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Fig. 1 | Respiratory Research

Fig. 1

From: Autonomic nervous system involvement in pulmonary arterial hypertension

Fig. 1

Schematic diagram summarizing autonomic nervous system involvement in PAH and various therapeutic strategies targetting the activation of SNS and RAAS in PAH. PAH is associated with increased sympathetic nervous system (SNS) and renin-angiotensin-aldosterone-system (RAAS) activation. The central nervous system provides autonomic output to the lungs and heart mainly through cranial nerves IX and X. The parasympathetic nervous system (shown in blue) originates from cranial nerves III, VII, IX, and X and the sacral nerves S2-S4. The SNS (shown in red) originates from the thoracolumbar region of the spinal cord and modulates; i) vascular and airway reactivity in the lungs, ii) heart rate and contractility in the heart and iii) RAAS activation in the kidneys and adrenal glands. Consequently, RAAS activation generates vasoactive compounds that result in pulmonary vasoconstriction and vascular remodeling, hallmarks of PAH. These vasoactive compounds may result in a feedback loop to the nervous system. Various pharmacological (α/β blockers, ACE inhibitors, AT1R inhibitors), surgical (pulmonary artery denervation (PADN), renal artery denervation) and experimental (Superior cervical and stellate ganglion block (SGB) approaches for modulating autonomic nervous system and RAAS are also shown boxed in red

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