Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis

TLDR

Rheumatoid arthritis is a chronic autoimmune disease driven by joint inflammation, and recent work has identified the vagus nerve as a neural circuit that can suppress tumor necrosis factor, a key inflammatory mediator, though its efficacy in human patients had not yet been demonstrated. The study shows that vagus nerve stimulation reduces TNF levels and lessens disease severity in RA patients.

Abstract

Significance Rheumatoid arthritis (RA) is a chronic, prevalent, and disabling autoimmune disease that occurs when inflammation damages joints. Recent advances in neuroscience and immunology have mapped neural circuits that regulate the onset and resolution of inflammation. In one circuit, termed “the inflammatory reflex,” action potentials transmitted in the vagus nerve inhibit the production of tumor necrosis factor (TNF), an inflammatory molecule that is a major therapeutic target in RA. Although studied in animal models of arthritis and other inflammatory diseases, whether electrical stimulation of the vagus nerve can inhibit TNF production in humans has remained unknown. The positive mechanistic results reported here extend the preclinical data to the clinic and reveal that vagus nerve stimulation inhibits TNF and attenuates disease severity in RA patients.