Hilton, Alistair
Localization of Cell Bodies of the Stellate and Superior
Cervical Ganglia in Relation to Innervation of Cardiac Muscle
and Vasculature of the Brain.

Faculty Mentor: Jonathan J. Wisco, Ph. D. Department of Physiology and Developmental Biology

Introduction: Arrhythmia is a serious heart defect that effects 14 million people in
the United States.i When the impulse rhythm becomes irregular or the frequency
of atrial and ventricular beats are different it is called arrhythmia.ii The most
serious effects of arrhythmia include sudden cardiac arrest and stroke.iii
Sympathetic nerve activity from the stellate ganglia increases prior to arrhythmia
events leading to sudden cardiac death.iv About 383,000 cases of cardiac arrest
are recorded annually in the United States alone.v Current treatment for
arrhythmia consists of ablation or intentional, permanent scarring of the heart
tissue, rather than a more targeted block of the nerves innervating the heart.

In a report complied in 2011 by the World Health Organization, stroke has the
second highest death rate of any disease worldwide, ending the lives of 6.1
million people annually.vi A hemorrhagic stroke is where the blood vessels
supplying the brain rupture, bleeding into, compressing, and damaging the brain
tissue.vii Following a stroke, ensuing spasms of the blood vessels in the brain can
cause further damage, increasing mortality by 1.5 to 3 fold. Blocking of
sympathetic nerves from the superior cervical ganglia has shown to be an
effective treatment for these spasms.viii

The stellate and superior cervical ganglia have nerve fibers running to a variety
of tissue performing a wide array of functions. Current techniques lack the
specificity to target just the fibers involved in arrhythmia and the blood vessel
spasms, and cut off all ganglia nerve function. The mapping of the nerve fiber
origins would allow for incredibly targeted treatments for both of these
challenging health concerns.

Methodology: 23 cadaveric heart specimens and their associated pairs of
sympathetic chain ganglia were obtained as opportunity samples from the West
Virginia University Medical School Human Gift Registry. The stellate and superior
cervical ganglia were excised from the chain and labeled to differentiate between
left and right and the superior and inferior halves of the ganglia. Following tissue
processing, the samples were embedded in wax prior to being cut and mounted
upon microscope slides. Two staining protocols were then performed: the
standard hematoxylin and eosin stain and the Mallory stain.

The cadaveric hearts were cut vertically along their length from back to front into
5 millimeter slabs. The slabs were examined for potential cardiac disease
pathology and suspect regions were biopsied.
Results: The slides of the ganglia revealed grouping of enlarged nerve cell
bodies. The mapping of the locations is still in progress, dependent on highresolution
images being obtained of the slides from a scanning facility. An
algorithm to perform the analysis is under development in connection with the Ira
A. Fulton College of Engineering and Technology. The cadaveric heart biopsies
require a longer time to process and analyze.

Discussion: This project helped me improve my research acumen. I am now
responsible for a team of my peers to speed up the completion of my project.
This leadership experience increased my independence and readiness for
medical school. The ORCA grant money was used to help me attend regional
conferences presenting on some of these findings in connection with prior heart
innervation research projects. The grant also enabled me to devote the
necessary time to undergo the time intensive process of processing the
specimens. This project was an outgrowth of some of my professor’s prior work
at the David Geffen School of Medicine at UCLA from a number of years ago and
required a lot of personal initiative to begin again. I learned the detailed steps of
tissue processing and analysis that can be applied broadly to all cell and tissue
level studies. Without this experience, I would have been unable to successfully
apply these concepts into the heart biopsies themselves. These were not initially
part of the project proposal, but I developed them with my advisor as my
scientific understanding and ability grew due to the previous research.

Conclusion: Nerve cell bodies remodel in groupings in connection with cardiac
disease. The exact locality may or may not be conserved across specimens.
Further precision will be developed as scanning and analysis is able to take
place. The knowledge of tissue processing I gained will be applied as I continue
to analyze the heart biopsies and pair that information with the nerve cells.

i Hulen, Tara. “Keeping the Beat.” UAB – UAB Magazine – Keeping the Beat. University of
Alabama Birmingham, Dec. 2010. Web. 18 Oct. 2015.
ii “Anatomy and Function of the Heart’s Electrical System.” Stanford Hospitals and Clinics.
Stanford University, n.d. Web. 21 Oct. 2015.
iii Engstom, Gunnar, MD, PhD, Bo Hedblad, MD, PhD, Steen Juul-Moller, MD,PhD, Patrik Tyden,
MD, PhD, and Lars Janzon, MD, PhD. “Cardiac Arrhythmias and Stroke.”Cardiac Arrhythmias
and Stroke. Malmo University Hospital, n.d. Web. 18 Oct. 2015.
iv Zhou S, et al. “Spontaneous stellate ganglion nerve activity and ventricular arrhythmias in a
canine model of sudden death.” Heart Rhythm. Jan 2008. 131–9. Web. 25 Oct. 2015.
v “Why Arrhythmia Matters.” American Heart Association, 5 Oct. 2012. Web. 21 Oct. 2015.
.
vi “The Top 10 Causes of Death.” World Health Organization. World Health Organization, July
2013. Web. 21 Oct. 2015. .
vii “Hemorrhagic Strokes (Bleeds).” American Heart Association and American Stroke Association,
7 Nov. 2013. Web. 25 Oct. 2015.
.
viii Treggiari MM. “Cervical sympathetic block to reverse delayed ischemic neurological deficits
after aneurysmal subarachnoid hemorrhage.” Stroke. April 2003;34:961–967. Web. 25 Oct. 2015.