Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06519, USA.
VA Connecticut Healthcare System, 950 Campbell Ave, -111B, West Haven, CT, 06516, USA.
Curr Cardiol Rep. 2023 Dec;25(12):1745-1758. doi: 10.1007/s11886-023-01990-8. Epub 2023 Nov 23.
The role of neuroimmune modulation and inflammation in cardiovascular disease has been historically underappreciated. Physiological connections between the heart and brain, termed the heart-brain axis (HBA), are bidirectional, occur through a complex network of autonomic nerves/hormones and cytokines, and play important roles in common disorders.
At the molecular level, advances in the past two decades reveal complex crosstalk mediated by the sympathetic and parasympathetic nervous systems, the renin-angiotensin aldosterone and hypothalamus-pituitary axes, microRNA, and cytokines. Afferent pathways amplify proinflammatory signals via the hypothalamus and brainstem to the periphery, promoting neurogenic inflammation. At the organ level, while stress-mediated cardiomyopathy is the prototypical disorder of the HBA, cardiac dysfunction can result from a myriad of neurologic insults including stroke and spinal injury. Atrial fibrillation is not necessarily a causative factor for cardioembolic stroke, but a manifestation of an abnormal atrial substrate, which can lead to the development of stroke independent of AF. Central and peripheral neurogenic proinflammatory factors have major roles in the HBA, manifesting as complex bi-directional relationships in common conditions such as stroke, arrhythmia, and cardiomyopathy.
神经免疫调节和炎症在心血管疾病中的作用在历史上一直被低估。心脏和大脑之间的生理联系，称为心脑轴（HBA），是双向的，通过自主神经系统/激素和细胞因子的复杂网络发生，并在常见疾病中发挥重要作用。
在分子水平上，过去二十年的进展揭示了交感和副交感神经系统、肾素-血管紧张素醛固酮和下丘脑-垂体轴、microRNA 和细胞因子介导的复杂串扰。传入途径通过下丘脑和脑干放大促炎信号到外周，促进神经原性炎症。在器官水平上，虽然应激介导的心肌病是 HBA 的典型疾病，但心脏功能障碍可由多种神经损伤引起，包括中风和脊髓损伤。房颤不一定是心源性脑栓塞的致病因素，但表现为异常的心房基质，可导致中风的发展独立于房颤。中枢和外周神经原性促炎因子在心脑轴中起主要作用，在中风、心律失常和心肌病等常见疾病中表现出复杂的双向关系。
