Haider Syedah Aleena, Sharif Ruth, Sharif Faisal
Department of Medicine, University of Galway, H91 TK33 Galway, Ireland.
Department of Cardiology, University Hospital Galway, H91 YR71 Galway, Ireland.
J Clin Med. 2025 Apr 16;14(8):2746. doi: 10.3390/jcm14082746.
The sympathetic division of the autonomic nervous system plays a crucial role in maintaining homeostasis, but its overactivity is implicated in various pathological conditions, including hypertension, hyperglycaemia, heart failure, and rheumatoid arthritis. Traditional pharmacotherapies often face limitations such as side effects and poor patient adherence, thus prompting the exploration of device-based multi-organ denervation as a therapeutic strategy. Crucially, this procedure can potentially offer therapeutic benefits throughout the 24 h circadian cycle, described as an "always-on" effect independent of medication compliance and pharmacokinetics. In this comprehensive review, we evaluate the evidence behind targeted multi-organ sympathetic denervation by considering the anatomy and function of the autonomic nervous system, examining the evidence linking sympathetic nervous system overactivity to various cardiometabolic and inflammatory conditions and exploring denervation studies within the literature. So far, renal denervation, developed in 2010, has shown promise in reducing blood pressure and may have broader applications for conditions including arrhythmias, glucose metabolism disorders, heart failure, chronic kidney disease and obstructive sleep apnoea. We review the existing literature surrounding the denervation of other organ systems including the hepatic and splenic arteries, as well as the pulmonary artery and carotid body, which may provide additional physiological benefits and enhance therapeutic effects if carried out simultaneously. Furthermore, we highlight the challenges and future directions for implementing multi-organ sympathetic ablation, emphasising the need for further clinical trials to establish optimal procedural technique, efficacy and safety.
自主神经系统的交感神经分支在维持体内平衡方面起着关键作用，但其过度活跃与包括高血压、高血糖、心力衰竭和类风湿性关节炎在内的各种病理状况有关。传统药物治疗常常面临副作用和患者依从性差等局限性，因此促使人们探索基于设备的多器官去神经支配作为一种治疗策略。至关重要的是，该手术有可能在整个24小时昼夜周期内提供治疗益处，被描述为一种独立于药物依从性和药代动力学的“始终开启”效应。在这篇全面综述中，我们通过考虑自主神经系统的解剖结构和功能、研究将交感神经系统过度活跃与各种心脏代谢和炎症状况联系起来的证据以及探索文献中的去神经支配研究，来评估靶向多器官交感神经去神经支配背后的证据。到目前为止，2010年开发的肾去神经支配在降低血压方面已显示出前景，并且可能在包括心律失常、糖代谢紊乱、心力衰竭、慢性肾病和阻塞性睡眠呼吸暂停等病症中有更广泛的应用。我们综述了围绕其他器官系统去神经支配的现有文献，包括肝动脉和脾动脉，以及肺动脉和颈动脉体，如果同时进行，这些可能会提供额外的生理益处并增强治疗效果。此外，我们强调了实施多器官交感神经消融的挑战和未来方向，强调需要进一步的临床试验来确定最佳手术技术、疗效和安全性。
