Vagus Nerve Stimulation May Be a Potential Adjunct Therapy F
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COVID-19 was initially described as lung inflammation, or pneumonia, in older adults. However, we now know that SARS-CoV-2 infections can cause a wide range of symptoms in people of all ages, ranging from no symptoms at all to systemic inflammation and even death. An excessive inflammatory phase called “cytokine storm” can occur in severely infected patients.

A new hypothesis and theory article focuses on the stimulation of the vagus nerve as a potential COVID-19 therapy. In this approach, the activity of cholinergic anti-inflammatory pathways is manipulated, and, recently, this therapeutic strategy has become an important approach for the treatment of inflammatory diseases and sepsis. This therapy exploits the cholinergic anti-inflammatory pathways (CAP) pathways that innervate the spleen via the efferent vagus nerve.

The spleen nerve relays and acts on macrophages by altering adrenergic stimulation into a cholinergic signal by the T cells of the spleen, which in turn causes an anti-inflammatory effect. Around 80% of the vagus nerve consists of afferent sensory fibers, which carry information from the periphery to the brain. NTS projections to brainstem nuclei alter the release of serotonin and norepinephrine in the brain, altering serotonin and N-phenomenon.

The electrical stimulation of the vagus nerve enhances the inflammatory reflex signaling and lowers the production of cytokine. This approach has successfully reduced disease severity in an animal study associated with inflammatory diseases and sepsis. Scientists have revealed that the approach of electrical stimulation of the vagus nerve has minimal side effects. For instance, implanted vagus nerve stimulation devices are being used for decades to treat severe recurrent refractory depression and refractory partial-onset seizures.

Scientists have found that vagus nerve stimulation by peripheral lipopolysaccharide lowers the inflammatory response in the central nervous system of rats. Further, in a porcine model of sepsis, this approach has successfully minimized multiple organ dysfunction. Thereby, researchers revealed that vagus nerve stimulation could be a promising adjunctive therapy for the treatment of COVID-19 patients.

This therapeutic strategy has also shown positive cardiovascular effects during sepsis, which includes antiarythmogen, lowering of myocardial oxygen consumption, and improved diastole. Recently, scientists have revealed that the use of non-invasive transcutaneous vagus nerve stimulation devices (t-VNS) has shown significant results in two COVID-19 patients. Researchers believe that the use of non-invasive VNS as adjunct therapy might reduce multiorgan dysfunction in COVID-19 patients.

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