Abstract
Modulation of the parasympathetic tone leads to extensive physiological reactions at several levels, including the decreased production of proinflammatory cytokines. Many studies have demonstrated that chronic inflammatory diseases are associated with reduced parasympathetic and increased sympathetic activities. Moreover, it was demonstrated that a low parasympathetic and a high sympathetic activity in patients with rheumatoid arthritis (RA) predicts a poor therapeutic response to anti-tumor necrosis factor (TNF) treatment compared to RA patients with a more balanced autonomic nervous system. The autonomic equilibrium could be restored by electrical stimulation of the vagus nerve. Considering the patients who do not sufficiently respond to the available drugs, patients for whom the effectiveness of the drugs wanes over time, or have drug-related adverse events, a nonpharmacological approach such as bioelectronics might be a useful supplement as an instrument in the successful extension of the therapeutic armamentarium for rheumatic diseases; however, there is a great need for further studies and the development of novel therapeutic strategies in the field of neuroimmunology.
Zusammenfassung
Eine Modulation des parasympathischen Tonus führt zu ausgedehnten physiologischen Reaktionen auf mehreren Ebenen einschließlich der verringerten Produktion proinflammatorischer Zytokine. Zahlreiche Studien zeigten, dass chronisch entzündliche Erkrankungen mit einer verminderten parasympathischen und einer erhöhten sympathischen Aktivität einhergehen. Darüber hinaus wurde gezeigt, dass eine niedrige parasympathische und hohe sympathische Aktivität bei Patienten mit rheumatoider Arthritis (RA) im Vergleich zu RA-Patienten mit einem gut balancierten autonomen Nervensystem ein schlechtes therapeutisches Ansprechen auf eine Anti-TNF(Tumor-Nekrose-Faktor)-Therapie vorhersagt. Das autonome Gleichgewicht könnte durch elektrische Stimulation des N. vagus wiederhergestellt werden. In Anbetracht der Patienten, die entweder auf die verfügbaren Medikamente nicht ausreichend ansprechen, bei denen im Laufe der Zeit die Wirksamkeit der Medikamente verloren geht oder die arzneimittelbedingte unerwünschte Ereignisse haben, könnte ein nichtpharmakologischer Ansatz wie Bioelektronik eine nützliche Ergänzung als Instrument zur erfolgreichen Erweiterung des therapeutischen Arsenals rheumatischer Erkrankungen sein. Es besteht jedoch ein großer Bedarf an Studien und der Entwicklung neuer therapeutischer Strategien im Bereich der Neuroimmunologie.
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O. Seifert and C. Baerwald declare that they have no competing interests.
For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.
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Seifert, O., Baerwald, C. Stimulation of the vagus nerve as a therapeutic principle. Z Rheumatol 83 (Suppl 1), 1–7 (2024). https://doi.org/10.1007/s00393-023-01398-3
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DOI: https://doi.org/10.1007/s00393-023-01398-3
Keywords
- Parasympathetic activity
- Neuroimmunology
- Proinflammatory cytokine
- Electrical stimulation
- Rheumatoid arthritis