Therapeutic Potential of Vagus Nerve Stimulation for Inflammatory Bowel Diseases.

Therapeutic Potential of Vagus Nerve Stimulation for Inflammatory Bowel Diseases.
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DOI:
10.3389/fnins.2021.650971
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发表时间:
2021
影响因子:
4.3
通讯作者:
Pellissier S
Pellissier S
中科院分区:
医学2区
文献类型:
--
作者:
Bonaz B;Sinniger V;Pellissier S

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迷走神经是一种混合神经,包括80%的传入纤维和20%的传出纤维。它允许中枢神经系统和消化道之间的双向交流。它具有双重抗炎特性,通过其传入激活下丘脑垂体肾上腺轴,还通过涉及传入(迷走神经)和传出(迷走神经)臂的迷走神经-迷走神经炎症反射,称为胆碱能抗炎途径。事实上,乙酰胆碱在其传出纤维末端的释放能够抑制巨噬细胞通过肠神经系统的中间神经元释放肿瘤坏死因子(TNF)α,所述中间神经元在传出迷走神经末梢和巨噬细胞之间突触并释放乙酰胆碱。迷走神经还与脾交感神经突触以抑制脾巨噬细胞释放TNF-α。它也可以激活脊髓交感神经系统后,其传入神经中枢整合。迷走神经的这种抗TNF-α作用可用于治疗慢性炎症性肠病,以克罗恩病和溃疡性结肠炎为代表,其中这种细胞因子起关键作用。通过迷走神经刺激的生物电子医学可能对这种非药物治疗方法感兴趣,作为传统抗TNF-α药物的替代品,这些药物并非没有患者担心的副作用。
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.
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