Regulation of Inflammatory Responses by Vagus Nerve Stimulation in Patients with Rheumatoid Arthritis

Kevin Tracey, M.D.

North Shore-Long Island Jewish Health System Foundation

Department of Microbiology & Immunology
Funded in September, 2007: $200000 for 3 years
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Regulation of Inflammatory Responses by Vagus Nerve Stimulation in Patients with Rheumatoid Arthritis

Researchers plan to determine whether an externally applied deep brain stimulator can control the activity of the vagus nerve to reduce painful inflammation and improve outcomes in patients with intractable autoimmune rheumatoid arthritis.  
Only recently have scientists begun to understand and appreciate the ability of the brain to directly control certain immune functions.  This is the case with the vagus nerve.  Scientists have long known that the nerve connects to the brain and lungs to control heart rate and respiration, and to many other organs, including the spleen and liver. These two organs are major sources of immune cells called “cytokines” that mount an inflammatory response. While the vagus nerve normally allows for a constant low level of cytokines to be produced and released into the body, the Long Island Jewish Hospital researchers recently have found that it is under-active in patients with rheumatoid arthritis.  This decreased vagus nerve activity allows an excessive amount of cytokines to be released into the body, where they produce painful joint inflammation.
The investigators hypothesize that an externally applied deep brain stimulator can increase vagus nerve activity to suppress cytokine production and reduce joint inflammation in rheumatoid arthritis patients. If so, this form of deep brain stimulation (DBS) could become a potent treatment for the 60 percent of rheumatoid arthritis patients who do not respond to available treatment.  They propose to test this hypothesis in 30 rheumatoid arthritis patients and 30 healthy volunteers.