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The autonomic nervous system is extremely diffuse with its pathways permeating all organ systems. So the autonomic nervous system with its central part and sympathetic and parasympathetic efferent systems is involved in virtually all diseases. Disharmony caused by intrinsic or extrinsic adverse forces is counteracted by an intricate network of physiologic responses that aim to re-establish the challenged body equilibrium. This adaptive response depends primarily on elaborate reflex circuits regulating hemodynamics. Owing to the role of the cardiovascular system in this adaption process the cardiovascular autonomic nervous system is most frequently examined. Furthermore its biosignals like heart frequency and blood pressure can be easily recorded and important diagnostic and prognostic information can be drawn from their analysis.

Obesity, the metabolic syndrome and diabetes mellitus have reached epidemic proportions worldwide. Owing to their extremely complex etiology and shared deleterious consequences these metabolic disorders are a major challenge of health care systems around the world. A characteristic commonality of these metabolic disorders is an increased basal sympathetic nervous system (SNS) activity but impaired sympathetic reactivity. Although targeting the SNS may seem an attractive undertaking for prevention and treatment of obesity and associated metabolic disorders, the cause-effect relationship remains unknown. Investigating this question is challenging since metabolic processes are controlled and modulated by an intricate network of autonomic efferent and neuroendocrine pathways (figure). In conjunction with the autonomic nervous system the hypothalamic-pituitary-adrenal (HPA) axis plays a crucial role within this tightly regulated environment. The integrity of the network and its precise interaction with central and peripheral components is essential for a successful response to various stimuli and stressors. Chronic stress represents a threat to homeostasis and may lead to manifestations that characterize a variety of diseases. The metabolic syndrome can be described as deranged metabolic homeostasis and is significantly associated with stress just as obesity. Permanent activation of major stress components such as the HPA and the SNS may contribute to accumulation of fat tissue. Obesity vice versa presents a state of chronic stress which may cause derangements in these systems. In addition it appears that adipokines play an important pathogenetic role in the development of metabolic disturbances.

The primary aim of our research is to investigate the complex interactions of autonomic-vascular, neuroendocrine and immune systems considering mental well-being, and their role for the development of metabolic disorders and associated complications. This research shall enable us to identify and formulate suitable targets for preventive measures. A second line of investigation attempts to explore the relevance of the integrity of autonomic and cardiovascular structures for rehabilitation, survival and outcome of critically ill patients.

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