Background Attacks of Hereditary Angioedema due to C1-inhibitor deficiency (Cl-INH-HAE) are often triggered by stressful events/hormonal changes. Objective Our study evaluates the relationship between autonomic nervous system (ANS) and contact/complement system activation. Methods Twenty-three HAE patients (6 males, mean age 47.5 +/- 11.4 years) during remission and 24 healthy controls (8 males, mean age 45.3 +/- 10.6 years) were studied. ECG, beat-by-beat blood pressure, respiratory activity were continuously recorded during rest (10') and 75degrees- head-up tilt (10'). C1-INH, C4, cleaved high molecular weight kininogen (cHK) were assessed; in 16 patients and 11 controls plasma catecholamines were also evaluated. Spectral analysis of heart rate variability allowed extraction of low-(LF) and high-(HF)frequency components, markers of sympathetic and vagal modulation respectively. Results HAE patients showed higher mean systolic arterial pressure (SAP) than controls during both rest and tilt. Tilt induced a significant increase in SAP and its variability only in controls. Although sympathetic modulation (LFnu) increased significantly with tilt in both groups, LF/HF ratio, index of sympathovagal balance, increased significantly only in controls. At rest HAE patients showed higher noradrenaline values (301.4 +/- 132.9 pg/ml vs 210.5 +/- 89.6 pg/ml, p = 0.05). Moreover, in patients tilt was associated with a significant increase in cHK, marker of contact system activation (49.5 +/- 7.5% after T vs 47.1 +/- 7.8% at R, p = 0.01). Conclusions Our data are consistent with altered ANS modulation in HAE patients, i.e. increased sympathetic activation at rest and blunted response to orthostatic challenge. Tilt test-induced increased HK cleavage suggests a link between stress and bradykinin production.

Hereditary angioedema: Assessing the hypothesis for underlying autonomic dysfunction / M.A. Wu, F. Casella, F. Perego, C. Suffritti, A.A. Nada, E. Tobaldini, A. Zanichelli, C. Chiara, N. Montano, M. Cicardi. - In: PLOS ONE. - ISSN 1932-6203. - 12:11(2017 Nov 08).

Hereditary angioedema: Assessing the hypothesis for underlying autonomic dysfunction

M.A. Wu;F. Casella;F. Perego;C. Suffritti;E. Tobaldini;A. Zanichelli;C. Chiara;N. Montano;M. Cicardi
2017-11-08

Abstract

Background Attacks of Hereditary Angioedema due to C1-inhibitor deficiency (Cl-INH-HAE) are often triggered by stressful events/hormonal changes. Objective Our study evaluates the relationship between autonomic nervous system (ANS) and contact/complement system activation. Methods Twenty-three HAE patients (6 males, mean age 47.5 +/- 11.4 years) during remission and 24 healthy controls (8 males, mean age 45.3 +/- 10.6 years) were studied. ECG, beat-by-beat blood pressure, respiratory activity were continuously recorded during rest (10') and 75degrees- head-up tilt (10'). C1-INH, C4, cleaved high molecular weight kininogen (cHK) were assessed; in 16 patients and 11 controls plasma catecholamines were also evaluated. Spectral analysis of heart rate variability allowed extraction of low-(LF) and high-(HF)frequency components, markers of sympathetic and vagal modulation respectively. Results HAE patients showed higher mean systolic arterial pressure (SAP) than controls during both rest and tilt. Tilt induced a significant increase in SAP and its variability only in controls. Although sympathetic modulation (LFnu) increased significantly with tilt in both groups, LF/HF ratio, index of sympathovagal balance, increased significantly only in controls. At rest HAE patients showed higher noradrenaline values (301.4 +/- 132.9 pg/ml vs 210.5 +/- 89.6 pg/ml, p = 0.05). Moreover, in patients tilt was associated with a significant increase in cHK, marker of contact system activation (49.5 +/- 7.5% after T vs 47.1 +/- 7.8% at R, p = 0.01). Conclusions Our data are consistent with altered ANS modulation in HAE patients, i.e. increased sympathetic activation at rest and blunted response to orthostatic challenge. Tilt test-induced increased HK cleavage suggests a link between stress and bradykinin production.
adult; angioedemas, hereditary; autonomic nervous system; blood pressure; case-control studies; electrocardiography; female; heart rate; humans; male; middle aged; biochemistry, genetics and molecular biology (all); agricultural and biological sciences (all)
Settore MED/16 - Reumatologia
Settore MED/09 - Medicina Interna
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/540214
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