title: Heart failure and the brain: new perspectives.
abstract: Despite recent therapeutic advances, the prognosis for patients with heart failure remains dismal. Unchecked neurohumoral excitation is a critical element in the progressive clinical deterioration associated with the heart failure syndrome, and its peripheral manifestations have become the principal targets for intervention. The link between peripheral systems activated in heart failure and the central nervous system as a source of neurohumoral drive has therefore come under close scrutiny. In this context, the forebrain and particularly the paraventricular nucleus of the hypothalamus have emerged as sites that sense humoral signals generated peripherally in response to the stresses of heart failure and contribute to the altered volume regulation and augmented sympathetic drive that characterize the heart failure syndrome. This brief review summarizes recent studies from our laboratory supporting the concept that the forebrain plays a critical role in the pathogenesis of ischemia-induced heart failure and suggesting that the forebrain contribution must be considered in designing therapeutic strategies. Forebrain signaling by neuroactive products of the renin-angiotensin system and the immune system are emphasized.
authors.affiliation: Department of Internal Medicine, University of Iowa, Iowa City, Iowa 52242, USA. felder@uiowa.edu
authors.forename: Robert B
authors.initials: RB
authors.lastname: Felder
authors.forename: Joseph
authors.initials: J
authors.lastname: Francis
authors.forename: Zhi-Hua
authors.initials: ZH
authors.lastname: Zhang
authors.forename: Shun-Guang
authors.initials: SG
authors.lastname: Wei
authors.forename: Robert M
authors.initials: RM
authors.lastname: Weiss
authors.forename: Alan Kim
authors.initials: AK
authors.lastname: Johnson
mesh_terms: D000818:Animals; D001921:Brain / Q000503:physiopathology*; D016207:Cytokines; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D007031:Hypothalamus / Q000503:physiopathology; D008954:Models, Biological; D012084:Renin-Angiotensin System
chemical_list: D016207:Cytokines