Peripheral beta-blockade differentially enhances cardiac and respiratory interoception

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Authors

Ashley Tyrer, Jesper Fischer Ehmsen, Kelly Hoogervorst, Niia Nikolova, Victor Pando-Naude, Christian Holm Steenkjaer, Arthur S Courtin, Francesca Fardo, Tobias Hauser, Francesco Bavato, Micah G. Allen

Abstract

Interoception, the perception of internal visceral states, arises from complex brain-body interactions across the central and peripheral nervous systems. Despite noradrenaline’s key role in these interactions, its specific contribution to interoceptive processes remains unclear. In a placebo-controlled, randomised, within-subject study, we employed computational modelling of interoceptive psychophysics to determine how pharmacological beta-adrenoceptor antagonism controls interoception across cardiac and respiratory domains. Both cardio-selective bisoprolol and non-selective propranolol improved cardiac perceptual sensitivity, with bisoprolol exerting an enhanced effect on cardiac metacognition. In contrast, both beta-blockers increased respiratory perceptual precision, with no corresponding changes in sensitivity or metacognition. These findings reveal a novel dissociation between central and peripheral beta-adrenergic mechanisms in interoception, highlighting the pivotal role of peripheral noradrenaline in regulating multi-organ brain-body interactions. Our results suggest that beta-blockers may provide promising routes for modulating distinct facets of interoception, potentially opening new avenues for intervention in conditions characterised by disrupted bodily self-awareness.