Lespérance Paul, Desbeaumes Jodoin Véronique, Drouin David, Racicot Frédéric, Miron Jean-Philippe, Longpré-Poirier Christophe, Fournier-Gosselin Marie-Pierre, Thebault Paméla, Lapointe Réjean, Arbour Nathalie, Cailhier Jean-François
Department of Psychiatry, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC H2X 0C1, Canada.
Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada.
Int J Mol Sci. 2024 Feb 26;25(5):2679. doi: 10.3390/ijms25052679.
Vagal neurostimulation (VNS) is used for the treatment of epilepsy and major medical-refractory depression. VNS has neuropsychiatric functions and systemic anti-inflammatory activity. The objective of this study is to measure the clinical efficacy and impact of VNS modulation in depressive patients. Six patients with refractory depression were enrolled. Depression symptoms were assessed with the Montgomery-Asberg Depression Rating, and anxiety symptoms with the Hamilton Anxiety Rating Scale. Plasmas were harvested prospectively before the implantation of VNS (baseline) and up to 4 years or more after continuous therapy. Forty soluble molecules were measured in the plasma by multiplex assays. Following VNS, the reduction in the mean depression severity score was 59.9% and the response rate was 87%. Anxiety levels were also greatly reduced. IL-7, CXCL8, CCL2, CCL13, CCL17, CCL22, Flt-1 and VEGFc levels were significantly lowered, whereas bFGF levels were increased ( values ranging from 0.004 to 0.02). This exploratory study is the first to focus on the long-term efficacy of VNS and its consequences on inflammatory biomarkers. VNS may modulate inflammation via an increase in blood-brain barrier integrity and a reduction in inflammatory cell recruitment. This opens the door to new pathways involved in the treatment of refractory depression.
迷走神经刺激（VNS）用于治疗癫痫和难治性重度抑郁症。VNS具有神经精神功能和全身抗炎活性。本研究的目的是评估VNS调节对抑郁症患者的临床疗效和影响。招募了6名难治性抑郁症患者。使用蒙哥马利-阿斯伯格抑郁量表评估抑郁症状，使用汉密尔顿焦虑量表评估焦虑症状。前瞻性地在植入VNS前（基线）以及持续治疗后长达4年或更长时间采集血浆。通过多重分析测定血浆中的40种可溶性分子。VNS治疗后，平均抑郁严重程度评分降低了59.9%，有效率为87%。焦虑水平也大幅降低。白细胞介素-7、趋化因子CXCL8、趋化因子CCL2、趋化因子CCL13、趋化因子CCL17、趋化因子CCL22、血管内皮生长因子受体1（Flt-1）和血管内皮生长因子c（VEGFc）水平显著降低，而碱性成纤维细胞生长因子（bFGF）水平升高（P值范围为0.004至0.02）。这项探索性研究首次关注VNS的长期疗效及其对炎症生物标志物的影响。VNS可能通过增加血脑屏障完整性和减少炎症细胞募集来调节炎症。这为难治性抑郁症的治疗开辟了新途径。
