Translating carotid body function into clinical medicine

Abstract

The carotid body (CB) is considered the main O₂ chemoreceptor, which contributes to the cardiorespiratory homeostasis and ventilatory acclimatization. In clinical medicine, the most common pathology associated with the CB are tumours. However, a growing body of evidences supports the novel idea that an enhanced CB chemosensory discharge contributes to the autonomic dysfunction and pathological consequences in obstructive sleep apnoea (OSA), hypertension, systolic heart failure (HF) and cardiometabolic diseases. The heightened CB chemosensory reactivity elicited by oxidative stress, has been involved in sympathetic hyperactivity, cardiorespiratory instability, hypertension and insulin resistance. The CB ablation that reduces sympathetic hyperactivity, decreases hypertension in animal models of OSA and hypertension, eliminates breathing instability and improves animal survival in HF, and restores insulin tolerance in cardiometabolic models. Thus, data obtained from preclinical studies highlights the CB importance in the progression of sympathetic-related diseases, supporting the idea that appeasing the enhanced CB chemosensory drive may be useful to improve cardiovascular, respiratory and endocrine alterations. Accordingly, the CB ablation has been proposed and used as a treatment for moderating resistant hypertension and HF-induced sympathetic hyperactivity in humans. First-studies-in human have shown that CB ablation reduces sympathetic overactivity, transiently reduces severe hypertension and improves quality of life in HF patients. Thus, CB ablation would be a useful therapy to revert sympathetic overactivation in HF and severe hypertension, but caution is required before its massive use due to the crucial physiological function played by the CB. Further studies in preclinical models are required to assess side-effects of CB ablation.

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