J Anesth Perioper Med. 2018;5(3):161-168. https://doi.org/10.24015/ebcmed.JAPM.2018.0012
From the Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Correspondence to Dr. Fu-Shan Xue at firstname.lastname@example.org or email@example.com.
EBCMED ID: ebcmed.JAPM.2018.0012 DOI: 10.24015/ebcmed.JAPM.2018.0012
Aim of review
The hyper-inflammatory response is the classical pathogenesis of sepsis course. It has been shown that efferent vagal nerve stimulation (VNS) can regulate inflammatory response through a combination of acetylcholine and special α7 nicotinic acetylcholine receptor expressed on macrophages, which is defined as the cholinergic anti-inflammatory pathway (CAP). Furthermore, therapeutic methods related to CAP have been studied on lots of pathologic conditions, such as sepsis, ischemia/reperfusion injury, pancreatitis and hemorrhagic shock, etc. The aim of this review is to provide the evidence that VNS may be an effective adjuvant treatment bringing benefits for prognosis of sepsis by controlling excessive inflammatory response.
We searched literatures published in the Pubmed with keywords “inflammation”, “sepsis” and “vagal nerve stimulation (VNS)” from January, 1986 to November, 2016, analyzed them and then assessed the evidence as to whether VNS may be an effective adjuvant for treatment of sepsis. In this review, the evidence regarding the role of hyper-inflammatory response in the pathogenesis of sepsis and inflammatory regulation of CAP will first be described. Then, the possible beneficial effects of VNS on inflammatory response of sepsis by modulating CAP will be provided.
Sepsis is complex interactions between infecting microorganism and host’s immune, inflammatory, and coagulation systems. The beneficial effects provided by CAP activation have been demonstrated on lots of pathologic conditions related to inflammation. Furthermore, VNS has been shown to promote the gastrointestinal motility and provide protection of intestinal barrier, reducing organ injury. In addition, VNS has been effectively used for treatment of some diseases in clinical practice.
There is limited number of effective therapies available for septic patients. Because the CAP plays an important role in the regulation of inflammatory response, we consider that with the standard intensive care therapy, VNS may be an effective adjuvant treatment bringing benefits for prognosis of sepsis by controlling excessive inflammatory response. If efficiency of this new intervention is proved by clinical experiments, it may represent an exciting opportunity to develop novel therapeutics recovering unregulated inflammatory response in septic patients. (Funded by the National Natural Science Foundation of China).
Declaration of Interests
The authors declare no other potential conflicts of interest for this work.
This research was funded by a grant (81170128) from the National Natural Science Foundation of China. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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