Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI, 53706, USA.
Department of Surgery, Division of Plastic and Reconstructive Surgery, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI, 53706, USA.
Brain Stimul. 2020 Jul-Aug;13(4):1024-1030. doi: 10.1016/j.brs.2020.03.012. Epub 2020 Mar 26.
INTRODUCTION: Vagus nerve stimulation (VNS) is an FDA-approved neuromodulatory treatment used in the clinic today for epilepsy, depression, and cluster headaches. Moreover, evidence in the literature has led to a growing list of possible clinical indications, with several small clinical trials applying VNS to treat conditions ranging from neurodegenerative diseases to arthritis, anxiety disorders, and obesity. Despite the growing list of therapeutic applications, the fundamental mechanisms by which VNS achieves its beneficial effects are poorly understood. In parallel, the glymphatic and meningeal lymphatic systems have recently been described as methods by which the brain maintains a healthy homeostasis and removes waste without a traditionally defined lymphatic system. In particular, the glymphatic system relates to the interchange of cerebrospinal fluid (CSF) and interstitial fluid (ISF) whose net effect is to wash through the brain parenchyma removing metabolic waste products and misfolded proteins. OBJECTIVE/HYPOTHESIS: As VNS has well-documented effects on many of the pathways recently linked to the clearance systems of the brain, we hypothesized that VNS could increase CSF penetrance in the brain. METHODS: We injected a low molecular weight lysine-fixable fluorescent tracer (TxRed-3kD) into the CSF system of mice with a cervical vagus nerve cuff implant and measured the amount of CSF penetrance following an application of a clinically-derived VNS paradigm (30 Hz, 10% duty cycle). RESULTS: We found that the clinical VNS group showed a significant increase in CSF tracer penetrance as compared to the naïve control and sham groups. CONCLUSION: (s): This study demonstrates that VNS therapeutic strategies already being applied in the clinic today may induce intended effects and/or unwanted side effects by altering CSF/ISF exchange in the brain. This may have broad ranging implications in the treatment of various CNS pathologies.
简介:迷走神经刺激(VNS)是一种经美国食品和药物管理局批准的神经调节治疗方法,目前用于治疗癫痫、抑郁症和丛集性头痛。此外,文献中的证据导致了一系列可能的临床适应症不断增加,几项小型临床试验将 VNS 应用于治疗从神经退行性疾病到关节炎、焦虑症和肥胖症等各种疾病。尽管治疗应用的范围不断扩大,但 VNS 实现其有益效果的基本机制仍知之甚少。与此同时,最近描述了糖质和脑膜淋巴管系统作为大脑维持健康的体内平衡并清除废物的方法,而没有传统定义的淋巴系统。特别是,糖质系统与脑脊液(CSF)和细胞间液(ISF)的交换有关,其净效应是通过大脑实质冲洗,清除代谢废物和错误折叠的蛋白质。 目的/假设:由于 VNS 对最近与大脑清除系统相关的许多途径有明确的影响,我们假设 VNS 可以增加 CSF 在大脑中的穿透性。 方法:我们将一种低分子量赖氨酸固定荧光示踪剂(TxRed-3kD)注入带有颈迷走神经袖套植入物的小鼠 CSF 系统,并在应用临床衍生的 VNS 范例(30 Hz,10%占空比)后测量 CSF 穿透量。 结果:我们发现,与未治疗对照组和假手术组相比,临床 VNS 组的 CSF 示踪剂穿透性显著增加。 结论:本研究表明,目前正在临床应用的 VNS 治疗策略可能通过改变大脑中的 CSF/ISF 交换来诱导预期的效果和/或不良的副作用。这可能对各种中枢神经系统疾病的治疗产生广泛的影响。
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