Purinergic profile of fainting divers is different from patients with vasovagal syncope

Joulia, Fabrice; Coulange, Mathieu; Desplantes, A.; Barberon, Bruno; Kipson, Nathalie; Gérolami, V.; Jammes, Yves; Kerbaul, François; Nee, Laetitia; Fromonot, Julien; Bruzzese, Laurie; Michelet, Pierre; Boussuges, Alain; Brignole, Michele; Deharo, Jean‐Claude; Guieu, Régis

doi:10.1016/j.ijcard.2014.04.090

Cited by 4 publications

(6 citation statements)

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“…The adenosinergic profile of divers is different from that of patients with VVS since the HUT test was positive in only 16% of divers compared with 80% in patients with VVS [76]. The CC variant of the SNP was observed in the majority (56%) of patients with VVS, whereas the TC variant was found in 56% of divers and 61% of divers who had previous TLOC during diving [76]. Heart rate and O 2 saturation were both correlated with APL in breath-hold divers.…”

Section: Syncope In Hypoxic Conditionsmentioning

confidence: 88%

“…Indeed, high APL was observed in basal conditions and further increased during breath-hold [76,113]. The adenosinergic profile of divers is different from that of patients with VVS since the HUT test was positive in only 16% of divers compared with 80% in patients with VVS [76]. The CC variant of the SNP was observed in the majority (56%) of patients with VVS, whereas the TC variant was found in 56% of divers and 61% of divers who had previous TLOC during diving [76].…”

Section: Syncope In Hypoxic Conditionsmentioning

confidence: 95%

“…Adenosine release, induced by hypoxia, may precipitate TLOC. Indeed, high APL was observed in basal conditions and further increased during breath-hold [76,113]. The adenosinergic profile of divers is different from that of patients with VVS since the HUT test was positive in only 16% of divers compared with 80% in patients with VVS [76].…”

Section: Syncope In Hypoxic Conditionsmentioning

confidence: 97%

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Adenosine and the Cardiovascular System: The Good and the Bad

Guieu

Deharo

Maille

et al. 2020

JCM

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Adenosine is a nucleoside that impacts the cardiovascular system via the activation of its membrane receptors, named A1R, A2AR, A2BR and A3R. Adenosine is released during hypoxia, ischemia, beta-adrenergic stimulation or inflammation and impacts heart rhythm and produces strong vasodilation in the systemic, coronary or pulmonary vascular system. This review summarizes the main role of adenosine on the cardiovascular system in several diseases and conditions. Adenosine release participates directly in the pathophysiology of atrial fibrillation and neurohumoral syncope. Adenosine has a key role in the adaptive response in pulmonary hypertension and heart failure, with the most relevant effects being slowing of heart rhythm, coronary vasodilation and decreasing blood pressure. In other conditions, such as altitude or apnea-induced hypoxia, obstructive sleep apnea, or systemic hypertension, the adenosinergic system activation appears in a context of an adaptive response. Due to its short half-life, adenosine allows very rapid adaptation of the cardiovascular system. Finally, the effects of adenosine on the cardiovascular system are sometimes beneficial and other times harmful. Future research should aim to develop modulating agents of adenosine receptors to slow down or conversely amplify the adenosinergic response according to the occurrence of different pathologic conditions.

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Section: Syncope In Hypoxic Conditionsmentioning

confidence: 88%

Section: Syncope In Hypoxic Conditionsmentioning

confidence: 95%

Section: Syncope In Hypoxic Conditionsmentioning

confidence: 97%

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Adenosine and the Cardiovascular System: The Good and the Bad

Guieu

Deharo

Maille

et al. 2020

JCM

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“…e . neuromediators such as adenosine [30,31], receptors, enzymes, hormones. In other words, the pathophysiology of the neuro-mediated syncope might be more complex than the only overexpression of muscarinic receptors They are mainly located in the cardiac atria and are primarily responsible for slowing the heart rate.…”

Section: Discussionmentioning

confidence: 99%

Increased expression of blood muscarinic receptors in patients with reflex syncope

et al. 2019

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Aims Pathophysiology of reflex syncope is not fully understood but a vagal overactivity might be involved in this syncope. Previously, overexpression of muscarinic M 2 receptors and acetylcholinesterase was found in particular in the heart and in lymphocytes of rabbits with vagal overactivity as well as in hearts of Sudden Infant Death Syndromes. The aim of this present study was to look at M 2 receptor expression in blood of patients with reflex syncope. The second objective was to measure acetylcholinesterase expression in these patients. Methods and results 136 subjects were enrolled. This monocenter study pooled 45 adults exhibiting recurrent reflex syncope compared with 32 healthy adult volunteers (18–50 years) and 38 children exhibiting reflex syncope requiring hospitalization compared with 21 controls (1–17 years). One blood sample was taken from each subject and blood mRNA expression of M2 receptors was assessed by qRT-PCR. Taking into account the non-symmetric distributions of values in both groups, statistical interferences were assessed using bayesian techniques. A M 2 receptor overexpression was observed in adult and pediatric patients compared to controls. The medians [q1;q3] were 0.9 [0.3;1.9] in patients versus 0.2 [0.1;1.0] in controls; the probability that M 2 receptor expression was higher in patients than in controls (Pr[patients>controls]) was estimated at 0.99. Acetylcholinesterase expression was also increased 0.7 [0.4;1.6] in patients versus 0.4 [0.2;1.1] in controls; the probability that acetylcholinesterase expression was higher in patients than in controls (Pr[patients>controls]) was estimated at 0.97. Both in adults and children, the expression ratio of M 2 receptors over acetylcholinesterase was greater in the patient group compared with the control group. Conclusion M 2 receptor overexpression has been detected in the blood of both, adults and children, exhibiting reflex syncope. As in our experimental model, i . e . rabbits with vagal overactivity, acetylcholinesterase overexpression was associated with M 2 receptor overexpression. For the first time, biological abnormalities are identified in vagal syncope in which only clinical signs are, so far, taken into account for differential diagnosis and therapeutic management. Further work will be needed to validate potential biomarkers of risk or severity associated with the cholinergic system.

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“…Adenosine (AD), an ATP derivative, is also implicated in the response to hypoxemia during breath hold ( Joulia et al, 2013 , 2014 ; Marlinge et al, 2019 ). Adenosine is released by endothelial cells and myocytes during hypoxia or ischemia.…”

Section: Introductionmentioning

confidence: 99%

Blood Adenosine Increase During Apnea in Spearfishermen Reinforces the Efficiency of the Cardiovascular Component of the Diving Reflex

et al. 2021

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The physiopathology consequences of hypoxia during breath-hold diving are a matter of debate. Adenosine (AD), an ATP derivative, is suspected to be implicated in the adaptive cardiovascular response to apnea, because of its vasodilating and bradycardic properties, two clinical manifestations observed during voluntary apnea. The aim of this study was to evaluate the adenosine response to apnea-induced hypoxia in trained spearfishermen (SFM) who are used to perform repetitive dives for 4–5 h. Twelve SFM (11 men and 1 woman, mean age 41 ± 3 years, apnea experience: 18 ± 9 years) and 10 control (CTL) subjects (age 44 ± 7 years) were enrolled in the study. Subjects were asked to main a dry static apnea and stopped it when they began the struggle phase (average duration: SFM 120 ± 78 s, CTL 78 ± 12 s). Capillary blood samples were collected at baseline and immediately after the apnea and analyzed for standard parameters and adenosine blood concentration ([AD]b). Heart rate (HR), systolic (SBP), and diastolic (DBP) blood pressures were also recorded continuously during the apnea. During the apnea, an increase in SBP and DBP and a decrease in HR were observed in both SFM and CTL. At baseline, [AD]b was higher in SFM compared with CTL (1.05 ± 0.2 vs. 0.73 ± 0.11 μM, p < 0.01). [AD]b increased significantly at the end of the apnea in both groups, but the increase was significantly greater in SFM than in controls (+90.4 vs. +12%, p < 0.01). Importantly, in SFM, we also observed significant correlations between [AD]b and HR (R = −0.8, p = 0.02), SpO2 (R = −0.69, p = 0.01), SBP (R = −0.89, p = 0.02), and DBP (R = −0.68, p = 0.03). Such associations were absent in CTL. The adenosine release during apnea was associated with blood O2 saturation and cardiovascular parameters in trained divers but not in controls. These data therefore suggest that adenosine may play a major role in the adaptive cardiovascular response to apnea and could reflect the level of training.

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Purinergic profile of fainting divers is different from patients with vasovagal syncope

Cited by 4 publications

References 10 publications

Adenosine and the Cardiovascular System: The Good and the Bad

Adenosine and the Cardiovascular System: The Good and the Bad

Increased expression of blood muscarinic receptors in patients with reflex syncope

Blood Adenosine Increase During Apnea in Spearfishermen Reinforces the Efficiency of the Cardiovascular Component of the Diving Reflex

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