Bibliography: leaves 118-161 / 161 [46] leaves : ill ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Physiology, 1984

Thesis (Ph.D.)--University of Adelaide, Dept. of Medicine, 1999. / Additional appendix (5 p.) is pasted onto back end-paper. Bibliography: leaves 219-244.

abstract: Electrical nerve stimulation is a promising drug-free technology that could treat a variety of ailments and disorders. Methods like Vagus Nerve Stimulation have been used for decades to treat disorders like epilepsy, and research with non-invasive vagus nerve stimulation has shown similar effects as its invasive counterpart. Non-invasive nerve stimulation methods like vagus nerve stimulation could help millions of people treat and manage various disorders. This study observed the effects of three different non-invasive nerve stimulation paradigms in human participants. The first study analyzed the safety and efficacy of transcutaneous auricular vagal nerve stimulation in healthy humans using a bilateral stimulation protocol with uniquely designed dry-hydrogel electrodes. Results demonstrate bilateral auricular vagal nerve stimulation has significant effects on specific parameters of autonomic activity and is safe and well tolerated. The second study analyzed the effects of non-invasive electrical stimulation of a region on the side of the neck that contains the Great Auricular Nerve and the Auricular Branch of the Vagus Nerve called the tympanomastoid fissure on golf hitting performance in healthy golfers. Results did not show significant effects on hitting performance or physiological activity, but the nerve stimulation had significant effects on reducing state-anxiety and improving the quality of feel of each shot. The third study analyzed the effects of non-invasive nerve stimulation of cervical nerves on the back of the neck on putting performance of yips-affected golfers. Results demonstrated that cervical nerve stimulation had significant effects on improving putting performance but did not have significant effects on physiological activity. Data from these studies show there are potential applications for non-invasive electrical nerve stimulation for healthy and athletic populations. Future research should also examine the effects of these stimulation methods in clinical populations. / Dissertation/Thesis / Doctoral Dissertation Biomedical Engineering 2020

Altered gut microbial diversity has been associated with several chronic disease states, including heart failure. Stimulation of the vagus nerve, which innervates the heart and abdominal organs, is proving to be an effective therapeutic in heart failure. We hypothesized that cervical vagus nerve stimulation (VNS) could alter fecal flora and prevent aberrations observed in fecal samples from heart failure animals. To determine whether microbial abundances were altered by pressure overload (PO), leading to heart failure and VNS therapy, a VNS pulse generator was implanted with a stimulus lead on either the left or right vagus nerve before creation of PO by aortic constriction. Animals received intermittent, open-loop stimulation or sham treatment, and their heart function was monitored by echocardiography. Left ventricular end-systolic and diastolic volumes, as well as cardiac output, were impaired in PO animals compared with baseline. VNS mitigated these effects. Metagenetic analysis was then performed using 16S rRNA sequencing to identify bacterial genera present in fecal samples. The abundance of 10 genera was significantly altered by PO, 8 of which were mitigated in animals receiving either left- or right-sided VNS. Metatranscriptomics analyses indicate that the abundance of genera that express genes associated with ATP-binding cassette transport and amino sugar/nitrogen metabolism was significantly changed following PO. These gut flora changes were not observed in PO animals subjected to VNS. These data suggest that VNS prevents aberrant gut flora following PO, which could contribute to its beneficial effects in heart failure patients.

Chronic heart failure (HF) is estimated to affect 23 million people worldwide, and many patients show minimal improvement after treatment with high-potency medications. HF with reduced left ventricular ejection fraction makes up approximately half of cases and is associated with high mortality: a 5-year survival rate of only 25% after hospitalization. This disease is marked by autonomic and cardiac dysfunction, as well as increased inflammatory markers both in the brain and microbiota of the gastrointestinal tract. As a main component of the autonomic nervous system, the vagus nerve has been identified as a potential treatment target for HF. Vagus nerve stimulation (VNS) is thought to help re-balance the autonomic system and has shown promising results in clinical trials for treatment of HF. Although the mechanism of action for VNS remains partially understood, anti-inflammatory pathways have been shown to play a significant role, and these pathways may be enhanced by microbiota signaling via the vagus nerve. The goal of the current study is to provide insight into VNS treatment for HF with reduced ejection fraction via a pressure overload (PO) model. Male Sprague-Dawley rats were randomly divided into age-matched control (n=7), PO (n=6), and PO+VNS (n=11). PO rats underwent aortic constriction (~40%) to induce HF, and a subset of these had VNS leads implanted around the left cervical vagus nerve. Treatment was initiated for PO+VNS rats after reaching a 20% drop in left ventricular relative ejection fraction (EF, p<0.001). VNS was delivered using 1.0 mA pulses at 20 Hz, with 14 sec on-time followed by 66 sec off-time for 2 months to model settings used in successful clinical studies. Echocardiography to image the heart and fecal samples to assess microbiota were collected at regular intervals for all rats. Hearts were weighed at termination for a final heart to body weight ratio, and brains were processed to assess neuroinflammation. Findings indicate that while PO reduced EF ~40% at termination (p<0.05), VNS treatment restored EF back to control levels (p<0.0001 compared to study midpoint). Further, the heart/body weight ratio was increased for PO rats (p<0.05) compared to controls and PO+VNS rats. These data demonstrate that physiological markers of heart failure can be mitigated using these VNS settings. Notably, 66% of microbiota populations altered by PO were prevented with VNS treatment. Further, prolonged VNS significantly affected microbiota populations involved in inflammatory processes. Neuroinflammation was assessed in two key autonomic nuclei: paraventricular nucleus of the hypothalamus and locus coeruleus. PO displayed increased neuroinflammation as measured by microglial density in both regions, and VNS attenuated this effect (p<0.001). These findings indicate relevant contributions of inflammatory mechanisms and microbiome alterations for beneficial VNS effects leading to improved cardiac function in HF.

Background: The efferent dorsal motor nucleus of the vagal nuclei complex may degenerate early in the course of Parkinson’s disease (PD), while efferent nucleus ambiguous, the principal source of parasympathetic vagal neurons innervating the heart, and afferent somatosensory nuclei remain intact.

Vagus nerve stimulation (VNS) is a promising neuromodulatory therapy under investigation for a range of disorders, including heart failure, gastric dysmotility, and migraine. Two primary forms of VNS are currently investigated: cervical VNS (cVNS), involving surgically implantation to activate vagal afferents in the cervical branch in the neck and transcutaneous auricular VNS (taVNS) which subcutaneously stimulates the auricular branch in the outer ear. The nucleus of the solitary tract (NTS) serves as a relay-station receiving 90% of vagal afferents, enabling connections with higher-order brain regions and other brainstem nuclei like the spinal trigeminal nucleus (Sp5) and locus coeruleus (LC), facilitating neuromodulation through VNS. Research has established the efficacy of VNS at 20–30 Hz for disorders like depression, but the impact of alternative stimulation parameters on medullary nuclei neuromodulation remains unclear. These studies used anesthetized rats to extracellularly record neuronal activity across varying VNS parameters within NTS, Sp5, and LC. Neuronal responses were classified as positive (increased activity), negative (decreased activity), or non-responders (no response). In LC, cVNS at standard paradigms (≥ 10 Hz) and bursting paradigms with shorter interburst intervals or increased pulses induced more positive responders, while standard 5 Hz generated more negative responders. Additionally, a build-up effect was observed in LC, with increased responders over consecutive VNS cycles. In NTS and Sp5, taVNS evoked comparable activation, with more positive responders at 20 Hz and 100 Hz and stronger responses at higher intensities. However, Sp5 responses were twice as strong compared to NTS. Furthermore, comparative analysis between taVNS and cVNS revealed similar overall activation in NTS, but distinct activation profiles in individual neurons indicate different pathways. Finally, the therapeutic efficacy of VNS therapy was evaluated in heart failure using a pressure-overload rat model. A 60-day cVNS treatment restored adverse cardiac remodeling and dysfunction, mitigated cardiac molecular changes, and prevented neuroinflammatory responses within brainstem nuclei. The findings presented herein demonstrated differential parameter-specific and nuclei-specific responses to taVNS and cVNS, investigated the mechanisms responsible for taVNS modulation, and confirmed that VNS therapy, when initiated early, can mitigate heart failure development and restore multiorgan homeostasis in a PO model.

Os nervos são abundantemente vascularizados em toda sua extensão, por intermédio de uma sucessão de vasos que, por suas consecutivas divisões e anastomoses no interior do nervo, formam uma rede vascular intraneural ininterrupta. Já está bem definido que o número de vasos nutrientes para um nervo em particular varia amplamente, não apenas de indivíduo para indivíduo, como também entre os dois lados do corpo. Nervos maiores não necessariamente recebem mais vasos que nervos menores. Os nervos podem percorrer distâncias consideráveis sem receber um vaso nutriente e o calibre desses vasos varia em amplos intervalos. Desse modo, o número e o tamanho dos vasos, juntamente com a sua distribuição no interior dos nervos estão sujeitos a uma grande variabilidade, não apenas em vários segmentos do mesmo nervo como também no mesmo nervo em diferentes sujeitos. Nosso objetivo, com o presente estudo foi o de realizar uma descrição do padrão longitudinal de vascularização do endoneuro e de avaliar a existência de uma possível correlação entre a área fascicular e a área endoneural ocupada pelos vasos capilares, no nervo vago de ratas da linhagem Wistar-Kyoto, em três diferentes fases da vida: 30, 180 e 360 dias de idade. Para tanto, três animais de cada grupo foram mortos e tiveram seus nervos vagos direitos preparados com técnicas histológicas de rotina para inclusão em resina epóxi. Secções transversais semifinas (0,4 µm) seriadas, obtidas a cada 100 µm de extensão longitudinal do nervo, até o esgotamento completo dos blocos, foram analisadas em nível de microscopia de luz. A morfometria dos fascículos e dos vasos capilares endoneurais, foi realizada com o auxílio de um sistema analisador de imagens computacional. A área fascicular média e a área média ocupada pelos capilares foram calculadas para cada segmento estudado (proximal, médio e distal) e comparadas entre segmentos (estudo longitudinal) e entre os grupos. A correlação entre a área fascicular total e a área endoneural ocupada pelos capilares foi estudada através de uma análise de regressão linear e do cálculo dos coeficientes de correlação. A porcentagem da área fascicular total ocupada pelos capilares endoneurais também foi calculada para cada segmento estudado e comparada entre segmentos e entre os grupos. Nossos resultados mostram que a área fascicular média de todos os segmentos estudados foi significativamente maior nos animais com 180 e 360 dias, comparados aos com 30 dias, em todos os segmentos estudados, acompanhando o ganho ponderal dos animais. Interessantemente, nos animais jovens (30 dias), houve uma tendência ao aumento dos valores dessa área no sentido longitudinal dos nervos, o que não foi observado nos animais mais velhos (180 e 360 dias). A área média dos capilares endoneurais aumentou no sentido longitudinal em todos os grupos estudados. Na comparação entre os grupos, houve uma estabilização da área fascicular média nos animais mais velhos enquanto que houve uma diminuição da área média dos capilares endoneurais com o avançar da idade. A porcentagem da área fascicular total ocupada pelos capilares aumentou, no sentido longitudinal, nos animais jovens (30 dias) e tendeu à estabilidade nos animais mais velhos (180 e 360 dias), havendo nítida diminuição progressiva dessa porcentagem com o avançar da idade. O estudo dos diâmetros dos capilares endoneurais mostrou que esses diâmetros variam amplamente, sem nenhum padrão específico entre segmentos de um mesmo grupo os entre os diferentes grupos. Nossos resultados também mostraram a existência de uma correlação positiva fraca (coeficientes de correlação com valores muito baixos) entre a área fascicular total e a área endoneural ocupada pelos capilares. Esses dados sugerem que a entrada dos capilares no nervo não é acompanhada de um aumento proporcional na área do fascículo. Os dados de diminuição da porcentagem da área fascicular total ocupada pelos capilares com o avançar da idade podem sugerir que os nervos de animais mais velhos possam ser mais susceptíveis aos processos isquêmicos. / Peripheral nerves are abundantly vascularised throughout their length by a succession of vessels which, by their repeated division and anastomosis within the nerve, for an unbroken intraneural vascular network. It is well defined that the number of nutrient vessels to any particular nerve varies greatly not only from subject to subject but also on the two sides of the body. Larger nerves do not necessarily receive more vessels than do smaller nerves. Nerves may run considerable distances without receiving a nutrient vessel and the caliber of the nutrient vessels fluctuates over wide limits. Thus, the number and size of these vessels, together with their distribution within the nerve, are subject to a wide range of variation, not only between various segments of a nerve but also in the same nerve in different specimens. In this way, our objectives were to study the longitudinal pattern of the endoneural vascularisation and, to determine the existence of a correlation between the fascicular total area and the endoneural area occupied by the capillary vessels on the vagus nerve of Wistar-Kyoto female rats, in three different ages. Three animas aged 30, 180 or 360 days were killed and their right vagus nerves were prepared for epoxy resin embedding and light microscopy study, by conventional techniques. Serial semihtin sections (0.4 µm), obtained every 100 µm of the vagus nerve longitudinal extension were measured with the aid of a computer software. The average fascicular area and the average area occupied by the endoneural capillary were obtained for each segment (proximal, medium and distal) and compared between segments (longitudinal study) and between ages. The correlation between the fascicular area and the area occupied by the endoneural capillary was accessed by linear regression analysis and correlation coefficient calculations. The percentage of the total fascicular area occupied by the capillaries was also calculated for each segment and compared between segments and between ages. Our results show that the average fascicular area, in all segments studied, was significantly larger in the older animals (180 and 360 days), compared to the younger (30 days). This was compatible with the weight gain of the animals. Interestingly, in the younger animals, there was a tendency of an increase in the average fascicular area from proximal to distal, and this was not observed in the older animals (180 and 360 days). The average area of the endoneural capillaries increased from proximal to distal in all groups studied. The analysis between groups showed a stabilization of the fascicular area in the older animals while the average capillary area got smaller with ageing. The percentage of the fascicular area occupied by the endoneural capillary vessels increased from proximal to distal in the younger animals (30 days) and got stable in the older (180 and 360 days). There was an obvious decrease in this percentage with ageing. The capillary vessels diameter study showed that this parameter varied considerably, without a established pattern between segments or groups. Our results also show the existence of a weak but positive correlation between the fascicular area and the area occupied by the endoneural capillary. This data suggests that the entrance of blood vessels to the endoneural space is not followed by an increase on the fascicular area. The result of a smaller percentage of the fascicular area occupied by the capillary vessels with ageing suggests that older animals may be more susceptible to nerve ischemia.

Studies have indicated that approximately 30% of people with heart disease experience major depressive disorder (MDD). Despite strong clinical evidence of a link between the two diseases, the neurobiological processes involved in the relationship are poorly understood. A growing number of studies are revealing similar neuroanatomical and neurochemical abnormalities resulting from both depression and heart disease. The locus coeruleus (LC) is a group of neurons in the pons that synthesize and release norepinephrine, and that is known to play a significant role in depression pathobiology. For example, there is evidence that tyrosine hydroxylase (TH) is elevated in the LC in depression. In addition, there is evidence that the LC plays a role in cardiovascular autonomic regulation. The hippocampus is another region that exhibits abnormalities in both depression and heart disease. In this study, the levels of TH in the hippocampus and LC were examined in the guinea pig pressure-overload model of heart disease. TH levels were also measured in the pressure-overload model treated with vagal nerve stimulation, a new investigational therapeutic intervention in heart disease. This study found that there were no changes in TH levels in the LC or the hippocampus of the pressure-overload model or in the pressure-overload model treated with vagal nerve stimulation.

Additional appendix (5 p.) is pasted onto back end-paper. / Bibliography: leaves 219-244. / v, 244, [14] p., 67 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Investigates the complexity of the vagal reflexes arising from the upper gastrointestinal tract by recording single unit vagal afferents and efferents in the ferret. The potential involvement of various neurotransmitters in mediating and modulating gastrointestinal tract inputs is also explored. / Thesis (Ph.D.)--University of Adelaide, Dept. of Medicine, 1999