LAUSR

Cardiovascular diseases (CVDs) make a substantial contribution to the global burden of disease. Prevention strategies have succeeded in reducing the effect of acute CVD events and deaths, but the long-term consequences of cardiovascular risk factors still represent the major cause of disability and chronic illness, suggesting that some pathophysiological mechanisms might not be adequately targeted by current therapies. Many of the underlying causes of CVD have now been recognized to have immune and inflammatory components. However, inflammation and immune activation were mostly regarded as a consequence of target-organ damage. Only more recent findings have indicated that immune dysregulation can be pathogenic for CVD, identifying a need for novel immunomodulatory therapeutic strategies. The nervous system, through an array of afferent and efferent arms of the autonomic nervous system, profoundly affects cardiovascular function. Interestingly, the autonomic nervous system also innervates immune organs, and neuroimmune interactions that are biologically relevant to CVD have been discovered, providing the foundation to target neural reflexes as an immunomodulatory therapeutic strategy. This Review summarizes how the neural regulation of immunity and inflammation participates in the onset and progression of CVD and explores promising opportunities for future therapeutic strategies. The autonomic nervous system profoundly affects the function of the cardiovascular and immune systems. In this Review, Carnevale summarizes how the neural regulation of immunity and inflammation participates in the onset and progression of cardiovascular disease and explores promising opportunities for therapeutic strategies. The main routes of communication between the brain and the cardiovascular system are the brain circumventricular organs, the autonomic nervous system and the hypothalamus–pituitary–adrenal axis. Immune organs are densely innervated by the peripheral nervous system. The nervous system might contribute to cardiovascular disease either directly through innervation of the cardiovascular system or indirectly by influencing the immune responses involved in cardiovascular pathology. Innovative approaches that are based on bioelectronic or ultrasound-driven modulation of immune organs are emerging options for the treatment of cardiovascular disorders. The main routes of communication between the brain and the cardiovascular system are the brain circumventricular organs, the autonomic nervous system and the hypothalamus–pituitary–adrenal axis. Immune organs are densely innervated by the peripheral nervous system. The nervous system might contribute to cardiovascular disease either directly through innervation of the cardiovascular system or indirectly by influencing the immune responses involved in cardiovascular pathology. Innovative approaches that are based on bioelectronic or ultrasound-driven modulation of immune organs are emerging options for the treatment of cardiovascular disorders.