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深部脑刺激和脊髓刺激的免疫调节和内分泌作用 - 系统评价。

Immunomodulatory and endocrine effects of deep brain stimulation and spinal cord stimulation - A systematic review.

机构信息

Department of Neurosurgery and Neurology, Jan Biziel University Hospital, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland.

Department of Neurosurgery and Neurology, Jan Biziel University Hospital, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, Poland.

出版信息

Biomed Pharmacother. 2023 Dec;168:115732. doi: 10.1016/j.biopha.2023.115732. Epub 2023 Oct 18.


DOI:10.1016/j.biopha.2023.115732
PMID:37862972
Abstract

INTRODUCTION: Deep Brain Stimulation (DBS) and Spinal Cord Stimulation (SCS) represent burgeoning treatments for diverse neurological disorders. This systematic review aims to consolidate findings on the immunological and endocrine effects of DBS and SCS, shedding light on the intricate mechanisms of neuromodulation. MATERIALS AND METHODS: This systematic review, aligned with PRISMA protocols, synthesizes findings from 33 references-20 on DBS and 13 on SCS-to unravel the immunological and endocrine impacts of neuromodulation. RESULTS: DBS interventions exhibited divergent effects on cytokines, with an increase in hepcidin levels and a variable impact on the IL-6/IL-10 ratio. While some studies reported elevated IL-6, animal studies consistently demonstrated a reduction in IL-1β and IL-6, with no significant changes in TNF-α and an increase in IL-10. Noteworthy hormonal changes included decreased corticosterone and ACTH concentrations and increased oxytocin levels following DBS of the hypothalamus. SCS mirrored similar effects on interleukins, indicating a reduction in IL-6 and IL-1β and an increase in IL-10 levels. Additionally, SCS led to reduced VEGF levels and elevated expression of neurotrophic factors such as BDNF and GDNF, particularly under burst stimulation. CONCLUSIONS: Both DBS and SCS exert anti-inflammatory effects, manifesting as a decrease in pro-inflammatory cytokines alongside the stimulation of anti-inflammatory cytokine synthesis. These findings, observed in both animal and human models, imply that neurostimulation may modify the trajectory of neurological diseases by modulating local immune responses in an immunomodulatory and endocrine manner. This comprehensive exploration sets the stage for future research endeavors in this evolving domain.

摘要

简介:深部脑刺激(DBS)和脊髓刺激(SCS)代表了针对多种神经疾病的新兴治疗方法。本系统综述旨在整合 DBS 和 SCS 的免疫和内分泌效应的研究结果,阐明神经调节的复杂机制。

材料和方法:本系统综述遵循 PRISMA 方案,综合了 33 篇参考文献的研究结果-20 篇关于 DBS,13 篇关于 SCS-以揭示神经调节的免疫和内分泌影响。

结果:DBS 干预对细胞因子表现出不同的影响,铁调素水平升高,IL-6/IL-10 比值存在差异。虽然一些研究报告 IL-6 升高,但动物研究一致表明 IL-1β 和 IL-6 减少,TNF-α 没有显著变化,IL-10 增加。值得注意的激素变化包括下丘脑 DBS 后皮质酮和 ACTH 浓度降低,催产素水平升高。SCS 对白细胞介素表现出类似的影响,表明 IL-6 和 IL-1β 减少,IL-10 水平增加。此外,SCS 导致 VEGF 水平降低和神经营养因子如 BDNF 和 GDNF 的表达增加,特别是在爆发刺激下。

结论:DBS 和 SCS 均具有抗炎作用,表现为促炎细胞因子减少,同时抗炎细胞因子合成增加。这些在动物和人类模型中观察到的发现表明,神经刺激可以通过调节局部免疫反应,以免疫调节和内分泌的方式改变神经疾病的轨迹。本综述为这一不断发展的领域的未来研究奠定了基础。

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