Gidron Yori, Kupper Nina, Kwaijtaal Martijn, Winter Jobst, Denollet Johan
CoRPS (Center of Research on Psychology in Somatic Diseases), Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands.
Atherosclerosis. 2007 Dec;195(2):e1-9. doi: 10.1016/j.atherosclerosis.2006.10.009. Epub 2006 Nov 13.
The current understanding of the pathophysiology of atherosclerosis leading to coronary artery disease (CAD) emphasizes the role of inflammatory mediators. Given the bidirectional communication between the immune and central nervous systems, an important question is whether the brain can be "informed" about and modulate CAD-related inflammation. A candidate communicator and modulator is the vagus nerve. Until now, the vagus nerve has received attention in cardiology mainly due to its role in the parasympathetic cardiovascular response. However, the vagus nerve can also "inform" the brain about peripheral inflammation since its paraganglia have receptors for interleukin-1. Furthermore, its efferent branch has a local anti-inflammatory effect. These effects have not been considered in research on the vagus nerve in CAD or in vagus nerve stimulation trials in CAD. In addition, various behavioural interventions, including relaxation, may influence CAD prognosis by affecting vagal activity. Based on this converging evidence, we propose a neuroimmunomodulation approach to atherogenesis. In this model, the vagus nerve "informs" the brain about CAD-related cytokines; in turn, activation of the vagus (via vagus nerve stimulation, vagomimetic drugs or relaxation) induces an anti-inflammatory response that can slow down the chronic process of atherogenesis.
目前对导致冠状动脉疾病（CAD）的动脉粥样硬化病理生理学的理解强调了炎症介质的作用。鉴于免疫和中枢神经系统之间的双向通信，一个重要的问题是大脑是否能够“获知”并调节与CAD相关的炎症。一个候选的通信者和调节者是迷走神经。到目前为止，迷走神经在心脏病学中受到关注主要是因为它在副交感神经心血管反应中的作用。然而，迷走神经也可以将外周炎症“告知”大脑，因为其副神经节有白细胞介素-1受体。此外，其传出分支具有局部抗炎作用。在CAD中对迷走神经的研究或CAD的迷走神经刺激试验中，这些作用尚未得到考虑。此外，包括放松在内的各种行为干预可能通过影响迷走神经活动来影响CAD的预后。基于这些汇聚的证据，我们提出一种针对动脉粥样硬化形成的神经免疫调节方法。在这个模型中，迷走神经将与CAD相关的细胞因子“告知”大脑；反过来，迷走神经的激活（通过迷走神经刺激、拟迷走神经药物或放松）诱导抗炎反应，这可以减缓动脉粥样硬化形成的慢性过程。
