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/NCT02311660
GENBANK/NCT01569503

Archives Highlights:

Implementation of biosecurity on equestrian premises: A narrative overview.
This narrative review summarises reported frequency of implementation for selected biosecurity measures, as well as evidence relating to potential barriers to implementation of biosecurity on equestrian premises. Possible opportunities for improvement in the adoption of equine biosecurity measures are also discussed.

A review of adverse events in animals and children after secondary exposure to transdermal hormone-containing medicinal products.
The clinical signs reported in animals included persistent signs of oestrus, poor growth rate, and birth defects. In humans, reported clinical signs included precocious puberty, unresolved virilisation, accelerated growth rate, and female infertility.

High-pressure injection of paint into the hand: A small injury with serious consequences.
High-pressure injection injury to the hand is a serious lesion threatening the limb. Several injected materials are involved, and paint is known to have the most serious consequences, with a high amputation rate. Early diagnosis and prompt treatment are two important prognostic factors for a better outcome.

Attitudes and Beliefs of a Sample of Australian Dog and Cat Owners towards Pet Confinement.
Dog owners showed the strongest support for confining dogs to the owners' property whenever unsupervised (98% agreement) and less support for confining dogs inside the house at night (54% agreement), and only 23% believed dogs had a negative impact on wildlife. Cat owners showed the strongest support for confining cats inside the house at night (89% agreement). Cat owners' non-supportive attitudes toward cat confinement were partly because of higher concern for cat quality of life and lower concern about their cats' predation behaviours, compared to non-cat owners.

Dimethyl sulfoxide favors the emetic efficacy of lycorine in beagle dogs - a novel strategy for the treatment of poisoning.
By emesis response analysis four dimethyl sulfoxide (DMSO)-based active pharmaceutical ingredient (API) formulations were favored. Two of them (lycorine hydrochloride, 15 mg/mL in 70% DMSO, 10% ethanol, and 20% water; and lycorine hydrochloride, 15 mg/mL in 50% DMSO, 50% water) qualified for further drug development. Both formulations ensure a safe pharmacologically induced emesis within about 30 min after injection, suitable for use as an in time decontaminant in acute poisoning of dogs. DMSO-based formulations were well tolerated and offer a novel promising strategy for treatment of poisoning.