Article about vagus nerve stimulation in treatment of arthritis

[BluesBrother]

I found an article which discusses the role of vagus nerve stimulation (using a new device) in the treatment of rheumatoid arthritis.

Koopman, F. A., P. R. Schuurman, M. J. Vervoordeldonk, and P. P. Tak. 2014. ?Vagus Nerve Stimulation: A New Bioelectronics Approach to Treat Rheumatoid Arthritis?? Best Practice & Research. Clinical Rheumatology 28 (4): 625?35. doi:10.1016/j.berh.2014.10.015.

The article can be freely accessed here: http://www.bprclinrheum.com/article/S1521-6942%2814%2900097-7/abstract

Rheumatoid arthritis is a chronic autoimmune disease. It has been suggested that POIS has features of an autoimmune condition. Since autoimmune conditions share similar features, the article might be relevant for POIS - also in light of the current research at Rutgers which focuses on the vagus nerve.

What made me wonder is whether there is also a connection to Niacin. The abstract is:

"There has been a marked improvement in the treatment of rheumatoid arthritis (RA), but most patients do not achieve disease remission. Therefore, there is still a need for new treatments. By screening an adenoviral short hairpin RNA library, we discovered that knockdown of the nicotinic acetylcholine receptor type 7 (α7nAChR) in RA fibroblast-like synoviocytes results in an increased production of mediators of inflammation and degradation. The α7nAChR is intimately involved in the cholinergic anti-inflammatory pathway (CAP). This led us to study the effects of α7nAChR activation in an animal model of RA, and we could show that this resulted in reduced arthritis activity. Accordingly, stimulation of the CAP by vagus nerve stimulation improved experimental arthritis. Conversely, we found aggravation of arthritis activity after unilateral cervical vagotomy as well as in α7nAChR-knockout mice. Together, these data provided the basis for exploration of vagus nerve stimulation in RA patients as a novel anti-inflammatory approach."

My knowledge about biology is extremely limited. Can someone explain whether the "nicotinic acetylcholine receptor type 7 (α7nAChR)" is related to Niacin?

[Quantum]

Hi BluesBrother,

You can find more information on this type of receptors at https://en.wikipedia.org/wiki/Alpha-7_nicotinic_receptor .  However, I did not find any link stating that niacin acts as an agonist or an antagonist to these receptors, so I do not see any link between the two.

Maybe the link above will help you find what you are looking for.

[Quantum]

Hi again , BluesBrother,

I have given a second thought to your question about niacin and the receptors you mention.  If they are nicotinic receptors, chances are I did not find niacin in the list of agonist because it is too obvious, as nicotinic acid and niacin are quite bioequivalent.  So, I think niacin is indeed an agonist of these receptors, meaning niacin activate them.

Niacin, anyway, is good for memory and cognition, which are helped by cholinergic activity, so niacin has cholinergic properties.  This is still more obvious when considering that niacin deficiency leads to cognition problems and memory loss ( see http://www.webmd.com/diet/niacin-deficiency-symptoms-and-treatments - note that this list is a mix of niacin and tryptophan deficiency symptoms, so you will find depression and apathy, among others, who are more related to tryptophan deficiency, which is absolutely needed for serotonin biosynthesis )

Not every POIS sufferer has low vagal tone.  As I have already mentioned, I have a very high vagal tone in general.   It is interesting, to say the least, that POIS never gave me any cognition and memory problems. Is it my high vagal tone that "protects" me from cognition problems , brain fog and memory loss ? I don'T know. If my way of seeing things is correct, vagal nerve stimulation would mostly relieve the cognition, brain fog and memory problems, what I call the pellagra-like and encenphalitis-like symptoms.  My high vagal tone do not "protect" me from fatigue and from depression, apathy, fatigue, loss of self-esteem, and other psychological and emotional symptoms.... I am eager to see what symptoms will be relieved by vagal nerve stimulation in the Rutgers study.  From my experience, I am not sure that emotional symptoms will be relieved by a higher vagal tone.  But reality is more complex than we think... the study results may be very surprising to me ... I stay open to anything that will happen. 

[demografx]

BluesBrother, thank you for starting this thread.

[BluesBrother]

Quantum, thanks a lot for your explanation!

I quote another part from the paper:

"These were the first indications that efferent vagus nerve activation could inhibit inflammation in an animal model. The combination of sensing peripheral inflammation by the afferent vagus nerve and the subsequent anti-inflammatory response of the efferent vagus nerve is currently known as the cholinergic anti-inflammatory pathway (CAP). The CAP can also be activated by electrical vagus nerve stimulation (VNS) or stimulation of the nicotinic acetylcholine receptor type 7 (α7nAChR)."

You hypothesize that only POIS patients with a low vagal tone might benefit from stimulation of the vagus nerve and that you yourself have a high vagal tone. You also wrote in different threads that Niacin has no effect for you. A hypothesis could thus be that in patients with high vagal tone the activation of the CAP - either by stimulation of the vagus nerve, or by taking Niacin - does have little or no beneficial effect. These might also be the patients with no cognitive symptoms. In contrast, patients with a low vagal tone might benefit from both taking Niacin and stimulation of the vagus nerve, and the channel might be activation of the CAP.

You also wrote in a different thread that for you Niacin has no effect, while stimulation of the vagus nerve makes symptoms worse. The mechanism is thus likely more complex - still, this is very interesting!

[Nightingale]

Regardless of if you tend to have high or low vagal tone, if your vagus nerve is dysregulated then you will likely benefit from a stimulator. It works not unlike a pacemaker, sending out pulses to help the nerve regulate itself if it is out of tone.

It can be confusing to understand if you have high or low vagal tone. It's counter-intuitive: high vagal tone and you will feel "low" (depressed, low heart rate, etc.), low vagal tone and you will feel "on edge" (anxiety, racing heart, upset stomach, etc.) I have confused myself before, and may have even confused people on the forums as a result.

But what should not be confusing is that vagal nerve dystonia, high or low, can be treated by a nerve stimulator!

[Stef]

...It can be confusing to understand if you have high or low vagal tone...I have confused myself before, and may have even confused people on the forums as a result...

Nightingale -- LOL!!

I've also been confused about the vagal tone concept. But you had nothing to do with my confusion -- I take full credit for it.

Actually -- you've just cleared it up (for me). Thank you. :-)

Stef

[Quantum]

You also wrote in a different thread that for you Niacin has no effect, while stimulation of the vagus nerve makes symptoms worse. The mechanism is thus likely more complex - still, this is very interesting!

Hi BluesBrother,

I just want to clarity that the symptoms that get worst for me when stimulating the vagus nerve are not my POIS symptoms.  When I get more 'vagal' , I get nausea, dizziness, and a headache, and those symptoms are not part of my POIS symptoms.  But you are absolutely right, POIS physiopathology is likely very complex.

[Quantum]

Regardless of if you tend to have high or low vagal tone, if your vagus nerve is dysregulated then you will likely benefit from a stimulator. It works not unlike a pacemaker, sending out pulses to help the nerve regulate itself if it is out of tone.

It can be confusing to understand if you have high or low vagal tone. It's counter-intuitive: high vagal tone and you will feel "low" (depressed, low heart rate, etc.), low vagal tone and you will feel "on edge" (anxiety, racing heart, upset stomach, etc.) I have confused myself before, and may have even confused people on the forums as a result.

But what should not be confusing is that vagal nerve dystonia, high or low, can be treated by a nerve stimulator!

Thank you for this interesting precision about the vagus nerve stimulators , Nightingale.  While I am familiar with the concept of vagal tone, I am not very familiar with the vagus nerve stimulator technology.  In the light of what you have said, this device should be called a vagus nerve "regulator", which would be more representative of what it really does.

Let's hope it will be useful in POIS, then, either for those with a too high or a too low vagal tone.