Abstract
Dysregulation of the “inflammatory reflex” with abnormal neurohumoral activation may contribute to proinflammatory activity driving the progression of COPD http://ow.ly/e9xx30k4kCk
From the authors:
We would like to thank S. Andreas for his interest in our study [1] and for the interesting comments. We agree with the insightful reasoning that subtle neurohormonal activation may be one of the explanations underlying the longitudinal association between subtle signs of cardiovascular autonomic dysfunction and higher risk of chronic obstructive pulmonary disease (COPD). In parallel to the findings in heart failure [2] and COPD [3], manifest clinical entities of cardiovascular autonomic dysfunction, such as orthostatic hypotension [4, 5] and postural orthostatic tachycardia syndrome [6], are all associated with clear signs of neurohormonal activation and inflammatory activation playing in the background.
The discovery that cholinergic neurons inhibit acute inflammation gave birth to the concept of “inflammatory reflex”, a “hard-wired” connection between the nervous and immune systems, where the ascending link between the nucleus tractus solitaries and the paraventricular nucleus provides a pathway that can modulate both vagus efferent activity inhibiting cytokine synthesis and neuro-hormonal anti-inflammatory responses [7, 8]. One hypothesis is that autonomic nervous system imbalance, with increased sympathetic activation and reduced parasympathetic activity, might be the inception of a dysregulation of the inflammatory reflex with abnormal neurohumoral activation contributing to local and systemic pro-inflammatory activity driving the progression of COPD.
Further investigations should explore the complex relationship between cardiovascular autonomic dysfunction and neurohormonal activation at the crossroad between inflammation and cardiovascular and pulmonary disease. Ultimately, this effort might identify specific neurohormonal mediators and pathophysiological mechanisms involved in the development and progression of COPD, which can be targeted in preventive or therapeutic efforts.
Footnotes
Conflict of interest: None declared.
- Received April 29, 2018.
- Accepted May 1, 2018.
- Copyright ©ERS 2018