Arthritis Microregulator
The results of a pilot study presented at the Annual European Congress of Rheumatology (EULAR 2019) confirm the effectiveness of electrical stimulation of the vagus nerve in the treatment of patients with rheumatoid arthritis. According to the authors, the results of the work will help not only with rheumatoid arthritis, but also other chronic inflammatory diseases.
The vagus nerve is the longest and most complex of the 12 pairs of cranial nerves. The name "vagus" in Latin means "wandering", it stretches from the brain to the organs of the neck, chest and abdomen.
Recent advances in neurobiology and immunology have identified mechanisms in the brain that regulate immune responses. In one of the chains (inflammatory reflex), impulses are transmitted to the vagus nerve and inhibit the production of cytokines, including tumor necrosis factor (TNF), a pro–inflammatory molecule that is the main therapeutic target for rheumatoid arthritis. Activation of this reflex is believed to modulate innate immune responses without suppressing them or causing significant immunosuppression.
A group of researchers from Stanford University observed 14 patients with active rheumatoid arthritis who showed insufficient response to more than two disease-modifying anti-rheumatic drugs or to janus kinase inhibitors with more than two mechanisms of action. All study participants remained on stable background methotrexate intake. Patients were implanted with a miniature stimulator MicroRegulator and randomized into three groups: placebo, vagal neurostimulation daily once a day for one minute, or neurostimulation daily four times a day for a minute. The study lasted 12 weeks, as a result, patients from the stimulation group showed a better response to therapy once a day compared to the other groups: two-thirds of patients had a satisfactory and good response according to the EULAR criteria scale, the disease Activity Score parameter DAS28 was 1.24. The average change in DAS28 in the placebo group was 0.16.
The results were also confirmed by biochemical tests for the blood content of three of the extensive group of signaling molecules – cytokines. In the neurostimulation groups, the level of interleukins IL 1ß, IL-6 and TNF-α decreased by more than 30%.
Implantation and neurostimulation were generally well tolerated by patients.
The effectiveness of vagus nerve stimulation with MicroRegulator, proven in this pilot study, shows the need for a larger placebo-controlled study of this method of treating rheumatoid arthritis and possibly other chronic inflammatory diseases.
Aminat Adzhieva, portal "Eternal Youth" http://vechnayamolodost.ru based on Eurekalert: Vagus nerve stimulation study shows significant reduction in rheumatoid arthritis symptoms.