Kocyigit Burhan Fatih, Assylbek Meirgul I, Akyol Ahmet, Abdurakhmanov Ruslan, Yessirkepov Marlen
Department of Physical Medicine and Rehabilitation, University of Health Sciences, Adana Health Practice and Research Center, Adana, Turkey.
Department of Neurology, Psychiatry, Neurosurgery and Rehabilitation, South Kazakhstan Medical Academy, Shymkent, Kazakhstan.
Rheumatol Int. 2024 Jan;44(1):1-8. doi: 10.1007/s00296-023-05477-1. Epub 2023 Oct 9.
The vagus nerve forms intricate neural connections with an extensive number of organs, particularly the digestive system. The vagus nerve has a pivotal role as a fundamental component of the autonomic nervous system, exhibiting an essential effect. It establishes a direct link with the parasympathetic system, consequently eliciting the synaptic release of acetylcholine. Recent studies have revealed the potential anti-inflammatory function of the vagus nerve. The activation of the hypothalamic system through the stimulation of vagal afferents is fundamentally involved in regulating inflammation. This activation process leads to the production of cortisol. The other mechanism, defined as the cholinergic anti-inflammatory pathway, is characterized by the involvement of vagal efferents. These fibers release the neurotransmitter acetylcholine at particular synaptic connections, involving interactions with macrophages and enteric neurons. The mechanism under consideration is ascribed to the α-7-nicotinic acetylcholine receptors. The fusion of acetylcholine receptors is responsible for the restricted secretion of inflammatory mediators by macrophages. A potential mechanism for anti-inflammatory effects involves the stimulation of the sympathetic system through the vagus nerve, leading to the control of immunological responses within the spleen. This article offers an extensive summary of the present knowledge regarding the therapeutic effectiveness of stimulating the vagus nerve in managing inflammatory rheumatic conditions based on the relationship of inflammation with the vagus nerve. Furthermore, the objective is to present alternatives that may be preferred while applying vagus nerve stimulation approaches.
迷走神经与大量器官，尤其是消化系统，形成了错综复杂的神经连接。迷走神经作为自主神经系统的基本组成部分，发挥着关键作用，具有重要影响。它与副交感神经系统建立了直接联系，从而引发乙酰胆碱的突触释放。最近的研究揭示了迷走神经潜在的抗炎功能。通过刺激迷走神经传入纤维激活下丘脑系统，从根本上参与炎症调节。这一激活过程会导致皮质醇的产生。另一种机制，即胆碱能抗炎途径，其特点是迷走神经传出纤维参与其中。这些纤维在特定的突触连接处释放神经递质乙酰胆碱，涉及与巨噬细胞和肠神经元的相互作用。所考虑的机制归因于α-7-烟碱型乙酰胆碱受体。乙酰胆碱受体的融合负责限制巨噬细胞分泌炎症介质。一种潜在的抗炎作用机制涉及通过迷走神经刺激交感神经系统，从而控制脾脏内的免疫反应。本文基于炎症与迷走神经的关系，对目前关于刺激迷走神经治疗炎性风湿性疾病的疗效的知识进行了广泛总结。此外，目的是提出在应用迷走神经刺激方法时可能更受青睐的替代方案。
