Metabo and Mechanoreceptor Expression in Heart Failure Patients: Relationships with Neural and Cardiovascular Responses to Exercise
Authors: Smith Joshua R , Hart Corey R , Ramos Paola A , Akinsanya Joshua G , Lanza Ian R , Olson Thomas P 
Published: June 2021

INTRODUCTIONHeart failure (HF) is characterized by reduced exercise capacity resulting from central and peripheral mechanisms. A primary peripheral mechanism is augmented neural feedback (via group III/IV afferents) arising from the locomotor muscles. This enhanced locomotor neural feedback may result from a variety of mechanisms including increased 1) metabo and/or mechanoreceptor expression, 2) metabolite production, and/or 3) mechano/metaboreceptor sensitivity. Previous studies have shown elevated expression of purinergic 2X3 (P2X3) and cyclooxygenase (COX‐2) in HF compared to sham animal models. However, it is unknown if metabo and/or mechanoreceptor (e.g., Piezo 1 and 2) expression are elevated in human HF. Further, it is unclear if altered receptor expression is related to the cardiovascular and ventilatory responses during exercise attributed to locomotor neural afferent feedback. The purpose of this study was to 1) determine if differences exist in the expression of skeletal muscle proteins associated with metabo/mechanoreflex activity between healthy individuals (CTL) and HF patients and 2) determine relationships between protein expression and the change in ventilatory and cardiovascular responses with locomotor muscle afferent inhibition during exercise. We hypothesized that 1) HF patients will demonstrate greater skeletal muscle protein expression associated with mechano/metaboreflex activity and 2) the increased protein expression will be associated with changes in ventilation, mean arterial pressure (MAP), and catecholamines during locomotor muscle afferent feedback inhibition in HF patients.METHODSIn a randomized, placebo controlled cross‐over design, 10 CTL and 6 systolic HF (Age: 60±12 vs. 60±4 yrs, p=0.96; BMI: 26±3 vs. 31±5 kg/m2, p=0.01, respectively) patients completed cycling exercise at 60%VO2 peak with lumbar intrathecal fentanyl or sham. Arterial blood pressure and catecholamines were measured via radial artery catheter during exercise. On a follow up visit, a muscle biopsy from the vastus lateralis was performed to isolate and measure COX‐2, P2X3, transient receptor potential vanilloid type 1 (TRPV1), Piezo 1, and Piezo 2 protein expression.RESULTSProtein expression of P2X3, COX‐2, and TRPV1 were greater in HF compared to CTL (all, p<0.05), with no difference between groups in Piezo 1 and 2 protein expression (p>0.05). HF compared to CTL had a greater decrease in ventilation with fentanyl compared to sham (−11±8 vs. −3±9%, p=0.04, respectively), with no difference between groups in MAP or norepinephrine (p>0.05). In HF, COX expression was negatively related to the change in ventilation (r= −0.87, p=0.02), MAP (r= −0.93, p<0.01), and norepinephrine (r= −0.85, p=0.03) with fentanyl.CONCLUSIONSThese data demonstrate that metaborecptors (i.e. P2X3, COX‐2, and TRPV1) are elevated in HF compared to CTL. Furthermore, protein expression of COX‐2 was related to the cardiovascular and ventilatory changes observed with fentanyl in HF patients. These findings suggest that elevated expression of metaboreflex associated proteins contribute to the augmented locomotor muscle afferent feedback during exercise in HF.Support or Funding InformationNHLBI RO1 HL126638AHA 18POST3990251This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.