Vagus nerve stimulation: a new promising therapeutic tool in inflammatory bowel disease.

J Intern Med. July 2017;282(1):46-63.

B Bonaz¹, V Sinniger², S Pellissier³

¹ University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France.; ² University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France.; ³ University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France.

Abstract

Inflammatory bowel disease (IBD), that is Crohn's disease (CD) and ulcerative colitis, affects about 1.5 million persons in the USA and 2.2 million in Europe. The pathophysiology of IBD involves immunological, genetic and environmental factors. The treatment is medico-surgical but suspensive. Anti-TNFα agents have revolutionized the treatment of IBD but have side effects. In addition, a non-negligible percentage of patients with IBD stop or take episodically their treatment. Consequently, a nondrug therapy targeting TNFα through a physiological pathway, devoid of major side effects and with a good cost-effectiveness ratio, would be of interest. The vagus nerve has dual anti-inflammatory properties through its afferent (i.e. hypothalamic-pituitary-adrenal axis) and efferent (i.e. the anti-TNFα effect of the cholinergic anti-inflammatory pathway) fibres. We have shown that there is an inverse relationship between vagal tone and plasma TNFα level in patients with CD, and have reported, for the first time, that chronic vagus nerve stimulation has anti-inflammatory properties in a rat model of colitis and in a pilot study performed in seven patients with moderate CD. Two of these patients failed to improve after 3 months of vagus nerve stimulation but five were in deep remission (clinical, biological and endoscopic) at 6 months of follow-up and vagal tone was restored. No major side effects were observed. Thus, vagus nerve stimulation provides a new therapeutic option in the treatment of CD.

Article Tools:

Medline

Email to me

Databanks:

GENBANK/NCT01569503
GENBANK/NCT02311660

Archives Highlights:

Prevalence of discospondylitis and association with congenital vertebral body malformations in English and French bulldogs.
The prevalence of discospondylitis was 3.4 (1.6-6.7) times higher in French bulldogs and 4.3 (1.7-9.8) times higher in English bulldogs, compared with the overall hospital cohort. One or more vertebral malformations were present in 12 French bulldogs (92.3%), 6 English bulldogs (75.0%), and 1 "other" breed dog (1.1%). Discospondylitis was diagnosed adjacent to congenital vertebral body malformations in 12 (80%) intervertebral discs in French bulldogs and 5 (50%) intervertebral discs in English bulldogs.

The Ideal Canine Companion: Re-Exploring Australian Perspectives on Ideal Characteristics for Companion Dogs.
The ideal dog was characterised as medium-sized, with a short- low- or non-shedding coat, and acquired as a puppy from a shelter/rescue. Desired traits included being affectionate, healthy, non-aggressive, safe with children, housetrained, non-destructive when alone, and not prone to escaping.

Risk Factors for Injury in Border Collies Competing in Agility Competitions.
The jump height relative to the shoulder height was associated with injury, with dogs jumping noticeably above or below shoulder height more likely to report a history of injury. Other identified risk factors included the number of weekends spent competing/year, the number of competitions at the national level, the age when starting elbow height jumps and backside jumps, the acquisition of the dog from a breeder, and the age of the handler.

Owner survey suggests cats may be undertreated for pain compared to dogs after an elective ovariohysterectomy or orchiectomy.
Analgesics were prescribed for 19 of 162 (12%) pets: 14 of 88 (16%) dogs and 5 of 74 (6.7%) cats. There was no difference in the prescription of analgesics between dogs and cats after ovariohysterectomy or orchiectomy. 15 of 19 owners reported their compliance in administering analgesics at 78.9%. Owners' subjective assessments showed that 24 of 86 (28%) dogs and 12 of 68 (17%) cats appeared painful at home.

How to plan and provide general anesthesia for a troop of 98 hamadryas baboons (Papio hamadryas) for contraceptive and preventative health interventions.
A group of 12 veterinarians, 2 zookeepers, and 6 volunteers anesthetized all animals within 2 days. The baboons were orally premedicated with midazolam (0.1 to 0.5 mg/kg) and anesthetized with medetomidine (40 to 60 µg/kg, IM) and ketamine (2 to 4 mg/kg, IM); isoflurane at rates of 1.5% to 2% was used for maintaining anesthesia if necessary. For population management, the animals received a contraceptive implant (adult females), orchiectomy (young males), or vasectomy (breeding males).