Clinique Universitaire d'Hépato-Gastroentérologie, CHU de Grenoble, Grenoble Cedex, France.
Neurogastroenterol Motil. 2013 Mar;25(3):208-21. doi: 10.1111/nmo.12076. Epub 2013 Jan 29.
The brain and the gut communicate bidirectionally through the autonomic nervous system (ANS). The vagus nerve (VN), a major component of the ANS, plays a key role in the neuro-endocrine-immune axis to maintain homeostasia through its afferents (through the activation of the hypothalamic pituitary adrenal axis and the central ANS) and through its efferents (i.e. the cholinergic anti-inflammatory pathway; CAP). The CAP has an anti-TNF effect both through the release of acetylcholine at the distal VN acting on macrophages and through the connection of the VN with the spleen through the splenic sympathetic nerve. Vagus nerve stimulation (VNS) of vagal afferents at high frequency (20-30 Hz) is used for the treatment of drug-resistant epilepsy and depression. Low-frequency (5 Hz) VNS of vagal efferents activates the CAP for an anti-inflammatory effect that is as an anti-TNF therapy in inflammatory diseases were TNF is a key cytokine as represented by experimental sepsis, postoperative ileus, burn-induced intestinal barrier injury, colitis. However, both vagal afferents and efferents are activated by VNS.
The objective of this review was to explore the following: (i) the supporting evidence for the importance of VNS in epilepsy (and depression) and its mechanisms of action, (ii) the anti-inflammatory characteristics of the VN, (iii) the experimental evidence that VNS impact on inflammatory disorders focusing on the digestive tract, and (iv) how VNS could potentially be harnessed therapeutically in human inflammatory disorders such as inflammatory bowel diseases, irritable bowel syndrome, postoperative ileus, rheumatoid arthritis as an anti-inflammatory therapy.
大脑和肠道通过自主神经系统（ANS）双向交流。迷走神经（VN）是 ANS 的主要组成部分，通过其传入神经（通过激活下丘脑-垂体-肾上腺轴和中枢 ANS）和传出神经（即胆碱能抗炎途径；CAP）在神经内分泌免疫轴中发挥关键作用，以维持体内平衡。CAP 通过在远端 VN 释放乙酰胆碱作用于巨噬细胞，以及通过 VN 与脾脏通过脾交感神经连接，具有抗 TNF 作用。高频（20-30 Hz）刺激迷走神经传入纤维的迷走神经刺激（VNS）用于治疗耐药性癫痫和抑郁症。低频（5 Hz）刺激迷走神经传出纤维激活 CAP 产生抗炎作用，作为 TNF 是实验性败血症、术后肠梗阻、烧伤诱导的肠屏障损伤、结肠炎等炎症性疾病中关键细胞因子的抗炎治疗。然而，VNS 既激活迷走神经传入纤维，也激活迷走神经传出纤维。
本综述的目的是探讨以下几点：（i）VNS 在癫痫（和抑郁症）中的重要性及其作用机制的支持证据，（ii）VN 的抗炎特性，（iii）VNS 对以消化道为重点的炎症性疾病的影响的实验证据，以及（iv）VNS 如何在人类炎症性疾病（如炎症性肠病、肠易激综合征、术后肠梗阻、类风湿关节炎）中作为抗炎治疗进行治疗。
