Neuroimmune interactions in cardiovascular homeostasis and disease

Cardiovascular homeostasis is an adaptive process shaped by the interplay between the nervous system and the heart. Emerging evidence demonstrates that immune cells integrate within and across these signaling pathways to modulate inflammatory responses to injury. This neuroimmune interface has a fundamental role in cardiovascular homeostasis and, when dysregulated, may contribute to the pathogenesis of several cardiovascular diseases. Despite its importance, research on the neuroimmune mechanisms in cardiovascular disease is scarce, possibly because it stands upon an intersection of two traditionally separate fields: immunology and neuroscience. This review provides a comprehensive overview of the role of autonomic nervous system within the brain-heart axis, with a focus on signaling pathways that regulate immune function. We detail the bidirectional afferent and efferent connections among central autonomic centers, cardiovascular, and immune tissues in maintaining homeostasis. Finally, we discuss how these neuroimmune circuits are altered in three major cardiovascular diseases, representative of both low-degree chronic inflammation and autonomic dysfunction: heart failure with preserved ejection fraction, hypertension, and atrial fibrillation. Our synthesis of current literature highlights the necessity for a deeper understanding of neuroimmune interactions. Advancing this knowledge may be crucial for developing targeted therapies that improve patient outcomes.