Development of a Renal Sympathetic Nerve Activity Monitoring Device

DESCRIPTION provided by applicant There is mounting evidence that major health problems like hypertension heart disease atrial fibrillation heart failure stroke and renal falure are caused by overactive sympathetic nerves However there is no diagnostic device available to measure sympathetic nerve activity SNA or establish over activity thresholds for illness that require treatment Measures like plasma norepinephrine NE levels plasma NE spillover levels heart rate variability and muscle sympathetic nerve activity MSNA are used to quantify SNA in experimental settings The recent Simplicity HTN study failed to show clinical efficacy in reducing hypertension primarily because of incomplete denervation due to the lack of in situ feedback to the physician from renal sympathetic nerve activity RSNA during the procedure Accordingly there is a significant need for developing new methods for clinically recording SNA and at different target sites to monitor disease progression and establish thresholds for preventative treatment In this proposal we address this need by developing a device to monitor RSNA Our previous studies demonstrated the feasibility of a local drug delivery catheter to inject a neurotropic drug and selectively induce degenerative changes in renal nerves and reduce RSNA We plan to incorporate a microelectrode in this device to monitor changes in RSNA during nerve block achieved by the neurotropic drug Success with this novel device could enhance our understanding on RSNA and provide a procedural tool for monitoring RSNA during device based treatment of hypertension and other chronic diseases mediated by the sympathetic nervous system New devices and methods could be designed for diagnosing other diseases by measuring SNA near their respective target organ sites Ultimately the proposal develops a method to quantify overactive SNA in the progression of chronic diseases and could significantly improve public health by early preventative treatment PUBLIC HEALTH RELEVANCE Major health problems like hypertension heart disease atrial fibrillation heart failure stroke and kidney failure are associated with overactive sympathetic nerves However there is no clinical device available to measure sympathetic nerve activity SNA or establish over activity thresholds for illness which require treatment In this proposal we examine the feasibility of developing a novel device to measure renal sympathetic nerve activity RSNA We expect the research work will lead to the development of a standard clinical test for measuring sympathetic over activity in humans help establish limits on healthy vs unhealthy renal nerve activity levels in hypertensive heart failure and chronic renal failure patients In addition proposal will enable the development of a RSNA device to provide real time feedback to clinicians performing renal denervation procedures to treat sympathetic hypertension Success of this proposal will enable the development of new devices and therapies to treat chronic diseases and target organs mediated by the sympathetic nervous system