Vagus Nerve Stimulation: A Personalized Therapeutic Approach for Crohn’s and Other Inflammatory Bowel Diseases

Abstract

Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, are incurable autoimmune diseases characterized by chronic inflammation of the gastrointestinal tract. There is increasing evidence that inappropriate interaction between the enteric nervous system and central nervous system and/or low activity of the vagus nerve, which connects the enteric and central nervous systems, could play a crucial role in their pathogenesis. Therefore, it has been suggested that appropriate neuroprosthetic stimulation of the vagus nerve could lead to the modulation of the inflammation of the gastrointestinal tract and consequent long-term control of these autoimmune diseases. In the present paper, we provide a comprehensive overview of (1) the cellular and molecular bases of the immune system, (2) the way central and enteric nervous systems interact and contribute to the immune responses, (3) the pathogenesis of the inflammatory bowel disease, and (4) the therapeutic use of vagus nerve stimulation, and in particular, the transcutaneous stimulation of the auricular branch of the vagus nerve. Then, we expose the working hypotheses for the modulation of the molecular processes that are responsible for intestinal inflammation in autoimmune diseases and the way we could develop personalized neuroprosthetic therapeutic devices and procedures in favor of the patients.

Dietary (Poly)phenols and the Gut–Brain Axis in Ageing

“…The autonomic nervous system plays a significant role in gut-brain communication, with both the parasympathetic vagus nerve and multiple sympathetic efferent fibres connecting and regulating endocrine, immune, humoral, and gastrointestinal functions. The vagus nerve represents a particularly important link between nutrition and neurological and inflammatory diseases, with vagal activity having been shown to modulate the enteric nervous system (ENS) and the gastrointestinal tract, with the gut microbiota playing a mediatory role [53,54]. Notably, alterations in the ENS occur prior to CNS manifestations of pathology, suggesting a potential "anticipatory" pathological communication with the brain [55].…”

Neuroimmunomodulation of vagus nerve stimulation and the therapeutic implications

“…The majority of the vagus nerve fibers are sensory afferent fibers that transmit sensory information from internal organs to the central nervous system. The vagal afferent signals arise from the tension receptors of the stomach and esophagus, chemoreceptors and mechanoreceptors from the GI mucosa (Cirillo et al, 2022 ). And sensory inputs from the liver and pancreas project to the nucleus tractus solitarii (NTS) via the vagal nodose ganglion, with secondary projections to the raphe nucleus, locus coeruleus (LC), thalamus, hypothalamus, amygdala, and cerebral cortex (Nemeroff et al, 2006 ; Decarie-Spain et al, 2023 ).…”

Carcinogenesis and Metastasis: Focus on TRPV1-Positive Neurons and Immune Cells

“…In turn, efferent fibers of the vagal nerve transmit central neuronal response into the visceral tissues as well as innate and adaptive immune cells [ 60 , 61 ]. The vagus nerve mediates neuro-immune interactions in cancer [ 62 ], in addition to its fundamental physiological regulatory functions in controlling circulation, temperature, digestion, respiration, and the immune response [ 63 , 64 , 65 , 66 ].…”