molecules that eventually accumulate and are cleared from circulating blood. The rise and fall of therapeutic blood levels, as well as patient compliance, contribute to the limitations associated with pharmacological therapies. In contrast, bioelectric neuromodulation holds promise to improve clinical outcomes in cardiovascular disease via beneficial alteration of central and peripheral reflex behavior along the neurocardiac axis using computer-generated neural stimulation.  

This Research Topic will focus on new approaches aligned with the ultimate goal of improving patient outcomes by reducing cardiovascular symptom expression and reducing mortality. The optimal bioelectric neuromodulation approach remains unknown; important considerations include but are not limited to: the stimulation site and implant/access techniques, electrode/tissue interface design, stimulation cycle patterns (temporal, spatial, intensity), therapy titration requirements and methods, biomarkers of therapeutic levels and benefits, durability of effects, remodeling of functional performance.  

Bioelectric therapies (stimulation or inhibition) resulting in beneficial neuromodulation exert acute and chronic effects. Chronic exposure to neuromodulation can contribute to pre-ganglionic, ganglionic, and post-ganglionic remodeling of neural structure and function, including at the level of end effectors. We anticipate that several Review Articles will be included with manuscripts describing Original Research covering various topics such as: Autonomic nervous system anatomy; Autonomic regulation of cardiovascular performance; Autonomic regulation of the immune system; Biomarkers of autonomic function and dysfunction; Therapeutic modulation of autonomic function to protect myocardium and treat cardiac disorders (AF & HF) including autonomic regulation therapy via vagus nerve stimulation, baroreceptor stimulation and cardiac contractility modulation. Original research in areas of basic science, pre-clinical and clinical neuroscience involving the cardiovascular system (neurocardiology) will appear in this Research Topic. 

The Guest Editors of this Research Topic encourage all interested researchers to submit an abstract before submitting their manuscript. Abstracts do not have to coincide with the final abstract of the manuscripts. However, abstract submission is not mandatory.

Topic Editor Bruce H. KenKnight, PhD is employee of LivaNova plc, a publicly-traded company; all patent rights have been assigned to companies and are not privately owned.

Topic Editor Richard Verrier, PhD is PI of grants to Beth Israel Deaconess Medical Center from LivaNova PLC (London UK) and is a member of the Medical Advisory Board of StratusNeuro. 

The other Topic Editor declares no competing interests with regards to the Research Topic subject.