1
|
Bonaz B. A novel neuroimmune modulation system for the treatment of rheumatoid arthritis. Bioelectron Med 2024; 10:9. [PMID: 38566215 PMCID: PMC10988796 DOI: 10.1186/s42234-024-00142-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/08/2024] [Indexed: 04/04/2024] Open
Abstract
The vagus nerve has an anti-inflammatory effect through the inflammatory reflex, which inhibits the release of proinflammatory cytokines by macrophages. Recent pilot clinical trials, using implantable bioelectronic devices, have demonstrated the efficacy of vagus nerve stimulation in adult patients with rheumatoid arthritis and inflammatory bowel diseases as an alternative to drugs, which are not devoid of side effects and are costly. In this issue of Bioelectronic Medicine, Peterson et al. report the safety of novel implantable neuroimmune modulation device for treating rheumatoid arthritis (The RESET RA study), which I will discuss in this commentary.
Collapse
Affiliation(s)
- Bruno Bonaz
- Université Grenoble Alpes-Faculté de Médicine, Grenoble Institut Neurosciences (GIN, Inserm U1216), site Santé, Bâtiment Edmond J. Safra, 31 Chem. Fortuné Ferrini, 38700, La Tronche, France.
| |
Collapse
|
2
|
Moe AAK, Bautista TG, Trewella MW, Korim WS, Yao ST, Behrens R, Driessen AK, McGovern AE, Mazzone SB. Investigation of vagal sensory neurons in mice using optical vagal stimulation and tracheal neuroanatomy. iScience 2024; 27:109182. [PMID: 38414860 PMCID: PMC10897902 DOI: 10.1016/j.isci.2024.109182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/28/2023] [Accepted: 02/06/2024] [Indexed: 02/29/2024] Open
Abstract
In rats and guinea pigs, sensory innervation of the airways is derived largely from the vagus nerve, with the extrapulmonary airways innervated by Wnt1+ jugular neurons and the intrapulmonary airways and lungs by Phox2b+ nodose neurons; however, our knowledge of airway innervation in mice is limited. We used genetically targeted expression of enhanced yellow fluorescent protein-channelrhodopsin-2 (EYFP-ChR2) in Wnt1+ or Phox2b+ tissues to characterize jugular and nodose-mediated physiological responses and airway innervation in mice. With optical stimulation, Phox2b+ vagal fibers modulated cardiorespiratory function in a frequency-dependent manner while right Wnt1+ vagal fibers induced a small increase in respiratory rate. Mouse tracheae contained sparse Phox2b-EYFP fibers but dense networks of Wnt1-EYFP fibers. Retrograde tracing from the airways showed limited tracheal innervation by the jugular sensory neurons, distinct from other species. These differences in physiology and vagal sensory distribution have important implications when using mice for studying airway neurobiology.
Collapse
Affiliation(s)
- Aung Aung Kywe Moe
- Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Clayton Campus, Clayton, VIC 3800, Australia
| | - Tara G Bautista
- Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Matthew W Trewella
- Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Willian S Korim
- Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Song T Yao
- Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Robert Behrens
- Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Alexandria K Driessen
- Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Alice E McGovern
- Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Stuart B Mazzone
- Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| |
Collapse
|
3
|
Hesampour F, Bernstein CN, Ghia JE. Brain-Gut Axis: Invasive and Noninvasive Vagus Nerve Stimulation, Limitations, and Potential Therapeutic Approaches. Inflamm Bowel Dis 2024; 30:482-495. [PMID: 37738641 DOI: 10.1093/ibd/izad211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Indexed: 09/24/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic relapsing condition with no known etiology and is characterized by disrupted gut homeostasis, chronic inflammation, and ulcerative lesions. Although current treatments can reduce disease activity, IBD frequently recurs once treatments are discontinued, indicating that treatments are ineffective in providing long-term remission. The lack of responsiveness and reluctance of some affected persons to take medications because of potential adverse effects has enhanced the need for novel therapeutic approaches. The vagus nerve (VN) is likely important in the pathogenesis of IBD, considering the decreased activity of the parasympathetic nervous system, especially the VN, and the impaired interaction between the enteric nervous system and central nervous system in patients with IBD. Vagus nerve stimulation (VNS) has demonstrated anti-inflammatory effects in various inflammatory disorders, including IBD, by inhibiting the production of inflammatory cytokines by immune cells. It has been suggested that stimulating the vagus nerve to induce its anti-inflammatory effects may be a potential therapeutic approach for IBD. Noninvasive techniques for VNS have been developed. Considering the importance of VN function in the brain-gut axis, VNS is a promising treatment option for IBD. This review discusses the potential therapeutic advantages and drawbacks of VNS, particularly the use of noninvasive transcutaneous auricular vagus nerve stimulation.
Collapse
Affiliation(s)
| | - Charles N Bernstein
- Internal Medicine, University of Manitoba, Winnipeg, Canada
- Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Canada
| | - Jean-Eric Ghia
- Immunology, University of Manitoba, Winnipeg, Canada
- Internal Medicine, University of Manitoba, Winnipeg, Canada
- Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| |
Collapse
|
4
|
Mondal B, Choudhury S, Banerjee R, Roy A, Chatterjee K, Basu P, Singh R, Halder S, Shubham S, Baker SN, Baker MR, Kumar H. Effects of non-invasive vagus nerve stimulation on clinical symptoms and molecular biomarkers in Parkinson's disease. Front Aging Neurosci 2024; 15:1331575. [PMID: 38384731 PMCID: PMC10879328 DOI: 10.3389/fnagi.2023.1331575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/20/2023] [Indexed: 02/23/2024] Open
Abstract
Non-invasive vagus nerve stimulation (nVNS) is an established neurostimulation therapy used in the treatment of epilepsy, migraine and cluster headache. In this randomized, double-blind, sham-controlled trial we explored the role of nVNS in the treatment of gait and other motor symptoms in Parkinson's disease (PD) patients. In a subgroup of patients, we measured selected neurotrophins, inflammatory markers and markers of oxidative stress in serum. Thirty-three PD patients with freezing of gait (FOG) were randomized to either active nVNS or sham nVNS. After baseline assessments, patients were instructed to deliver six 2 min stimulations (12 min/day) of the active nVNS/sham nVNS device for 1 month at home. Patients were then re-assessed. After a one-month washout period, they were allocated to the alternate treatment arm and the same process was followed. Significant improvements in key gait parameters (speed, stance time and step length) were observed with active nVNS. While serum tumor necrosis factor- α decreased, glutathione and brain-derived neurotrophic factor levels increased significantly (p < 0.05) after active nVNS treatment. Here we present the first evidence of the efficacy and safety of nVNS in the treatment of gait in PD patients, and propose that nVNS can be used as an adjunctive therapy in the management of PD patients, especially those suffering from FOG. Clinical trial registration: identifier ISRCTN14797144.
Collapse
Affiliation(s)
| | | | | | - Akash Roy
- Institute of Neurosciences Kolkata, Kolkata, India
| | | | - Purba Basu
- Institute of Neurosciences Kolkata, Kolkata, India
| | - Ravi Singh
- Institute of Neurosciences Kolkata, Kolkata, India
| | | | | | - Stuart N. Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark R. Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | | |
Collapse
|
5
|
Bonaz B, Sinniger V. Targeting the Vagus Nerve to Treat Inflammatory Bowel Disease? J Crohns Colitis 2023; 17:1893-1894. [PMID: 37738475 DOI: 10.1093/ecco-jcc/jjad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Affiliation(s)
- Bruno Bonaz
- Université Grenoble Alpes, Service d'Hépato-Gastroentérologie, Grenoble Institut Neurosciences, Grenoble, France
| | - Valérie Sinniger
- Université Grenoble Alpes, Service d'Hépato-Gastroentérologie, Grenoble Institut Neurosciences, Grenoble, France
| |
Collapse
|
6
|
Bonaz B. Non-invasive vagus nerve stimulation: the future of inflammatory bowel disease treatment? Bioelectron Med 2023; 9:26. [PMID: 38017496 PMCID: PMC10685668 DOI: 10.1186/s42234-023-00129-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 11/30/2023] Open
Abstract
The vagus nerve regulates inflammation and cytokine release through the inflammatory reflex. Recent pilot clinical trials using implantable bioelectronic devices have demonstrated the efficacy of vagus nerve stimulation (VNS) in adult patients with inflammatory bowel diseases (IBD) as an alternative to drug treatments. However, the use of non-invasive VNS should be of interest in adults with IBD and even more in pediatric IBD. In this issue of Bioelectronic Medicine, Sahn et al. report that non-invasive transcutaneous auricular VNS attenuated signs and symptoms in a pediatric cohort with mild to moderate IBD thus opening new therapeutic avenues in the management of pediatric but also adult IBD patients.
Collapse
Affiliation(s)
- Bruno Bonaz
- Service d'Hépato-Gastroentérologie, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France.
| |
Collapse
|
7
|
Mylavarapu RV, Kanumuri VV, de Rivero Vaccari JP, Misra A, McMillan DW, Ganzer PD. Importance of timing optimization for closed-loop applications of vagus nerve stimulation. Bioelectron Med 2023; 9:8. [PMID: 37101239 PMCID: PMC10134677 DOI: 10.1186/s42234-023-00110-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023] Open
Abstract
In recent decades, vagus nerve stimulation (VNS) therapy has become widely used for clinical applications including epilepsy, depression, and enhancing the effects of rehabilitation. However, several questions remain regarding optimization of this therapy to maximize clinical outcomes. Although stimulation parameters such as pulse width, amplitude, and frequency are well studied, the timing of stimulation delivery both acutely (with respect to disease events) and chronically (over the timeline of a disease's progression) has generally received less attention. Leveraging such information would provide a framework for the implementation of next generation closed-loop VNS therapies. In this mini-review, we summarize a number of VNS therapies and discuss (1) general timing considerations for these applications and (2) open questions that could lead to further therapy optimization.
Collapse
Affiliation(s)
| | - Vivek V Kanumuri
- Department of Otolaryngology, University of Miami, Miami, FL, USA
| | - Juan Pablo de Rivero Vaccari
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Amrit Misra
- Newton Wellesley Neurology Associates, Newton, MA, USA
| | - David W McMillan
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Patrick D Ganzer
- Department of Biomedical Engineering, University of Miami, Miami, FL, USA.
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA.
| |
Collapse
|
8
|
Huffman WJ, Musselman ED, Pelot NA, Grill WM. Measuring and modeling the effects of vagus nerve stimulation on heart rate and laryngeal muscles. Bioelectron Med 2023; 9:3. [PMID: 36797733 PMCID: PMC9936668 DOI: 10.1186/s42234-023-00107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Reduced heart rate (HR) during vagus nerve stimulation (VNS) is associated with therapy for heart failure, but stimulation frequency and amplitude are limited by patient tolerance. An understanding of physiological responses to parameter adjustments would allow differential control of therapeutic and side effects. To investigate selective modulation of the physiological responses to VNS, we quantified the effects and interactions of parameter selection on two physiological outcomes: one related to therapy (reduced HR) and one related to side effects (laryngeal muscle EMG). METHODS We applied a broad range of stimulation parameters (mean pulse rates (MPR), intra-burst frequencies, and amplitudes) to the vagus nerve of anesthetized mice. We leveraged the in vivo recordings to parameterize and validate computational models of HR and laryngeal muscle activity across amplitudes and temporal patterns of VNS. We constructed a finite element model of excitation of fibers within the mouse cervical vagus nerve. RESULTS HR decreased with increased amplitude, increased MPR, and decreased intra-burst frequency. EMG increased with increased MPR. Preferential HR effects over laryngeal EMG effects required combined adjustments of amplitude and MPR. The model of HR responses highlighted contributions of ganglionic filtering to VNS-evoked changes in HR at high stimulation frequencies. Overlap in activation thresholds between small and large modeled fibers was consistent with the overlap in dynamic ranges of related physiological measures (HR and EMG). CONCLUSION The present study provides insights into physiological responses to VNS required for informed parameter adjustment to modulate selectively therapeutic effects and side effects.
Collapse
Affiliation(s)
- William J. Huffman
- grid.26009.3d0000 0004 1936 7961Department of Biomedical Engineering, Duke University, Fitzpatrick CIEMAS, Box 90281, Room 1427, 101 Science Drive, Durham, NC 27708-0281 USA
| | - Eric D. Musselman
- grid.26009.3d0000 0004 1936 7961Department of Biomedical Engineering, Duke University, Fitzpatrick CIEMAS, Box 90281, Room 1427, 101 Science Drive, Durham, NC 27708-0281 USA
| | - Nicole A. Pelot
- grid.26009.3d0000 0004 1936 7961Department of Biomedical Engineering, Duke University, Fitzpatrick CIEMAS, Box 90281, Room 1427, 101 Science Drive, Durham, NC 27708-0281 USA
| | - Warren M. Grill
- grid.26009.3d0000 0004 1936 7961Department of Biomedical Engineering, Duke University, Fitzpatrick CIEMAS, Box 90281, Room 1427, 101 Science Drive, Durham, NC 27708-0281 USA ,grid.26009.3d0000 0004 1936 7961Department of Electrical and Computer Engineering, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Neurobiology Engineering, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Neurosurgery Engineering, Duke University, Durham, USA
| |
Collapse
|
9
|
Donahue MJ, Ejneby MS, Jakešová M, Caravaca AS, Andersson G, Sahalianov I, Đerek V, Hult H, Olofsson PS, Głowacki ED. Wireless optoelectronic devices for vagus nerve stimulation in mice. J Neural Eng 2022; 19. [PMID: 36356313 DOI: 10.1088/1741-2552/aca1e3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/10/2022] [Indexed: 11/12/2022]
Abstract
Objective.Vagus nerve stimulation (VNS) is a promising approach for the treatment of a wide variety of debilitating conditions, including autoimmune diseases and intractable epilepsy. Much remains to be learned about the molecular mechanisms involved in vagus nerve regulation of organ function. Despite an abundance of well-characterized rodent models of common chronic diseases, currently available technologies are rarely suitable for the required long-term experiments in freely moving animals, particularly experimental mice. Due to challenging anatomical limitations, many relevant experiments require miniaturized, less invasive, and wireless devices for precise stimulation of the vagus nerve and other peripheral nerves of interest. Our objective is to outline possible solutions to this problem by using nongenetic light-based stimulation.Approach.We describe how to design and benchmark new microstimulation devices that are based on transcutaneous photovoltaic stimulation. The approach is to use wired multielectrode cuffs to test different stimulation patterns, and then build photovoltaic stimulators to generate the most optimal patterns. We validate stimulation through heart rate analysis.Main results.A range of different stimulation geometries are explored with large differences in performance. Two types of photovoltaic devices are fabricated to deliver stimulation: photocapacitors and photovoltaic flags. The former is simple and more compact, but has limited efficiency. The photovoltaic flag approach is more elaborate, but highly efficient. Both can be used for wireless actuation of the vagus nerve using light impulses.Significance.These approaches can enable studies in small animals that were previously challenging, such as long-termin vivostudies for mapping functional vagus nerve innervation. This new knowledge may have potential to support clinical translation of VNS for treatment of select inflammatory and neurologic diseases.
Collapse
Affiliation(s)
- Mary J Donahue
- Laboratory of Organic Electronics, Campus Norrköping, Linköping University, SE-60174 Norrköping, Sweden
| | - Malin Silverå Ejneby
- Laboratory of Organic Electronics, Campus Norrköping, Linköping University, SE-60174 Norrköping, Sweden.,Wallenberg Centre for Molecular Medicine, Linköping University, SE-58185 Linköping, Sweden
| | - Marie Jakešová
- Bioelectronics Materials and Devices Laboratory, Central European Institute of Technology, Brno University of Technology, Purkyňova 123, 61200 Brno, Czech Republic
| | - April S Caravaca
- Laboratory of Immunobiology, Center for Bioelectronic Medicine, Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Stockholm Center for Bioelectronic Medicine, MedTechLabs, Karolinska University Hospital, Solna, Sweden
| | | | - Ihor Sahalianov
- Bioelectronics Materials and Devices Laboratory, Central European Institute of Technology, Brno University of Technology, Purkyňova 123, 61200 Brno, Czech Republic
| | - Vedran Đerek
- Department of Physics, Faculty of Science, University of Zagreb, Bijenička c. 32, 10000 Zagreb, Croatia
| | - Henrik Hult
- Stockholm Center for Bioelectronic Medicine, MedTechLabs, Karolinska University Hospital, Solna, Sweden.,Department of Mathematics, KTH, 11428 Stockholm, Sweden
| | - Peder S Olofsson
- Laboratory of Immunobiology, Center for Bioelectronic Medicine, Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Stockholm Center for Bioelectronic Medicine, MedTechLabs, Karolinska University Hospital, Solna, Sweden.,Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, United States of America
| | - Eric Daniel Głowacki
- Laboratory of Organic Electronics, Campus Norrköping, Linköping University, SE-60174 Norrköping, Sweden.,Bioelectronics Materials and Devices Laboratory, Central European Institute of Technology, Brno University of Technology, Purkyňova 123, 61200 Brno, Czech Republic
| |
Collapse
|
10
|
Uehara L, Corrêa JCF, Ritti R, Leite P, de Faria DRG, Pacheco-Barrios K, Castelo-Branco L, Fregni F, Corrêa FI. Transcutaneous auricular vagus nerve stimulation effects on inflammatory markers and clinical evolution of patients with COVID-19: a pilot randomized clinical trial. Expert Rev Med Devices 2022; 19:915-920. [DOI: 10.1080/17434440.2022.2154147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Laura Uehara
- Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | | | - Raphael Ritti
- Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Paulo Leite
- Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | | | - Kevin Pacheco-Barrios
- Harvard Medical School, Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Mass, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Luis Castelo-Branco
- Harvard Medical School, Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Mass, USA
| | - Felipe Fregni
- Harvard Medical School, Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Mass, USA
| | | |
Collapse
|
11
|
Abiri A, Chau S, James NR, Goshtasbi K, Birkenbeuel JL, Sahyouni R, Edwards R, Djalilian HR, Lin HW. Selective Neural Electrical Stimulation of an Injured Facial Nerve Using Chronically Implanted Dual Cuff Electrodes. Brain Sci 2022; 12:brainsci12111457. [PMID: 36358383 PMCID: PMC9688741 DOI: 10.3390/brainsci12111457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 02/08/2023] Open
Abstract
Facial nerve (FN) injury can lead to debilitating and permanent facial paresis/paralysis (FP), where facial muscles progressively lose tone, atrophy, and ultimately reduce to scar tissue. Despite considerable efforts in the recent decades, therapies for FP still possess high failure rates and provide inadequate recovery of muscle function. In this pilot study, we used a feline model to demonstrate the potential for chronically implanted multichannel dual-cuff electrodes (MCE) to selectively stimulate injured facial nerves at low current intensities to avoid stimulus-induced neural injury. Selective facial muscle activation was achieved over six months after FN injury and MCE implantation in two domestic shorthaired cats (Felis catus). Through utilization of bipolar stimulation, specific muscles were activated at significantly lower electrical currents than was achievable with single channel stimulation. Moreover, interval increases in subthreshold current intensities using bipolar stimulation enabled a graded EMG voltage response while maintaining muscle selectivity. Histological examination of neural tissue at implant sites showed no appreciable signs of stimulation-induced nerve injury. Thus, by selectively activating facial musculature six months following initial FN injury and MCE implantation, we demonstrated the potential for our neural stimulator system to be safely and effectively applied to the chronic setting, with implications for FP treatment.
Collapse
Affiliation(s)
- Arash Abiri
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Steven Chau
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Nathan R. James
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Jack L. Birkenbeuel
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Ronald Sahyouni
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Robert Edwards
- Department of Pathology and Laboratory Medicine, University of California, Irvine School of Medicine, Irvine, CA 92617, USA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA
| | - Harrison W. Lin
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine Medical Center, Orange, CA 92868, USA
- Correspondence: ; Tel.: +1-(714)-456-5753; Fax: +1-(714)-456-5747
| |
Collapse
|
12
|
Katayama PL, Leirão IP, Kanashiro A, Menani JV, Zoccal DB, Colombari DSA, Colombari E. The carotid body: A novel key player in neuroimmune interactions. Front Immunol 2022; 13:1033774. [PMID: 36389846 PMCID: PMC9644854 DOI: 10.3389/fimmu.2022.1033774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
The idea that the nervous system communicates with the immune system to regulate physiological and pathological processes is not new. However, there is still much to learn about how these interactions occur under different conditions. The carotid body (CB) is a sensory organ located in the neck, classically known as the primary sensor of the oxygen (O2) levels in the organism of mammals. When the partial pressure of O2 in the arterial blood falls, the CB alerts the brain which coordinates cardiorespiratory responses to ensure adequate O2 supply to all tissues and organs in the body. A growing body of evidence, however, has demonstrated that the CB is much more than an O2 sensor. Actually, the CB is a multimodal sensor with the extraordinary ability to detect a wide diversity of circulating molecules in the arterial blood, including inflammatory mediators. In this review, we introduce the literature supporting the role of the CB as a critical component of neuroimmune interactions. Based on ours and other studies, we propose a novel neuroimmune pathway in which the CB acts as a sensor of circulating inflammatory mediators and, in conditions of systemic inflammation, recruits a sympathetic-mediated counteracting mechanism that appears to be a protective response.
Collapse
Affiliation(s)
- Pedro L. Katayama
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Isabela P. Leirão
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Alexandre Kanashiro
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José V. Menani
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Daniel B. Zoccal
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Débora S. A. Colombari
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| | - Eduardo Colombari
- Department of Physiology and Pathology, School of Dentistry, São Paulo State University, Araraquara, São Paulo, Brazil
| |
Collapse
|
13
|
Maharjan A, Khwaounjoo P, Peng M, Cakmak YO. Non-contact neuromodulation of the human autonomic nervous system function via different odors: Sex, menstrual cycle, and odor dose- and duration-specific effects. Front Neurosci 2022; 16:950282. [PMID: 36312014 PMCID: PMC9596915 DOI: 10.3389/fnins.2022.950282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022] Open
Abstract
In recent decades, it has been uncovered that the autonomic nervous system (ANS) can be influenced using non-contact neuromodulation via odor stimulation. Increasing parasympathetic-vagal activation of the ANS is integral to improving the sympathovagal balance between the sympathetic- and parasympathetic nervous systems, which is often imbalanced in several chronic inflammatory disorders, such as rheumatoid arthritis and inflammatory bowel diseases. Although research into olfactory stimulation has been observed on the ANS, it is still lacking in the exploration of odor concentration and odor-specific effects. This is particularly the case as research has not utilized specified tools, such as the olfactometer to provide precise odor delivery. Furthermore, no research has compared the results in separate sex cohorts to investigate the role of sex or the menstrual stage on the subsequent interactions. In this study, we investigated the olfactory stimulation effects of four natural odors (mushroom, lavender, jasmine, and rose) in three concentrations (low, moderate, and high) on the ANS. To observe activity from the ANS, we used an electrocardiogram (ECG) based heart rate variability (HRV) and eye-tracker technology (pupil diameter). We found for the first time in literature that there were acute dose- and duration-specific odor effects of odors on the ANS. We also found sex and menstrual cycle effects in this interaction. Furthermore, there were stark distinctions in sympathovagal activity dependent ANS activation (HRV) in comparison to the oculomotor nerve-parasympathetic/cervical sympathetic nerves dependent ANS responses (pupil diameter). Sympathovagal activity dependent HRV showed odor, sex, and menstrual-stage interactions in both divisions of the ANS while the pupil responses only indicated increased sympathetic activation. These results shed light on the use of odor-specific stimulation to modulate the ANS activity in the context of sex and the menstrual stage. Future studies should be performed using a chronic odor delivery design to investigate the long-term effects of odors on the ANS.
Collapse
Affiliation(s)
- Ashim Maharjan
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Prashanna Khwaounjoo
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Medical Technologies Centre of Research Excellence, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Mei Peng
- Sensory Neuroscience Laboratory, Department of Food Science, University of Otago, Dunedin, New Zealand
| | - Yusuf Ozgur Cakmak
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
- Medical Technologies Centre of Research Excellence, Auckland, New Zealand
- Brain Health Research Centre, Dunedin, New Zealand
- Centre for Bioengineering and Nanotechnology, Point of Care Technologies, University of Otago, Dunedin, New Zealand
- *Correspondence: Yusuf Ozgur Cakmak,
| |
Collapse
|
14
|
Tarasenko A, Guazzotti S, Minot T, Oganesyan M, Vysokov N. Determination of the Effects of Transcutaneous Auricular Vagus Nerve Stimulation on the Heart Rate Variability Using a Machine Learning Pipeline. Bioelectricity 2022; 4:168-177. [PMID: 36168512 PMCID: PMC9508455 DOI: 10.1089/bioe.2021.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background We are all aware of day-to-day healthy stress, but, when sustained for long periods, stress is believed to lead to serious physical and mental health issues. Materials and Methods In this study, we investigated the potential effects of transcutaneous auricular vagus nerve stimulation (taVNS) on stress processing as reflected in the electrocardiogram (ECG)-derived biomarkers of stress adaptability. Stress reflecting biomarkers included a range of heart rate variability metrics: standard deviation of N-N intervals (SDNN), root mean squared of successive differences in heartbeat intervals (RMSSD), low-frequency component, high-frequency component and their ratio (LF, HF, and LF/HF).In addition, we created a machine learning model capable of distinguishing between the stimulated and nonstimulated conditions from the ECG-derive data from various subjects and states. The model consisted of a deep convolutional neural network, which was trained on R-R interval (RRI) data extracted from ECG and time traces of LF, HF, LF/HF, SDNN, and RMSSD. Results Only LF/HF ratio demonstrated a statistically significant change in response to stimulation. Although the LF/HF ratio is expected to increase during exposure to stress, we have observed that stimulation during exposure to stress counteracts this increase or even reduces the LF/HF ratio. This could be an indication that the vagus nerve stimulation decreases the sympathetic activation during stress inducement.Our Machine Learning model achieved an accuracy of 70% with no significant variations across the three states (baseline, stress, and recovery). However, training an analogous neural network to identify the states (baseline, stress, and recovery) proved to be unsuccessful. Conclusion Overall, in this study, we showed further evidence of the beneficial effect of taVNS on stress processing. Importantly we have also demonstrated the promising potential of ECG metrics as a biomarker for the development of closed-loop stimulation systems.
Collapse
Affiliation(s)
| | - Stefano Guazzotti
- BrainPatch Ltd., London, United Kingdom.,School of Physics and CRANN Institute, Trinity College Dublin, Dublin, Ireland
| | | | | | - Nickolai Vysokov
- BrainPatch Ltd., London, United Kingdom.,Address correspondence to: Nickolai Vysokov, PhD, BrainPatch Ltd., Unit 324, Edinburgh House, 170 Kennington Lane, London SE11 5DP, United Kingdom
| |
Collapse
|
15
|
Eller OC, Willits AB, Young EE, Baumbauer KM. Pharmacological and non-pharmacological therapeutic interventions for the treatment of spinal cord injury-induced pain. FRONTIERS IN PAIN RESEARCH 2022; 3:991736. [PMID: 36093389 PMCID: PMC9448954 DOI: 10.3389/fpain.2022.991736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022] Open
Abstract
Spinal cord injury (SCI) is a complex neurophysiological disorder, which can result in many long-term complications including changes in mobility, bowel and bladder function, cardiovascular function, and metabolism. In addition, most individuals with SCI experience some form of chronic pain, with one-third of these individuals rating their pain as severe and unrelenting. SCI-induced chronic pain is considered to be "high impact" and broadly affects a number of outcome measures, including daily activity, physical and cognitive function, mood, sleep, and overall quality of life. The majority of SCI pain patients suffer from pain that emanates from regions located below the level of injury. This pain is often rated as the most severe and the underlying mechanisms involve injury-induced plasticity along the entire neuraxis and within the peripheral nervous system. Unfortunately, current therapies for SCI-induced chronic pain lack universal efficacy. Pharmacological treatments, such as opioids, anticonvulsants, and antidepressants, have been shown to have limited success in promoting pain relief. In addition, these treatments are accompanied by many adverse events and safety issues that compound existing functional deficits in the spinally injured, such as gastrointestinal motility and respiration. Non-pharmacological treatments are safer alternatives that can be specifically tailored to the individual and used in tandem with pharmacological therapies if needed. This review describes existing non-pharmacological therapies that have been used to treat SCI-induced pain in both preclinical models and clinical populations. These include physical (i.e., exercise, acupuncture, and hyper- or hypothermia treatments), psychological (i.e., meditation and cognitive behavioral therapy), and dietary interventions (i.e., ketogenic and anti-inflammatory diet). Findings on the effectiveness of these interventions in reducing SCI-induced pain and improving quality of life are discussed. Overall, although studies suggest non-pharmacological treatments could be beneficial in reducing SCI-induced chronic pain, further research is needed. Additionally, because chronic pain, including SCI pain, is complex and has both emotional and physiological components, treatment should be multidisciplinary in nature and ideally tailored specifically to the patient.
Collapse
Affiliation(s)
- Olivia C. Eller
- Department of Cell Biology and Physiology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Adam B. Willits
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Erin E. Young
- Department of Cell Biology and Physiology, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Kyle M. Baumbauer
- Department of Cell Biology and Physiology, University of Kansas Medical Center, Kansas City, KS, United States
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, United States
| |
Collapse
|
16
|
Bloom O, Tracey KJ, Pavlov VA. Exploring the vagus nerve and the inflammatory reflex for therapeutic benefit in chronic spinal cord injury. Curr Opin Neurol 2022; 35:249-257. [PMID: 35102123 PMCID: PMC9258775 DOI: 10.1097/wco.0000000000001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe features and implications of chronic systemic inflammation in individuals with spinal cord injury (SCI) and to summarize the growing therapeutic possibilities to explore the vagus nerve-mediated inflammatory reflex in this context. RECENT FINDINGS The discovery of the inflammatory reflex provides a rationale to explore neuromodulation modalities, that is, electrical vagus nerve stimulation and pharmacological cholinergic modalities to regulate inflammation after SCI. SUMMARY Inflammation in individuals with SCI may negatively impact functional recovery and medical consequences after SCI. Exploring the potential of the vagus nerve-based inflammatory reflex to restore autonomic regulation and control inflammation may provide a novel approach for functional improvement in SCI.
Collapse
Affiliation(s)
- Ona Bloom
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset
- Donald and Barbara Zucker School of Medicine, Hempstead, New York, USA
| | - Kevin J. Tracey
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset
- Donald and Barbara Zucker School of Medicine, Hempstead, New York, USA
| | - Valentin A. Pavlov
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset
- Donald and Barbara Zucker School of Medicine, Hempstead, New York, USA
| |
Collapse
|
17
|
Wright JP, Mughrabi IT, Wong J, Mathew J, Jayaprakash N, Crosfield C, Chang EH, Chavan SS, Tracey KJ, Pavlov VA, Al-Abed Y, Zanos TP, Zanos S, Datta-Chaudhuri T. A fully implantable wireless bidirectional neuromodulation system for mice. Biosens Bioelectron 2022; 200:113886. [PMID: 34995836 PMCID: PMC9258776 DOI: 10.1016/j.bios.2021.113886] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 01/09/2023]
Abstract
Novel research in the field of bioelectronic medicine requires neuromodulation systems that pair high-performance neurostimulation and bio-signal acquisition hardware with advanced signal processing and control algorithms. Although mice are the most commonly used animal in medical research, the size, weight, and power requirements of such bioelectronic systems either preclude use in mice or impose significant constraints on experimental design. Here, a fully-implantable recording and stimulation neuromodulation system suitable for use in mice is presented, measuring 2.2 cm3 and weighing 2.8 g. The bidirectional wireless interface allows simultaneous readout of multiple physiological signals and complete control over stimulation parameters, and a wirelessly rechargeable battery provides a lifetime of up to 5 days on a single charge. The device was implanted to deliver vagus nerve stimulation (n = 12 animals) and a functional neural interface (capable of inducing acute bradycardia) was demonstrated with lifetimes exceeding three weeks. The design utilizes only commercially-available electrical components and 3D-printed packaging, with the goal of facilitating widespread adoption and accelerating discovery and translation of future bioelectronic therapeutics.
Collapse
Affiliation(s)
- Jason P Wright
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Ibrahim T Mughrabi
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Jason Wong
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Jose Mathew
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Naveen Jayaprakash
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Christine Crosfield
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Eric H Chang
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Sangeeta S Chavan
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Valentin A Pavlov
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, United States.
| |
Collapse
|
18
|
Hamid ARRH, Maliawan S, Samatra DPGP, Astawa NM, Bakta IM, Jawi IM, Manuaba IBP, Sukrama IMD, Perdanakusuma DS. Effect of immediate electrical stimulation in the distal segment of the nerve with Wallerian degeneration in rats with sciatic nerve injury. MEDICAL JOURNAL OF INDONESIA 2022. [DOI: 10.13181/mji.oa.225870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Electrical stimulation in the proximal segment is one of the modalities for peripheral nerve injury, although it is prone to cause excessive axonal sprouting growth in the proximal segment of the nerve. This study aimed to show that immediate electrical stimulation in the distal segment of the sciatic nerve in Wistar rats accelerated Wallerian degeneration by increasing the expression of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-10, and galectin-3/MAC-2 macrophages to avoid sprouting axons excessively in the proximal segment.
METHODS This was an experimental study using male Wistar rats (Rattus norvegicus) with a randomized post-test only control group design. The treatment group received immediate electrical stimulation (20 Hz, 2 mA, for 5 sec) to the distal nerve after sciatic nerve injury, while the control group received no treatment. After 3 days, tissue samples were extracted from the distal segment of the sciatic nerve to examine the level of TNF-α, IL-10, and galectin 3/Mac-2 macrophages using ELISA and from proximal nerves to histologically examine the sprouting axons.
RESULTS Rats in the treatment group had higher TNF-α (52.1 [10.32] versus 40.4 [17.71] pg/100 mg, p = 0.031) and higher IL-10 (918 [167.6] versus 759 [158.9] pg/ml, p = 0.010). Expression of galectin 3/Mac-2 macrophages was similar in both groups (465 [49.5] versus 444 [54.4] pg/100 mg, p = 0.247). The number of sprouting axons was lower in the treatment group (2 [IQR 1–2] versus 2.5 [IQR 2–3], p = 0.003).
CONCLUSIONS Immediate electrical stimulation in the distal segment of the sciatic nerve can accelerate nerve regeneration.
Collapse
|
19
|
Farhat K, Stavrakis S. Identification of nexus points within the cardiac neuraxis: a sine qua non of neuromodulation therapies. Heart Rhythm 2022; 19:984-985. [DOI: 10.1016/j.hrthm.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/04/2022]
|
20
|
Go YY, Ju WM, Lee CM, Chae SW, Song JJ. Different Transcutaneous Auricular Vagus Nerve Stimulation Parameters Modulate the Anti-Inflammatory Effects on Lipopolysaccharide-Induced Acute Inflammation in Mice. Biomedicines 2022; 10:biomedicines10020247. [PMID: 35203459 PMCID: PMC8869637 DOI: 10.3390/biomedicines10020247] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Vagus nerve stimulation (VNS) is considered a potential method for anti-inflammation due to the involvement of the VN in the cholinergic anti-inflammatory pathway (CAP) formation of a connection between the central nervous system and peripheral immune cells that help relieve inflammation. However, whether a non-invasive transcutaneous auricular VNS (taVNS) modulates the inflammation levels via altering the parameter of taVNS is poorly understood. This study aimed to determine the differential inhibitory effects of taVNS on lipopolysaccharide (LPS)-induced systemic inflammation using electrical stimulation parameters such as pulse frequency and time. The taVNS-promoted CAP activity significantly recovered LPS-induced tissue injuries (lung, spleen, and intestine) and decreased inflammatory cytokine levels and tissue-infiltrated immune cells. Interestingly, the anti-inflammatory capacity of taVNS with 15 Hz was much higher than that of taVNS with 25 Hz. When a cytokine array was used to investigate the changes of inflammation and immune response-related cytokines/chemokines expression in taVNS with 15 Hz or 25 Hz treatment in LPS-induced endotoxemia in mice, most of the expression of cytokines/chemokines associated with pro-inflammation was severely decreased in taVNS with 15 Hz compared to 25 Hz. This study demonstrated that the taVNS parameter could differentially modulate the inflammation levels of animals, suggesting the importance of taVNS parameter selection for use in feasible interventions for acute inflammation treatment.
Collapse
Affiliation(s)
- Yoon-Young Go
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 08308, Korea; (Y.-Y.G.); (W.-M.J.); (C.-M.L.); (S.-W.C.)
- Institute for Health Care Convergence Center, Korea University Guro Hospital, Seoul 08308, Korea
| | - Won-Min Ju
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 08308, Korea; (Y.-Y.G.); (W.-M.J.); (C.-M.L.); (S.-W.C.)
| | - Chan-Mi Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 08308, Korea; (Y.-Y.G.); (W.-M.J.); (C.-M.L.); (S.-W.C.)
| | - Sung-Won Chae
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 08308, Korea; (Y.-Y.G.); (W.-M.J.); (C.-M.L.); (S.-W.C.)
- Institute for Health Care Convergence Center, Korea University Guro Hospital, Seoul 08308, Korea
| | - Jae-Jun Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 08308, Korea; (Y.-Y.G.); (W.-M.J.); (C.-M.L.); (S.-W.C.)
- Institute for Health Care Convergence Center, Korea University Guro Hospital, Seoul 08308, Korea
- Neurive Institute, Neurive Co., Ltd., Seoul 08308, Korea
- Correspondence: or ; Tel.: +82-2-2626-3186; Fax: +82-2-2626-0475
| |
Collapse
|
21
|
Veiz E, Kieslich SK, Czesnik D, Herrmann-Lingen C, Meyer T, Staab J. Increased Concentrations of Circulating Interleukins following Non-Invasive Vagus Nerve Stimulation: Results from a Randomized, Sham-Controlled, Crossover Study in Healthy Subjects. Neuroimmunomodulation 2022; 29:450-459. [PMID: 35576915 DOI: 10.1159/000524646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/15/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The vagus nerve constitutes the main component of the parasympathetic nervous system and plays an important role in the regulation of neuro-immune responses. Invasive stimulation of the vagus nerve produces anti-inflammatory effects; however, data on humoral immune responses of transcutaneous vagus nerve stimulation (tVNS) are rare. Therefore, the present study investigated changes in serum cytokine concentrations of interleukin-1β (IL-1β), IL-6, IL-8, and tumor necrosis factor α (TNFα) following a short-term, non-invasive stimulation of the vagus nerve. METHODS Whole blood samples were collected before and after a short-lived application of active tVNS at the inner tragus as well as sham stimulation of the earlobe. Cytokine serum concentrations were determined in two healthy cohorts of younger (n = 20) and older participants (n = 19). Differences between active and sham conditions were analyzed using linear mixed models and post hoc F tests after applying Yeo-Johnson power transformations. This trial was part of a larger study registered on ClinicalTrials.gov (NCT05007743). RESULTS In the young cohort, IL-6 and IL-1β concentrations were significantly increased after active stimulation, whereas they were slightly decreased after sham stimulation (IL-6: p = 0.012; IL-1β: p = 0.012). Likewise, in the older cohort, IL-1β and IL-8 concentrations were significantly elevated after active stimulation and reduced after sham application (IL-8: p = 0.007; IL-1β: p = 0.001). In contrast, circulating TNFα concentrations did not change significantly in either group. CONCLUSION Our results show that active tVNS led to an immediate increase in the serum concentrations of certain pro-inflammatory cytokines such as IL-1β, IL-6, and/or IL-8 in two independent cohorts of healthy study participants.
Collapse
Affiliation(s)
- Elisabeth Veiz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Göttingen, Germany
- Department of Neurology, University Medical Centre, Göttingen, Germany
| | - Susann-Kristin Kieslich
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Göttingen, Germany
| | - Dirk Czesnik
- Department of Neurology, University Medical Centre, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Göttingen, Germany,
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany,
| | - Julia Staab
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| |
Collapse
|
22
|
Ramos-Martínez IE, Rodríguez MC, Cerbón M, Ramos-Martínez JC, Ramos-Martínez EG. Role of the Cholinergic Anti-Inflammatory Reflex in Central Nervous System Diseases. Int J Mol Sci 2021; 22:ijms222413427. [PMID: 34948222 PMCID: PMC8705572 DOI: 10.3390/ijms222413427] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022] Open
Abstract
In several central nervous system diseases, it has been reported that inflammation may be related to the etiologic process, therefore, therapeutic strategies are being implemented to control inflammation. As the nervous system and the immune system maintain close bidirectional communication in physiological and pathological conditions, the modulation of inflammation through the cholinergic anti-inflammatory reflex has been proposed. In this review, we summarized the evidence supporting chemical stimulation with cholinergic agonists and vagus nerve stimulation as therapeutic strategies in the treatment of various central nervous system pathologies, and their effect on inflammation.
Collapse
Affiliation(s)
- Ivan Emmanuel Ramos-Martínez
- Glycobiology, Cell Growth and Tissue Repair Research Unit (Gly-CRRET), Université Paris Est Créteil (UPEC), 94010 Créteil, France;
| | - María Carmen Rodríguez
- Centro de Investigación Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, SSA, Morelos 62100, Mexico;
| | - Marco Cerbón
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
- Correspondence: (M.C.); (E.G.R.-M.)
| | - Juan Carlos Ramos-Martínez
- Cardiology Department, Hospital General Regional Lic. Ignacio Garcia Tellez IMSS, Yucatán 97150, Mexico;
| | - Edgar Gustavo Ramos-Martínez
- Escuela de Ciencias, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca 68120, Mexico
- Instituto de Cómputo Aplicado en Ciencias, Oaxaca 68044, Mexico
- Correspondence: (M.C.); (E.G.R.-M.)
| |
Collapse
|
23
|
Tarnawski L, Olofsson PS. Inflammation neuroscience: neuro-immune crosstalk and interfaces. Clin Transl Immunology 2021; 10:e1352. [PMID: 34754449 PMCID: PMC8558388 DOI: 10.1002/cti2.1352] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/01/2021] [Accepted: 10/10/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammation is a key process in antimicrobial defence and tissue repair, and failure to properly regulate inflammation can result in tissue damage and death. Neural circuits play important roles throughout the course of an inflammatory response, and the neurophysiological and molecular mechanisms are only partly understood. Here, we review key evidence for the neural regulation of inflammation and discuss emerging technologies to further map and harness this neurophysiology, a cornerstone in the rapidly evolving field of inflammation neuroscience.
Collapse
Affiliation(s)
- Laura Tarnawski
- Laboratory of ImmunobiologyDivision of Cardiovascular MedicineDepartment of Medicine, SolnaKarolinska InstitutetStockholmSweden
- Stockholm Center for Bioelectronic MedicineMedTechLabsBioclinicumKarolinska University HospitalSolnaSweden
| | - Peder S Olofsson
- Laboratory of ImmunobiologyDivision of Cardiovascular MedicineDepartment of Medicine, SolnaKarolinska InstitutetStockholmSweden
- Stockholm Center for Bioelectronic MedicineMedTechLabsBioclinicumKarolinska University HospitalSolnaSweden
- Institute of Bioelectronic MedicineFeinstein Institutes for Medical ResearchManhassetNYUSA
| |
Collapse
|
24
|
Carnevale L, Perrotta M, Lembo G. A Focused Review of Neural Recording and Stimulation Techniques With Immune-Modulatory Targets. Front Immunol 2021; 12:689344. [PMID: 34646261 PMCID: PMC8502970 DOI: 10.3389/fimmu.2021.689344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022] Open
Abstract
The complex interactions established between the nervous and immune systems have been investigated for a long time. With the advent of small and portable devices to record and stimulate nerve activity, researchers from many fields began to be interested in how nervous activity can elicit immune responses and whether this activity can be manipulated to trigger specific immune responses. Pioneering works demonstrated the existence of a cholinergic inflammatory reflex, capable of controlling the systemic inflammatory response through a vagus nerve-mediated modulation of the spleen. This work inspired many different areas of technological and conceptual advancement, which are here reviewed to provide a concise reference for the main works expanding the knowledge on vagus nerve immune-modulatory capabilities. In these works the enabling technologies of peripheral nervous activity recordings were implemented and embody the current efforts aimed at controlling neural activity with modulating functions in immune response, both in experimental and clinical contexts.
Collapse
Affiliation(s)
- Lorenzo Carnevale
- Research Unit of Neuro and Cardiovascular Pathophysiology, IRCCS Neuromed, Department of Angiocardioneurology and Translational Medicine, Pozzilli (IS), Italy
| | - Marialuisa Perrotta
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Lembo
- Research Unit of Neuro and Cardiovascular Pathophysiology, IRCCS Neuromed, Department of Angiocardioneurology and Translational Medicine, Pozzilli (IS), Italy.,Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
25
|
Gonzalez-Gonzalez MA, Bendale GS, Wang K, Wallace GG, Romero-Ortega M. Platinized graphene fiber electrodes uncover direct spleen-vagus communication. Commun Biol 2021; 4:1097. [PMID: 34535751 PMCID: PMC8448843 DOI: 10.1038/s42003-021-02628-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/30/2021] [Indexed: 11/21/2022] Open
Abstract
Neural interfacing nerve fascicles along the splenic neurovascular plexus (SNVP) is needed to better understand the spleen physiology, and for selective neuromodulation of this major organ. However, their small size and anatomical location have proven to be a significant challenge. Here, we use a reduced liquid crystalline graphene oxide (rGO) fiber coated with platinum (Pt) as a super-flexible suture-like electrode to interface multiple SNVP. The Pt-rGO fibers work as a handover knot electrodes over the small SNVP, allowing sensitive recording from four splenic nerve terminal branches (SN 1–4), to uncover differential activity and axon composition among them. Here, the asymmetric defasciculation of the SN branches is revealed by electron microscopy, and the functional compartmentalization in spleen innervation is evidenced in response to hypoxia and pharmacological modulation of mean arterial pressure. We demonstrate that electrical stimulation of cervical and sub-diaphragmatic vagus nerve (VN), evokes activity in a subset of SN terminal branches, providing evidence for a direct VN control over the spleen. This notion is supported by adenoviral tract-tracing of SN branches, revealing an unconventional direct brain-spleen projection. High-performance Pt-rGO fiber electrodes, may be used for the fine neural modulation of other small neurovascular plexus at the point of entry of major organs as a bioelectronic medical alternative. Gonzalez-Gonzalez et al. use high-performance platinized graphene fiber electrodes to interface individual neurovascular plexus that innervate the spleen. Their approach provides evidence for distinct function of individual spleen terminal branches in organ function.
Collapse
Affiliation(s)
- Maria A Gonzalez-Gonzalez
- Biomedical Engineering and Biomedical Sciences, University of Houston, Health 2, 4849 Calhoun Rd., Room 6014, Houston, TX, 77204-6064, USA
| | - Geetanjali S Bendale
- Biomedical Engineering and Biomedical Sciences, University of Houston, Health 2, 4849 Calhoun Rd., Room 6014, Houston, TX, 77204-6064, USA
| | - Kezhong Wang
- Intelligent Polymer Research Institute, ARC Centre of Excellence for Electromaterials Science, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Gordon G Wallace
- Intelligent Polymer Research Institute, ARC Centre of Excellence for Electromaterials Science, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Mario Romero-Ortega
- Biomedical Engineering and Biomedical Sciences, University of Houston, Health 2, 4849 Calhoun Rd., Room 6014, Houston, TX, 77204-6064, USA.
| |
Collapse
|
26
|
Falvey A, Metz CN, Tracey KJ, Pavlov VA. Peripheral nerve stimulation and immunity: the expanding opportunities for providing mechanistic insight and therapeutic intervention. Int Immunol 2021; 34:107-118. [PMID: 34498051 DOI: 10.1093/intimm/dxab068] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/07/2021] [Indexed: 12/29/2022] Open
Abstract
Pre-clinical research advances our understanding of the vagus nerve-mediated regulation of immunity and clinical trials successfully utilize electrical vagus nerve stimulation in the treatment of patients with inflammatory disorders. This symbiotic relationship between pre-clinical and clinical research exploring the vagus nerve-based 'inflammatory reflex' has substantially contributed to establishing the field of bioelectronic medicine. Recent studies identify a crosstalk between the vagus nerve and other neural circuitries in controlling inflammation and delineate new neural immunoregulatory pathways. Here we outline current mechanistic insights into the role of vagal and non-vagal neural pathways in neuro-immune communication and inflammatory regulation. We also provide a timely overview of expanding opportunities for bioelectronic neuromodulation in the treatment of various inflammatory disorders.
Collapse
Affiliation(s)
- Aidan Falvey
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, United States
| | - Christine N Metz
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, United States.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, United States
| | - Kevin J Tracey
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, United States.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, United States
| | - Valentin A Pavlov
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, United States.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, United States
| |
Collapse
|
27
|
Datta-Chaudhuri T. Closed-loop neuromodulation will increase the utility of mouse models in Bioelectronic Medicine. Bioelectron Med 2021; 7:10. [PMID: 34193309 PMCID: PMC8244222 DOI: 10.1186/s42234-021-00071-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/01/2021] [Indexed: 01/16/2023] Open
Abstract
Mouse models have been of tremendous benefit to medical science for the better part of a century, yet bioelectronic medicine research using mice has been limited to mostly acute studies because of a lack of tools for chronic stimulation and sensing. A wireless neuromodulation platform small enough for implantation in mice will significantly increase the utility of mouse models in bioelectronic medicine. This perspective examines the necessary functionality of such a system and the technical challenges needed to be overcome for its development. Recent progress is examined and the outlook for the future of implantable devices for mice is discussed.
Collapse
Affiliation(s)
- Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA. .,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra University, Hempstead, NY, 11549, USA.
| |
Collapse
|
28
|
Mampay M, Flint MS, Sheridan GK. Tumour brain: Pretreatment cognitive and affective disorders caused by peripheral cancers. Br J Pharmacol 2021; 178:3977-3996. [PMID: 34029379 DOI: 10.1111/bph.15571] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/12/2021] [Accepted: 05/05/2021] [Indexed: 12/20/2022] Open
Abstract
People that develop extracranial cancers often display co-morbid neurological disorders, such as anxiety, depression and cognitive impairment, even before commencement of chemotherapy. This suggests bidirectional crosstalk between non-CNS tumours and the brain, which can regulate peripheral tumour growth. However, the reciprocal neurological effects of tumour progression on brain homeostasis are not well understood. Here, we review brain regions involved in regulating peripheral tumour development and how they, in turn, are adversely affected by advancing tumour burden. Tumour-induced activation of the immune system, blood-brain barrier breakdown and chronic neuroinflammation can lead to circadian rhythm dysfunction, sleep disturbances, aberrant glucocorticoid production, decreased hippocampal neurogenesis and dysregulation of neural network activity, resulting in depression and memory impairments. Given that cancer-related cognitive impairment diminishes patient quality of life, reduces adherence to chemotherapy and worsens cancer prognosis, it is essential that more research is focused at understanding how peripheral tumours affect brain homeostasis.
Collapse
Affiliation(s)
- Myrthe Mampay
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Melanie S Flint
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Graham K Sheridan
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| |
Collapse
|
29
|
Mondal B, Choudhury S, Banerjee R, Roy A, Chatterjee K, Basu P, Singh R, Halder S, Shubham S, Baker SN, Baker MR, Kumar H. Non-invasive vagus nerve stimulation improves clinical and molecular biomarkers of Parkinson's disease in patients with freezing of gait. NPJ PARKINSONS DISEASE 2021; 7:46. [PMID: 34045464 PMCID: PMC8160211 DOI: 10.1038/s41531-021-00190-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/21/2021] [Indexed: 12/19/2022]
Abstract
Non-invasive vagus nerve stimulation (nVNS) is an established neurostimulation therapy used in the treatment of epilepsy, migraine and cluster headache. In this randomized, double-blind, sham-controlled crossover trial we explored the role of nVNS in the treatment of gait and other motor symptoms in Parkinson’s disease (PD) patients. In a subgroup of patients, we measured selected neurotrophin levels and markers of inflammation and oxidative stress in serum, before and after the experimental intervention. Thirty-three PD patients with associated freezing of gait were randomised to either nVNS or sham. After baseline assessments, patients were instructed to deliver 6 two-minute stimulations (total 12 min/day) of the nVNS/sham device (electroCore, Inc. USA) for one month at home. Patients were then re-assessed. After a washout period of one month, the same patients were allocated to the alternate treatment arm and the same process was followed. Significant improvements in key gait parameters were observed with nVNS, including walking speed, stance time and step length, compared to sham. Similarly, overall motor function (MDS-UPDRS III) also improved significantly following nVNS stimulation. Serum Tumor Necrosis Factor (TNF)-α and glutathione levels decreased and brain-derived neurotrophic factor (BDNF) levels increased significantly (p < 0.05) after treatment with nVNS. Here we present the first double-blind sham-controlled trial evidence of the efficacy and safety of nVNS in the treatment of gait and motor function in patients with PD.
Collapse
Affiliation(s)
| | | | | | - Akash Roy
- Institute of Neurosciences Kolkata, Kolkata, India
| | | | - Purba Basu
- Institute of Neurosciences Kolkata, Kolkata, India
| | - Ravi Singh
- Institute of Neurosciences Kolkata, Kolkata, India
| | | | | | - Stuart N Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Mark R Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle, UK
| | | |
Collapse
|
30
|
Datta-Chaudhuri T, Zanos T, Chang EH, Olofsson PS, Bickel S, Bouton C, Grande D, Rieth L, Aranow C, Bloom O, Mehta AD, Civillico G, Stevens MM, Głowacki E, Bettinger C, Schüettler M, Puleo C, Rennaker R, Mohanta S, Carnevale D, Conde SV, Bonaz B, Chernoff D, Kapa S, Berggren M, Ludwig K, Zanos S, Miller L, Weber D, Yoshor D, Steinman L, Chavan SS, Pavlov VA, Al-Abed Y, Tracey KJ. The Fourth Bioelectronic Medicine Summit "Technology Targeting Molecular Mechanisms": current progress, challenges, and charting the future. Bioelectron Med 2021; 7:7. [PMID: 34024277 PMCID: PMC8142479 DOI: 10.1186/s42234-021-00068-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 02/06/2023] Open
Abstract
There is a broad and growing interest in Bioelectronic Medicine, a dynamic field that continues to generate new approaches in disease treatment. The fourth bioelectronic medicine summit "Technology targeting molecular mechanisms" took place on September 23 and 24, 2020. This virtual meeting was hosted by the Feinstein Institutes for Medical Research, Northwell Health. The summit called international attention to Bioelectronic Medicine as a platform for new developments in science, technology, and healthcare. The meeting was an arena for exchanging new ideas and seeding potential collaborations involving teams in academia and industry. The summit provided a forum for leaders in the field to discuss current progress, challenges, and future developments in Bioelectronic Medicine. The main topics discussed at the summit are outlined here.
Collapse
Affiliation(s)
| | - Theodoros Zanos
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Eric H. Chang
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | | | - Stephan Bickel
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Chad Bouton
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Daniel Grande
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Loren Rieth
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
- University of Utah, Salt Lake City, UT USA
| | - Cynthia Aranow
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Ona Bloom
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Ashesh D. Mehta
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | | | | | | | | | | | | | | | - Saroj Mohanta
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
| | - Daniela Carnevale
- Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Silvia V. Conde
- CEDOC, Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Bruno Bonaz
- University of Grenoble Alpes, INSERM, Grenoble, France
| | | | | | | | - Kip Ludwig
- University of Wisconsin, Madison, WI USA
| | - Stavros Zanos
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Larry Miller
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Doug Weber
- Carnegie Mellon University, Pittsburgh, PA USA
| | | | | | - Sangeeta S. Chavan
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Valentin A. Pavlov
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Yousef Al-Abed
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Kevin J. Tracey
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| |
Collapse
|
31
|
Verma N, Mudge JD, Kasole M, Chen RC, Blanz SL, Trevathan JK, Lovett EG, Williams JC, Ludwig KA. Auricular Vagus Neuromodulation-A Systematic Review on Quality of Evidence and Clinical Effects. Front Neurosci 2021; 15:664740. [PMID: 33994937 PMCID: PMC8120162 DOI: 10.3389/fnins.2021.664740] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background: The auricular branch of the vagus nerve runs superficially, which makes it a favorable target for non-invasive stimulation techniques to modulate vagal activity. For this reason, there have been many early-stage clinical trials on a diverse range of conditions. These trials often report conflicting results for the same indication. Methods: Using the Cochrane Risk of Bias tool we conducted a systematic review of auricular vagus nerve stimulation (aVNS) randomized controlled trials (RCTs) to identify the factors that led to these conflicting results. The majority of aVNS studies were assessed as having "some" or "high" risk of bias, which makes it difficult to interpret their results in a broader context. Results: There is evidence of a modest decrease in heart rate during higher stimulation dosages, sometimes at above the level of sensory discomfort. Findings on heart rate variability conflict between studies and are hindered by trial design, including inappropriate washout periods, and multiple methods used to quantify heart rate variability. There is early-stage evidence to suggest aVNS may reduce circulating levels and endotoxin-induced levels of inflammatory markers. Studies on epilepsy reached primary endpoints similar to previous RCTs testing implantable vagus nerve stimulation therapy. Preliminary evidence shows that aVNS ameliorated pathological pain but not evoked pain. Discussion: Based on results of the Cochrane analysis we list common improvements for the reporting of results, which can be implemented immediately to improve the quality of evidence. In the long term, existing data from aVNS studies and salient lessons from drug development highlight the need for direct measures of local neural target engagement. Direct measures of neural activity around the electrode will provide data for the optimization of electrode design, placement, and stimulation waveform parameters to improve on-target engagement and minimize off-target activation. Furthermore, direct measures of target engagement, along with consistent evaluation of blinding success, must be used to improve the design of controls-a major source of concern identified in the Cochrane analysis. The need for direct measures of neural target engagement and consistent evaluation of blinding success is applicable to the development of other paresthesia-inducing neuromodulation therapies and their control designs.
Collapse
Affiliation(s)
- Nishant Verma
- Department of Biomedical Engineering, University of Wisconsin – Madison, Madison, WI, United States
- Wisconsin Institute for Translational Neuroengineering (WITNe) – Madison, Madison, WI, United States
| | - Jonah D. Mudge
- Department of Biomedical Engineering, University of Wisconsin – Madison, Madison, WI, United States
- Wisconsin Institute for Translational Neuroengineering (WITNe) – Madison, Madison, WI, United States
| | - Maïsha Kasole
- Department of Biomedical Engineering, University of Wisconsin – Madison, Madison, WI, United States
- Wisconsin Institute for Translational Neuroengineering (WITNe) – Madison, Madison, WI, United States
| | - Rex C. Chen
- Department of Biomedical Engineering, University of Wisconsin – Madison, Madison, WI, United States
- Wisconsin Institute for Translational Neuroengineering (WITNe) – Madison, Madison, WI, United States
| | - Stephan L. Blanz
- Department of Biomedical Engineering, University of Wisconsin – Madison, Madison, WI, United States
- Wisconsin Institute for Translational Neuroengineering (WITNe) – Madison, Madison, WI, United States
| | - James K. Trevathan
- Department of Biomedical Engineering, University of Wisconsin – Madison, Madison, WI, United States
- Wisconsin Institute for Translational Neuroengineering (WITNe) – Madison, Madison, WI, United States
| | | | - Justin C. Williams
- Department of Biomedical Engineering, University of Wisconsin – Madison, Madison, WI, United States
- Wisconsin Institute for Translational Neuroengineering (WITNe) – Madison, Madison, WI, United States
- Department of Neurosurgery, University of Wisconsin – Madison, Madison, WI, United States
| | - Kip A. Ludwig
- Department of Biomedical Engineering, University of Wisconsin – Madison, Madison, WI, United States
- Wisconsin Institute for Translational Neuroengineering (WITNe) – Madison, Madison, WI, United States
- Department of Neurosurgery, University of Wisconsin – Madison, Madison, WI, United States
| |
Collapse
|
32
|
Mughrabi IT, Hickman J, Jayaprakash N, Thompson D, Ahmed U, Papadoyannis ES, Chang YC, Abbas A, Datta-Chaudhuri T, Chang EH, Zanos TP, Lee SC, Froemke RC, Tracey KJ, Welle C, Al-Abed Y, Zanos S. Development and characterization of a chronic implant mouse model for vagus nerve stimulation. eLife 2021; 10:e61270. [PMID: 33821789 PMCID: PMC8051950 DOI: 10.7554/elife.61270] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 04/02/2021] [Indexed: 12/17/2022] Open
Abstract
Vagus nerve stimulation (VNS) suppresses inflammation and autoimmune diseases in preclinical and clinical studies. The underlying molecular, neurological, and anatomical mechanisms have been well characterized using acute electrophysiological stimulation of the vagus. However, there are several unanswered mechanistic questions about the effects of chronic VNS, which require solving numerous technical challenges for a long-term interface with the vagus in mice. Here, we describe a scalable model for long-term VNS in mice developed and validated in four research laboratories. We observed significant heart rate responses for at least 4 weeks in 60-90% of animals. Device implantation did not impair vagus-mediated reflexes. VNS using this implant significantly suppressed TNF levels in endotoxemia. Histological examination of implanted nerves revealed fibrotic encapsulation without axonal pathology. This model may be useful to study the physiology of the vagus and provides a tool to systematically investigate long-term VNS as therapy for chronic diseases modeled in mice.
Collapse
Affiliation(s)
- Ibrahim T Mughrabi
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Jordan Hickman
- Departments of Neurosurgery, University of Colorado Anschutz Medical CampusAuroraUnited States
- Department of Physiology and Biophysics, University of Colorado Anschutz Medical CampusAuroraUnited States
| | - Naveen Jayaprakash
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Dane Thompson
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
- The Elmezzi Graduate School of Molecular MedicineManhassetUnited States
| | - Umair Ahmed
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Eleni S Papadoyannis
- Skirball Institute for Biomolecular Medicine, New York University School of Medicine, New York UniversityNew YorkUnited States
- Department of Neuroscience and Physiology, Neuroscience Institute, Center for Neural Science, New York University School of Medicine, New York UniversityNew YorkUnited States
- Department of Otolaryngology, New York University School of Medicine, New York UniversityNew YorkUnited States
- Howard Hughes Medical Institute Faculty Scholar, New York University School of Medicine, New York UniversityNew YorkUnited States
| | - Yao-Chuan Chang
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Adam Abbas
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Eric H Chang
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Sunhee C Lee
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Robert C Froemke
- Skirball Institute for Biomolecular Medicine, New York University School of Medicine, New York UniversityNew YorkUnited States
- Department of Neuroscience and Physiology, Neuroscience Institute, Center for Neural Science, New York University School of Medicine, New York UniversityNew YorkUnited States
- Department of Otolaryngology, New York University School of Medicine, New York UniversityNew YorkUnited States
- Howard Hughes Medical Institute Faculty Scholar, New York University School of Medicine, New York UniversityNew YorkUnited States
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Cristin Welle
- Departments of Neurosurgery, University of Colorado Anschutz Medical CampusAuroraUnited States
- Department of Physiology and Biophysics, University of Colorado Anschutz Medical CampusAuroraUnited States
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| |
Collapse
|
33
|
Bonaz B, Sinniger V, Pellissier S. Therapeutic Potential of Vagus Nerve Stimulation for Inflammatory Bowel Diseases. Front Neurosci 2021; 15:650971. [PMID: 33828455 PMCID: PMC8019822 DOI: 10.3389/fnins.2021.650971] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
The vagus nerve is a mixed nerve, comprising 80% afferent fibers and 20% efferent fibers. It allows a bidirectional communication between the central nervous system and the digestive tract. It has a dual anti-inflammatory properties via activation of the hypothalamic pituitary adrenal axis, by its afferents, but also through a vago-vagal inflammatory reflex involving an afferent (vagal) and an efferent (vagal) arm, called the cholinergic anti-inflammatory pathway. Indeed, the release of acetylcholine at the end of its efferent fibers is able to inhibit the release of tumor necrosis factor (TNF) alpha by macrophages via an interneuron of the enteric nervous system synapsing between the efferent vagal endings and the macrophages and releasing acetylcholine. The vagus nerve also synapses with the splenic sympathetic nerve to inhibit the release of TNF-alpha by splenic macrophages. It can also activate the spinal sympathetic system after central integration of its afferents. This anti-TNF-alpha effect of the vagus nerve can be used in the treatment of chronic inflammatory bowel diseases, represented by Crohn’s disease and ulcerative colitis where this cytokine plays a key role. Bioelectronic medicine, via vagus nerve stimulation, may have an interest in this non-drug therapeutic approach as an alternative to conventional anti-TNF-alpha drugs, which are not devoid of side effects feared by patients.
Collapse
Affiliation(s)
- Bruno Bonaz
- Division of Hepato-Gastroenterology, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Grenoble Institute of Neurosciences, Inserm U1216, University Grenoble Alpes, Grenoble, France
| | - Valérie Sinniger
- Division of Hepato-Gastroenterology, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Grenoble Institute of Neurosciences, Inserm U1216, University Grenoble Alpes, Grenoble, France
| | - Sonia Pellissier
- Laboratoire Inter-Universitaire de Psychologie Personnalité, Cognition, Changement Social, University Grenoble Alpes, University Savoie Mont Blanc, Grenoble, France
| |
Collapse
|
34
|
Ten Hove AS, Brinkman DJ, Li Yim AYF, Verseijden C, Hakvoort TBM, Admiraal I, Welting O, van Hamersveld PHP, Sinniger V, Bonaz B, Luyer MD, de Jonge WJ. The role of nicotinic receptors in SARS-CoV-2 receptor ACE2 expression in intestinal epithelia. Bioelectron Med 2020; 6:20. [PMID: 33123616 PMCID: PMC7592135 DOI: 10.1186/s42234-020-00057-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/14/2020] [Indexed: 02/08/2023] Open
Abstract
Background Recent evidence demonstrated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) propagates in intestinal epithelial cells expressing Angiotensin-Converting Enzyme 2 (ACE2), implying that these cells represent an important entry site for the viral infection. Nicotinic receptors (nAChRs) have been put forward as potential regulators of inflammation and of ACE2 expression. As vagus nerve stimulation (VNS) activates nAChRs, we aimed to investigate whether VNS can be instrumental in affecting intestinal epithelial ACE2 expression. Methods By using publicly available datasets we qualified epithelial ACE2 expression in human intestine, and assessed gene co-expression of ACE2 and SARS-CoV-2 priming Transmembrane Serine Protease 2 (TMPRSS2) with nAChRs in intestinal epithelial cells. Next, we investigated mouse and human ACE2 expression in intestinal tissues after chronic VNS via implanted devices. Results We show co-expression of ACE2 and TMPRSS2 with nAChRs and α7 nAChR in particular in intestinal stem cells, goblet cells, and enterocytes. However, VNS did not affect ACE2 expression in murine or human intestinal tissue, albeit in colitis setting. Conclusions ACE2 and TMPRSS2 are specifically expressed in epithelial cells of human intestine, and both are co-expressed with nAChRs. However, no evidence for regulation of ACE2 expression through VNS could be found. Hence, a therapeutic value of VNS with respect to SARS-CoV-2 infection risk through ACE2 receptor modulation in intestinal epithelia could not be established.
Collapse
Affiliation(s)
- Anne S Ten Hove
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
| | - David J Brinkman
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands.,Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, the Netherlands
| | - Andrew Y F Li Yim
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands.,Department of Clinical Genetics, Genome Diagnostics Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, 1105 AZ the Netherlands
| | - Caroline Verseijden
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
| | - Theo B M Hakvoort
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
| | - Iris Admiraal
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
| | - Olaf Welting
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
| | - Patricia H P van Hamersveld
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands
| | - Valérie Sinniger
- Grenoble Institute of Neurosciences, Division of Hepato-Gastroenterology, University Grenoble Alpes, Inserm U1216, 38000 Grenoble, France
| | - Bruno Bonaz
- Grenoble Institute of Neurosciences, Division of Hepato-Gastroenterology, University Grenoble Alpes, Inserm U1216, 38000 Grenoble, France
| | - Misha D Luyer
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, the Netherlands
| | - Wouter J de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam University Medical Centers, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, 1105 BK the Netherlands.,Department of General, Visceral-, Thoracic and Vascular Surgery, University Hospital Bonn, 53127 Bonn, Germany
| |
Collapse
|
35
|
Bonaz B, Sinniger V, Pellissier S. Targeting the cholinergic anti-inflammatory pathway with vagus nerve stimulation in patients with Covid-19? Bioelectron Med 2020; 6:15. [PMID: 32743022 PMCID: PMC7387121 DOI: 10.1186/s42234-020-00051-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), at the origin of the worldwide COVID-19 pandemic, is characterized by a dramatic cytokine storm in some critical patients with COVID-19. This storm is due to the release of high levels of pro-inflammatory cytokines such as interleukin (IL)-1 β, IL-6, tumor necrosis factor (TNF), and chemokines by respiratory epithelial and dendritic cells, and macrophages. We hypothesize that this cytokine storm and the worsening of patients’ health status can be dampened or even prevented by specifically targeting the vagal-driven cholinergic anti-inflammatory pathway (CAP). The CAP is a concept that involves an anti-inflammatory effect of vagal efferents by the release of acetylcholine (ACh). Nicotinic acetylcholine receptor alpha7 subunit (α7nAChRs) is required for ACh inhibition of macrophage-TNF release and cytokine modulation. Hence, targeting the α7nAChRs through vagus nerve stimulation (VNS) could be of interest in the management of patients with SARS-CoV-2 infection. Indeed, through the wide innervation of the organism by the vagus nerve, especially the lungs and gastrointestinal tract, VNS appears as a serious candidate for a few side effect treatment that could dampen or prevent the cytokine storm observed in COVID-19 patients with severe symptoms. Finally, a continuous vagal tone monitoring in patients with COVID-19 could be used as a predictive marker of COVID-19 illness course but also as a predictive marker of response to COVID-19 treatment such as VNS or others.
Collapse
Affiliation(s)
- Bruno Bonaz
- Division of Hepato-Gastroenterology, Grenoble University Hospital, 38000 Grenoble, France.,Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institute Neurosciences, 38000 Grenoble, France
| | - Valérie Sinniger
- Division of Hepato-Gastroenterology, Grenoble University Hospital, 38000 Grenoble, France.,Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institute Neurosciences, 38000 Grenoble, France
| | - Sonia Pellissier
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc and LIP/PC2S, 38000 Grenoble, France
| |
Collapse
|
36
|
Falcone JD, Liu T, Goldman L, David D P, Rieth L, Bouton CE, Straka M, Sohal HS. A novel microwire interface for small diameter peripheral nerves in a chronic, awake murine model. J Neural Eng 2020; 17:046003. [DOI: 10.1088/1741-2552/ab9b6d] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
37
|
Bonaz B. Parameters matter: modulating cytokines using nerve stimulation. Bioelectron Med 2020; 6:12. [PMID: 32607391 PMCID: PMC7318398 DOI: 10.1186/s42234-020-00049-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/23/2020] [Indexed: 12/15/2022] Open
Abstract
The vagus nerve-based inflammatory reflex regulates inflammation and cytokine release. Recent successful clinical trials using implantable bioelectronic devices to modulate the inflammatory reflex in patients with rheumatoid arthritis and inflammatory bowel disease have demonstrated the efficacy of targeting neural circuits as an efficient alternative to drug treatments. However, the optimal vagus nerve stimulation parameters to achieve efficacious symptomatic relief for inflammation are still unknown. In this issue of Bioelectronic Medicine, Tsaava et al. tested whether altering these electrical stimulation parameters would change circulating cytokine levels in healthy mice. They found that specific combinations of parameters produced significant increases in serum TNF while other parameters selectively lowered serum TNF levels, as compared to sham stimulated mice. These results have considerable implications for determining the optimal stimulation parameters to better treat common conditions and diseases that involve immune regulation.
Collapse
Affiliation(s)
- Bruno Bonaz
- University Grenoble Alpes, Inserm, U1216, Grenoble Institute Neurosciences and Division of Hepato-Gastroenterology, CHU Grenoble Alpes, 38000 Grenoble, France
| |
Collapse
|