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Snyder HE, Pai N, Meaney B, Sloan Birbeck C, Whitney R, Johnson N, Rosato L, Jones K. Significant vomiting and weight loss in a pediatric epilepsy patient secondary to vagus nerve stimulation: A case report and review of the literature. Epilepsy Behav Rep 2023; 24:100626. [PMID: 37867486 PMCID: PMC10585338 DOI: 10.1016/j.ebr.2023.100626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023] Open
Abstract
Vagus nerve stimulation is a neuromodulatory treatment option for individuals with drug resistant epilepsy who are not resective surgical candidates. As the vagus nerve has widespread neural connections, stimulation can lead to an array of adverse effects. While vomiting and weight loss are known side effects of vagus nerve stimulation, these are typically transient, mild, and do not limit the ability to continue treatment. We describe a 17-year-old female with drug resistant focal epilepsy secondary to tuberous sclerosis complex, who began to experience daily emesis and significant weight loss approximately 2.5 years after VNS device insertion. Her body mass index progressively fell from between the 75th-85th percentiles to less than the first percentile. She underwent extensive workup by neurology, gastroenterology, and adolescent medicine services with no obvious cause identified. Prior to the insertion of an enteral tube for feeding support and urgent weight restoration, her vagus nerve stimulator was switched off, resulting in immediate cessation of her vomiting and a dramatically rapid recovery of weight over the ensuing few months. This case emphasizes the need to consider adverse effects of vagus nerve stimulation in the differential diagnosis of patients with otherwise unexplained new medical sequelae, and provides evidence potentially linking vagal stimulation to significant malnutrition-related complications. Outside of GI-related effects, few studies have shown late-onset adverse effects from VNS, including laryngeal and facial pain as well as bradyarrhythmia. Further research is needed to elucidate the exact mechanisms of vagus nerve stimulation to better anticipate and mitigate adverse effects, and to understand the pathophysiology of late-onset adverse effects in previously tolerant VNS patients.
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Affiliation(s)
- Hannah E. Snyder
- Division of Pediatric Neurology, Department of Pediatrics, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Nikhil Pai
- Division of Pediatric Gastroenterology, Department of Pediatrics, McMaster University, Hamilton, Ontario L8S 4K1, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Brandon Meaney
- Division of Pediatric Neurology, Department of Pediatrics, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Cynthia Sloan Birbeck
- Division of Pediatric Neurology, Department of Pediatrics, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Robyn Whitney
- Division of Pediatric Neurology, Department of Pediatrics, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Natasha Johnson
- Division of Adolescent Medicine, Department of Pediatrics, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Laura Rosato
- Division of Child Psychiatry, Department of Psychiatry and Behavioural Neurosciences, St. Joseph’s Healthcare Hamilton West 5 Campus, Hamilton, Ontario L8N 3K7, Canada
| | - Kevin Jones
- Division of Pediatric Neurology, Department of Pediatrics, McMaster University, Hamilton, Ontario L8S 4K1, Canada
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Fadel MG, Fehervari M, Das B, Soleimani-Nouri P, Ashrafian H. Vagal Nerve Therapy in the Management of Obesity: A Systematic Review and Meta-Analysis. Eur Surg Res 2023; 64:365-375. [PMID: 37544303 DOI: 10.1159/000533358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The vagus nerve has an important role in satiety, metabolism, and autonomic control in upper gastrointestinal function. However, the role and effects of vagal nerve therapy on weight loss remain controversial. This systematic review and meta-analysis assessed the effects of vagal nerve therapy on weight loss, body mass index (BMI), and obesity-related conditions. METHODS MEDLINE, EMBASE, and CINAHL databases were searched for studies up to April 2022 that reported on percentage excess weight loss (%EWL) or BMI at 12 months or remission of obesity-related conditions following vagal nerve therapy from January 2000 to April 2022. Weighted mean difference (WMD) was calculated, meta-analysis was performed using random-effects models, and between-study heterogeneity was assessed. RESULTS Fifteen studies, of which nine were randomised controlled trials, of 1,447 patients were included. Vagal nerve therapy led to some improvement in %EWL (WMD 17.19%; 95% confidence interval [CI]: 10.94-23.44; p < 0.001) and BMI (WMD -2.24 kg/m2; 95% CI: -4.07 to -0.42; p = 0.016). There was a general improvement found in HbA1c following vagal nerve therapy when compared to no treatment given. No major complications were reported. CONCLUSIONS Vagal nerve therapy can safely result in a mild-to-moderate improvement in weight loss. However, further clinical trials are required to confirm these results and investigate the possibility of the long-term benefit of vagal nerve therapy as a dual therapy combined with standard surgical bariatric interventions.
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Affiliation(s)
- Michael G Fadel
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matyas Fehervari
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Bibek Das
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
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Chang YC, Ahmed U, Jayaprakash N, Mughrabi I, Lin Q, Wu YC, Gerber M, Abbas A, Daytz A, Gabalski AH, Ashville J, Dokos S, Rieth L, Datta-Chaudhuri T, Tracey KJ, Guo T, Al-Abed Y, Zanos S. kHz-frequency electrical stimulation selectively activates small, unmyelinated vagus afferents. Brain Stimul 2022; 15:1389-1404. [PMID: 36241025 PMCID: PMC10164362 DOI: 10.1016/j.brs.2022.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Vagal reflexes regulate homeostasis in visceral organs and systems through afferent and efferent neurons and nerve fibers. Small, unmyelinated, C-type afferents comprise over 80% of fibers in the vagus and form the sensory arc of autonomic reflexes of the gut, lungs, heart and vessels and the immune system. Selective bioelectronic activation of C-afferents could be used to mechanistically study and treat diseases of peripheral organs in which vagal reflexes are involved, but it has not been achieved. METHODS We stimulated the vagus in rats and mice using trains of kHz-frequency stimuli. Stimulation effects were assessed using neuronal c-Fos expression, physiological and nerve fiber responses, optogenetic and computational methods. RESULTS Intermittent kHz stimulation for 30 min activates specific motor and, preferentially, sensory vagus neurons in the brainstem. At sufficiently high frequencies (>5 kHz) and at intensities within a specific range (7-10 times activation threshold, T, in rats; 15-25 × T in mice), C-afferents are activated, whereas larger, A- and B-fibers, are blocked. This was determined by measuring fiber-specific acute physiological responses to kHz stimulus trains, and by assessing fiber excitability around kHz stimulus trains through compound action potentials evoked by probing pulses. Aspects of selective activation of C-afferents are explained in computational models of nerve fibers by how fiber size and myelin shape the response of sodium channels to kHz-frequency stimuli. CONCLUSION kHz stimulation is a neuromodulation strategy to robustly and selectively activate vagal C-afferents implicated in physiological homeostasis and disease, over larger vagal fibers.
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Affiliation(s)
- Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Naveen Jayaprakash
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Ibrahim Mughrabi
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Qihang Lin
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2052, Australia
| | - Yi-Chen Wu
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Michael Gerber
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Adam Abbas
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Anna Daytz
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Arielle H Gabalski
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Jason Ashville
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2052, Australia
| | - Loren Rieth
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, 26506, United States
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Tianruo Guo
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2052, Australia
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
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Kozorosky EM, Lee CH, Lee JG, Nunez Martinez V, Padayachee LE, Stauss HM. Transcutaneous auricular vagus nerve stimulation augments postprandial inhibition of ghrelin. Physiol Rep 2022; 10:e15253. [PMID: 35441808 PMCID: PMC9020171 DOI: 10.14814/phy2.15253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 05/15/2023] Open
Abstract
Vagus nerve stimulation (VNS) facilitates weight loss in animals and patients treated with VNS for depression or epilepsy. Likewise, chronic transcutaneous auricular VNS (taVNS) reduces weight gain and improves glucose tolerance in Zucker diabetic fatty rats. If these metabolic effects of taVNS observed in rats translate to humans is unknown. Therefore, the hypothesis of this study was that acute application of taVNS affects glucotropic and orexigenic hormones which could potentially facilitate weight loss and improve glucose tolerance if taVNS were applied chronically. In two single-blinded randomized cross-over protocols, blood glucose levels, plasma concentrations of insulin, C-peptide, glucagon, leptin, and ghrelin, together with heart rate variability and baroreceptor-heart rate reflex sensitivity were determined before and after taVNS (left ear, 10 Hz, 300 µs, 2.0-2.5 mA, 30 min) or sham-taVNS (electrode attached to ear with the stimulator turned off). In a first protocol, subjects (n = 16) were fasted throughout the protocol and in a second protocol, subjects (n = 10) received a high-calorie beverage (220 kCal) after the first blood sample, just before initiation of taVNS or sham-taVNS. No significant effects of taVNS on heart rate variability and baroreceptor-heart rate reflex sensitivity and only minor effects on glucotropic hormones were observed. However, in the second protocol taVNS significantly lowered postprandial plasma ghrelin levels (taVNS: -115.5 ± 28.3 pg/ml vs. sham-taVNS: -51.2 ± 30.6 pg/ml, p < 0.05). This finding provides a rationale for follow-up studies testing the hypothesis that chronic application of taVNS may reduce food intake through inhibition of ghrelin and, therefore, may indirectly improve glucose tolerance through weight loss.
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Affiliation(s)
| | - Cristina H. Lee
- Burrell College of Osteopathic MedicineLas CrucesNew MexicoUSA
| | - Jessica G. Lee
- Burrell College of Osteopathic MedicineLas CrucesNew MexicoUSA
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5
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Acute vagus nerve stimulation does not affect liking or wanting ratings of food in healthy participants. Appetite 2021; 169:105813. [PMID: 34798227 DOI: 10.1016/j.appet.2021.105813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
The vagus nerve plays a vital role in the regulation of food intake and vagal afferent signals may help regulate food cue reactivity by providing negative homeostatic feedback. Despite strong evidence from preclinical studies on vagal afferent "satiety" signals in guiding food intake, evidence from human studies is largely inconclusive to date. Here, we investigated the acute effects of left or right transcutaneous auricular vagus nerve stimulation (taVNS) on subjective ratings of wanting and liking of various food and non-food items in 82 healthy participants (46 women, MBMI = 23.1 kg/m2). In contrast to previous reports in patients with depression, we found moderate to anecdotal evidence supporting the absence of taVNS-induced changes in food ratings. To test whether the absence of taVNS effects on food ratings is due to heterogeneity in the sample, we conducted post hoc subgroup analyses by splitting the data according to stimulation side and sex (between-subject factors) as well as caloric density, perceived healthiness, and flavor (sweet vs. savory) of the food (within-subject factors). This multiverse analysis largely supported the absence of taVNS-induced changes since the strongest subgroup effects provided only anecdotal evidence in favor of taVNS-induced changes. We conclude that acute taVNS only has a marginal effect on subjective ratings of food, suggesting that it is an unlikely mechanism for the reported long-term effects of VNS on body weight. In light of an absence of acute taVNS effects on conscious food liking and wanting, our results call for future research on the correspondence between acute and chronic effects of vagal afferent stimulation.
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Maharjan A, Peng M, Cakmak YO. The effects of frequency-specific, non-invasive, median nerve stimulation on food-related attention and appetite. Appetite 2021; 169:105807. [PMID: 34798222 DOI: 10.1016/j.appet.2021.105807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/17/2022]
Abstract
Median nerve stimulation (MNS) in the existing literature has been used for treating gastrointestinal disorders and amelioration of nausea and vomiting. Recently, studies have shown that MNS can also exert effects on olfactory performances and corresponding anatomical regions through the activation of vagal pathways. This study aimed to test effects of specific frequencies of MNS on food-related attention and appetite. The experiment used an odourised, dot probe task for testing food-related attention and a combination of behavioural (i.e., visual analogue scales; VAS) and physiological approaches (i.e., electrocardiograph; ECG - root mean square of successive differences between normal heartbeats-RMSSD: parasympathetic nervous system activation (RMSSD), stress index-SI: sympathetic nervous system activation) for measuring hunger, appetite, and satiation. Twenty-four healthy, male adults completed a VAS and dot probe task before and after receiving either 40 Hz-, 80 Hz-, 120 Hz MNS or sham (control) across four different sessions with continuous ECG recording throughout each session. Data from the dot probe task were analysed using repeated-measures ANOVA, while pair-wise tests were used for ECG recordings and VAS. Improvements on the dot probe task, not specific to odour-food congruence were found after 40 Hz MNS (p-value = 0.048; strong effect size (0.308 partial eta squared)) while increased ratings of hunger (VAS) (p-value = 0.03, small effect size (0.47 Cohen-D)) and RMSSD scores (p-value < 0.001; medium effect size (0.76 Cohen-D)) were found after 120 Hz MNS. These findings implore further testing of MNS frequency parameters on improving RMSSD, a characteristic marker of measuring parasympathetic/autonomic nervous system activation pertaining to the vagal network. Furthermore, improving sympathovagal balance is associated with cardiovascular benefits in numerous health-related conditions such as obesity, hypertension and diabetes.
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Affiliation(s)
- Ashim Maharjan
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Mei Peng
- Sensory Neuroscience Laboratory, Department of Food Science, University of Otago, Dunedin, New Zealand
| | - Yusuf O Cakmak
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand; Brain Health Research Centre, Dunedin, New Zealand; Medical Technologies Centre of Research Excellence, Auckland, New Zealand.
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7
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Loper H, Leinen M, Bassoff L, Sample J, Romero-Ortega M, Gustafson KJ, Taylor DM, Schiefer MA. Both high fat and high carbohydrate diets impair vagus nerve signaling of satiety. Sci Rep 2021; 11:10394. [PMID: 34001925 PMCID: PMC8128917 DOI: 10.1038/s41598-021-89465-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/26/2021] [Indexed: 11/23/2022] Open
Abstract
Obesity remains prevalent in the US. One potential treatment is vagus nerve stimulation (VNS), which activates the sensory afferents innervating the stomach that convey stomach volume and establish satiety. However, current VNS approaches and stimulus optimization could benefit from additional understanding of the underlying neural response to stomach distension. In this study, obesity-prone Sprague Dawley rats consumed a standard, high-carbohydrate, or high-fat diet for several months, leading to diet-induced obesity in the latter two groups. Under anesthesia, the neural activity in the vagus nerve was recorded with a penetrating microelectrode array while the stomach was distended with an implanted balloon. Vagal tone during distension was compared to baseline tone prior to distension. Responses were strongly correlated with stomach distension, but the sensitivity to distension was significantly lower in animals that had been fed the nonstandard diets. The results indicate that both high fat and high carbohydrate diets impair vagus activity.
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Affiliation(s)
- Hailley Loper
- Malcom Randall VA Medical Center, Gainesville, FL, USA.,Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Monique Leinen
- Malcom Randall VA Medical Center, Gainesville, FL, USA.,Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Logan Bassoff
- Malcom Randall VA Medical Center, Gainesville, FL, USA.,Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Jack Sample
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,College of Medicine & Life Sciences, University of Toledo, Toledo, OH, USA
| | - Mario Romero-Ortega
- Departments of Biomedical Engineering and Biomedical Sciences, University of Houston, Houston, TX, USA
| | - Kenneth J Gustafson
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Dawn M Taylor
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Department of Neurosciences, The Cleveland Clinic, Cleveland, OH, USA
| | - Matthew A Schiefer
- Malcom Randall VA Medical Center, Gainesville, FL, USA. .,Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA. .,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
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8
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Tseng CT, Brougher J, Gaulding SJ, Hassan BS, Thorn CA. Vagus nerve stimulation promotes cortical reorganization and reduces task-dependent calorie intake in male and female rats. Brain Res 2020; 1748:147099. [DOI: 10.1016/j.brainres.2020.147099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 12/29/2022]
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Abstract
Present project is concerned with the possibility to modulate the neural regulation of food intake by non-invasive stimulation of the vagus nerve. This nerve carries viscero-afferent information from the gut and other internal organs and therefore serves an important role in ingestive behavior. The electrical stimulation of the vagus nerve (VNS) is a qualified procedure in the treatment of drug-resistant epilepsy and depression. Since weight loss is a known common side effect of VNS treatment in patients with implanted devices, VNS is evaluated as a treatment of obesity. To investigate potential VNS-related changes in the cognitive processing of food-related items, 21 healthy participants were recorded in a 3-Tesla scanner in two counterbalanced sessions. Participants were presented with 72 food pictures and asked to rate how much they liked that food. Before entering the scanner subjects received a 1-h sham or verum stimulation, which was implemented transcutanously with a Cerbomed NEMOS® device. We found significant activations in core areas of the vagal afferent pathway, including left brainstem, thalamus, temporal pole, amygdala, insula, hippocampus, and supplementary motor area for the interaction between ratings (high vs low) and session (verum vs sham stimulation). Significant activations were also found for the main effect of verum compared to sham stimulation in the left inferior and superior parietal cortex. These results demonstrate an effect of tVNS on food image processing even with a preceding short stimulation period. This is a necessary prerequisite for a therapeutic application of tVNS which has to be evaluated in longer-term studies.
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Abstract
PURPOSE OF REVIEW Appetitive behaviors are mediated through homeostatic and reward signaling of brain circuits. There has been increasing interest in the use of neuromodulation techniques aimed at targeting brain regions such as the lateral prefrontal and subcortical regions associated with dysregulation of eating behaviors. RECENT FINDINGS Invasive brain stimulation techniques have demonstrated promising results in treating severe and enduring anorexia nervosa and morbid obesity. In addition, non-invasive techniques have been shown to successfully reduce food craving, hunger ratings, and calorie intake as well as binge/purge symptoms in eating disorders. Brain stimulation offers promising results for treating symptoms associated with eating disorders and modifying appetitive behaviors including craving and caloric consumption. Future research should focus on identifying optimal frequency and duration of stimulation and employ longitudinal studies to assess long-term effectiveness on clinical outcomes such as eating disorder symptomatology, weight loss, and sustained improvements in eating behaviors over time.
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Affiliation(s)
- Rebecca Dendy
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 4212 North 16th Street, Room 541, Phoenix, AZ, 85016, USA
| | - Emma J Stinson
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, PA, USA
| | | | - Marci E Gluck
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 4212 North 16th Street, Room 541, Phoenix, AZ, 85016, USA.
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11
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Barathikannan K, Chelliah R, Rubab M, Daliri EBM, Elahi F, Kim DH, Agastian P, Oh SY, Oh DH. Gut Microbiome Modulation Based on Probiotic Application for Anti-Obesity: A Review on Efficacy and Validation. Microorganisms 2019; 7:microorganisms7100456. [PMID: 31623075 PMCID: PMC6843309 DOI: 10.3390/microorganisms7100456] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/27/2019] [Accepted: 10/12/2019] [Indexed: 12/12/2022] Open
Abstract
The growing prevalence of obesity has become an important problem worldwide as obesity has several health risks. Notably, factors such as excessive food consumption, a sedentary way of life, high sugar consumption, a fat-rich diet, and a certain genetic profile may lead to obesity. The present review brings together recent advances regarding the significance of interventions involving intestinal gut bacteria and host metabolic phenotypes. We assess important biological molecular mechanisms underlying the impact of gut microbiota on hosts including bile salt metabolism, short-chain fatty acids, and metabolic endotoxemia. Some previous studies have shown a link between microbiota and obesity, and associated disease reports have been documented. Thus, this review focuses on obesity and gut microbiota interactions and further develops the mechanism of the gut microbiome approach related to human obesity. Specifically, we highlight several alternative diet treatments including dietary changes and supplementation with probiotics. The future direction or comparative significance of fecal transplantation, synbiotics, and metabolomics as an approach to the modulation of intestinal microbes is also discussed.
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Affiliation(s)
- Kaliyan Barathikannan
- Department of Food Science and Biotechnology, College of Agriculture and Life Sciences, Kangwon National University, Chuncheon, Gangwon-do 24341, Korea.
| | - Ramachandran Chelliah
- Department of Food Science and Biotechnology, College of Agriculture and Life Sciences, Kangwon National University, Chuncheon, Gangwon-do 24341, Korea.
| | - Momna Rubab
- Department of Food Science and Biotechnology, College of Agriculture and Life Sciences, Kangwon National University, Chuncheon, Gangwon-do 24341, Korea.
| | - Eric Banan-Mwine Daliri
- Department of Food Science and Biotechnology, College of Agriculture and Life Sciences, Kangwon National University, Chuncheon, Gangwon-do 24341, Korea.
| | - Fazle Elahi
- Department of Food Science and Biotechnology, College of Agriculture and Life Sciences, Kangwon National University, Chuncheon, Gangwon-do 24341, Korea.
| | - Dong-Hwan Kim
- Kangwon Institute of Inclusive Technology, Kangwon National University, Chuncheon, Gangwon-do 24341, Korea.
| | - Paul Agastian
- Department of Plant Biology and Biotechnology, Loyola College, Chennai 600-034, India.
| | - Seong-Yoon Oh
- Three & Four Co., Ltd., 992-15, Jusan-ri, Hojeo-myeon, Wonju-si 26460, Korea.
| | - Deog Hwan Oh
- Department of Food Science and Biotechnology, College of Agriculture and Life Sciences, Kangwon National University, Chuncheon, Gangwon-do 24341, Korea.
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12
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Stauss HM, Daman LM, Rohlf MM, Sainju RK. Effect of vagus nerve stimulation on blood glucose concentration in epilepsy patients - Importance of stimulation parameters. Physiol Rep 2019; 7:e14169. [PMID: 31325231 PMCID: PMC6642273 DOI: 10.14814/phy2.14169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 11/24/2022] Open
Abstract
In previous animal experiments, we demonstrated that cervical vagus nerve stimulation (VNS) inhibits pancreatic insulin secretion, thereby raises blood glucose levels, and impairs glucose tolerance through afferent signaling. However, there are no reports suggesting that similar effects occur in patients treated with chronic cervical VNS for epilepsy. In contrast to clinical VNS used for epilepsy, where the stimulation is intermittent with cycles of on and off periods, stimulation was continuous in our previous animal experiments. Thus, we hypothesized that the timing of the stimulation on/off cycles is critical to prevent impaired glucose tolerance in epilepsy patients chronically treated with cervical VNS. We conducted a retrospective analysis of medical records from patients with epilepsy. Blood glucose levels did not differ between patients treated with pharmacotherapy only (98 ± 4 mg/dL, n = 16) and patients treated with VNS plus pharmacotherapy (99 ± 3 mg/dL, n = 24, duration of VNS 4.5 ± 0.5 years). However, a multiple linear correlation analysis of patients with VNS demonstrated that during the follow‐up period of 7.9 ± 0.7 years, blood glucose levels increased in patients with long on and short off periods, whereas blood glucose did not change or even decreased in patients that were stimulated with short on and long off periods. We conclude that chronic cervical VNS in patients with epilepsy is unlikely to induce glucose intolerance or hyperglycemia with commonly used stimulation parameters. However, stimulation on times of longer than 25 sec may bear a risk for hyperglycemia, especially if the stimulation off time is shorter than 200 sec.
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Affiliation(s)
- Harald M Stauss
- Department of Biomedical Sciences, Burrell College of Osteopathic Medicine, Las Cruces, New Mexico.,Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
| | - Lucienne M Daman
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
| | - Megan M Rohlf
- Pediatric Neurology, Department of Pediatrics, The University of Iowa, Iowa City, Iowa
| | - Rup K Sainju
- Department of Neurology, The University of Iowa, Iowa City, Iowa
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Mercante B, Ginatempo F, Manca A, Melis F, Enrico P, Deriu F. Anatomo-Physiologic Basis for Auricular Stimulation. Med Acupunct 2018; 30:141-150. [PMID: 29937968 DOI: 10.1089/acu.2017.1254] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: Stimulation of cranial nerves modulates central nervous system (CNS) activity via the extensive connections of their brainstem nuclei to higher-order structures. Clinical experience with vagus-nerve stimulation (VNS) demonstrates that it produces robust therapeutic effects, however, posing concerns related to its invasiveness and side-effects. Discussion: Trigeminal nerve stimulation (TNS) has been recently proposed as a valid alternative to VNS. The ear presents afferent vagus and trigeminal-nerve distribution; its innervation is the theoretical basis of different reflex therapies, including auriculotherapy. An increasing number of studies have shown that several therapeutic effects induced by invasive VNS and TNS, can be reproduced by noninvasive auricular-nerve stimulation. However, the sites and neurobiologic mechanisms by which VNS and TNS produce their therapeutic effects are not clear yet. Conclusions: Accumulating evidence suggests that VNS and TNS share multiple levels and mechanisms of action in the CNS.
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Affiliation(s)
- Beniamina Mercante
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100 Sassari Italy
| | - Francesca Ginatempo
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100 Sassari Italy
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100 Sassari Italy
| | - Francesco Melis
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100 Sassari Italy
| | - Paolo Enrico
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100 Sassari Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43/b, 07100 Sassari Italy
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14
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Cozzens JW. The Surgical Technique of Vagus Nerve Stimulator Implantation. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Stauss HM. Differential hemodynamic and respiratory responses to right and left cervical vagal nerve stimulation in rats. Physiol Rep 2017; 5:5/7/e13244. [PMID: 28400500 PMCID: PMC5392529 DOI: 10.14814/phy2.13244] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 12/30/2022] Open
Abstract
Neuromodulation through vagal nerve stimulation (VNS) is currently explored for a variety of clinical conditions. However, there are no established VNS parameters for animal models of human diseases, such as hypertension. Therefore, the aim of this study was to assess hemodynamic and respiratory responses to right‐ or left‐sided cervical VNS in a hypertensive rat model. Anesthetized stroke‐prone spontaneously hypertensive rats were instrumented for arterial blood pressure and heart rate monitoring and left‐ or right‐sided VNS. Cervical VNS was applied through bipolar coil electrodes. Stimulation parameters tested were 3 V and 6 V, 2 Hz to 20 Hz stimulation frequency, and 50 μsec to 20 msec pulse duration. Each combination of stimulation parameters was applied twice with altered polarity, that is, anode and cathode in the cranial and caudal position. Respiration rate was derived from systolic blood pressure fluctuations. In general, cervical VNS caused bradycardia, hypotension, and tachypnea. These responses were more pronounced with left‐sided than with right‐sided VNS and depended on the stimulation voltage, stimulation frequency, and pulse duration, but not on the polarity of stimulation. Furthermore, the results suggest that at low stimulation frequencies (<5 Hz) and short pulse durations (<0.5 msec) primarily larger A‐fibers are activated, while at longer pulse durations (>0.5 msec) smaller B‐fibers are also recruited. In conclusion, in rats left‐sided cervical VNS causes greater cardio‐respiratory responses than right‐sided VNS and at lower stimulation frequencies (e.g., 5 Hz), longer pulse durations (>0.5 msec) seem to be required to consistently recruit B‐fibers in addition to A‐fibers.
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Affiliation(s)
- Harald M Stauss
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
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16
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Torres-Fuentes C, Schellekens H, Dinan TG, Cryan JF. The microbiota-gut-brain axis in obesity. Lancet Gastroenterol Hepatol 2017; 2:747-756. [PMID: 28844808 DOI: 10.1016/s2468-1253(17)30147-4] [Citation(s) in RCA: 361] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/04/2017] [Accepted: 05/07/2017] [Indexed: 12/16/2022]
Abstract
Changes in microbial diversity and composition are increasingly associated with several disease states including obesity and behavioural disorders. Obesity-associated microbiota alter host energy harvesting, insulin resistance, inflammation, and fat deposition. Additionally, intestinal microbiota can regulate metabolism, adiposity, homoeostasis, and energy balance as well as central appetite and food reward signalling, which together have crucial roles in obesity. Moreover, some strains of bacteria and their metabolites might target the brain directly via vagal stimulation or indirectly through immune-neuroendocrine mechanisms. Therefore, the gut microbiota is becoming a target for new anti-obesity therapies. Further investigations are needed to elucidate the intricate gut-microbiota-host relationship and the potential of gut-microbiota-targeted strategies, such as dietary interventions and faecal microbiota transplantation, as promising metabolic therapies that help patients to maintain a healthy weight throughout life.
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Affiliation(s)
| | - Harriët Schellekens
- APC Microbiome Institute, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Timothy G Dinan
- APC Microbiome Institute, University College Cork, Cork, Ireland; Department of Psychiatry and Neurobehavioural Sciences, University College Cork, Cork, Ireland
| | - John F Cryan
- APC Microbiome Institute, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland.
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17
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Khan FA, Poongkunran M, Buratto B. Desensitization of stimulation-induced weight loss: A secondary finding in a patient with vagal nerve stimulator for drug-resistant epilepsy. EPILEPSY & BEHAVIOR CASE REPORTS 2017; 8:51-54. [PMID: 28879091 PMCID: PMC5577401 DOI: 10.1016/j.ebcr.2017.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/01/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Fawad A Khan
- The International Center for Epilepsy at Ochsner, Ochsner Neuroscience Institute, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, United States.,The University of Queensland School of Medicine, Ochsner Clinical School, 1514 Jefferson Highway, New Orleans, LA 70121, United States
| | - Mugilan Poongkunran
- The International Center for Epilepsy at Ochsner, Ochsner Neuroscience Institute, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, United States
| | - Bonnie Buratto
- The International Center for Epilepsy at Ochsner, Ochsner Neuroscience Institute, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, United States
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18
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Effects of chronic abdominal vagal stimulation of small-diameter neurons on brain metabolism and food intake. Brain Stimul 2017; 10:735-743. [PMID: 28551320 DOI: 10.1016/j.brs.2017.04.126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/20/2017] [Accepted: 04/23/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Abdominal bilateral vagal stimulation reduces food intake in animals. However, the classical square wave, mA range current generator is poorly effective to evoke action potentials on A∂ and C neurons that represent the majority of vagal neurons at the abdominal level. OBJECTIVE/HYPOTHESIS METHODS: The current thresholds for pulsons (S2 & S3) and millisecond pulses (S1) required to trigger action potentials were calculated in 5 anaesthetized pigs using single fibre recording. Similar stimulation protocols were compared chronically to sham stimulation in 24 pigs. After two weeks of chronic stimulation, food intake and brain metabolism were investigated. The electrical characteristics and histology of the vagus nerve were also studied. RESULTS S3 stimulation required a lower amount of charges to trigger an action potential. Chronically applied S2 & S3 activated the dorsal vagal complex and increased the metabolism of its afferent cortical structures. They also reduced energy intake together with a reduced ingestion of high fat and high sugar diets. All these effects were not observed for the S1 group. The vagal histology for the S1, S2 and S3 groups was not different from that of the sham. CONCLUSIONS These findings demonstrate that pulsons applied bilaterally on the abdominal vagus reduced food intake as a consequence of the activation of the brainstem and higher-order brain areas.
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19
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Malbert CH, Picq C, Divoux JL, Henry C, Horowitz M. Obesity-Associated Alterations in Glucose Metabolism Are Reversed by Chronic Bilateral Stimulation of the Abdominal Vagus Nerve. Diabetes 2017; 66:848-857. [PMID: 28082456 DOI: 10.2337/db16-0847] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/09/2017] [Indexed: 02/05/2023]
Abstract
Acute vagal stimulation modifies glucose and insulin metabolism, but the effect of chronic bilateral vagal stimulation is not known. Our aim was to quantify the changes in whole-body and organ-specific insulin sensitivities 12 weeks after permanent, bilateral, vagal stimulation performed at the abdominal level in adult mini-pigs. In 15 adult mini-pigs, stimulating electrodes were placed around the dorsal and ventral vagi using laparoscopy and connected to a dual-channel stimulator placed subcutaneously. Animals were divided into three groups based on stimulation and body weight (i.e., lean nonstimulated, obese nonstimulated, and obese stimulated). Twelve weeks after surgery, glucose uptake and insulin sensitivity were measured using positron emission tomography during an isoglycemic clamp. Mean whole-body insulin sensitivity was lower by 34% (P < 0.01) and the hepatic glucose uptake rate was lower by 33% (P < 0.01) in obese-nonstimulated mini-pigs but was no different in obese-stimulated compared with lean mini-pigs. An improvement in skeletal glucose uptake rate was also observed in obese-stimulated compared with obese-nonstimulated groups (P < 0.01). Vagal stimulation was associated with increased glucose metabolism in the cingulate and prefrontal brain areas. We conclude that chronic vagal stimulation improves insulin sensitivity substantially in diet-induced obesity by both peripheral and central mechanisms.
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Affiliation(s)
- Charles-Henri Malbert
- Ani-Scans, Department of Nutrition, French National Institute for Agricultural Research, Saint-Gilles, France
| | | | | | | | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
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20
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Young HA, Watkins H. Eating disinhibition and vagal tone moderate the postprandial response to glycemic load: a randomised controlled trial. Sci Rep 2016; 6:35740. [PMID: 27761024 PMCID: PMC5071767 DOI: 10.1038/srep35740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/04/2016] [Indexed: 11/18/2022] Open
Abstract
Reducing the glycemic load (GL) of the diet may benefit appetite control but its utility is complicated by psychological influences on eating. Disinhibited behaviour, a risk factor for overconsumption, is characterized by reduced prefrontal cortex activity, which in turn modulates vagal tone; a phenomenon associated with glucoregulation. This double blind randomised controlled trial explored for the first time the influence of disinhibited eating and vagal tone (heart rate variability (HRV)) on hunger and the postprandial response to GL. Blood glucose (BG) and hunger were measured 30 and 150 min after consumption of water, glucose or isomaltulose (low glycemic sugar). After consuming glucose, independently of BMI or habitual diet, those with the highest levels of disinhibition had higher BG levels after thirty minutes (B = 0.192, 95% CI LL. 086, UL 0.297), and lower BG after one hundred and fifty minutes (B = −0.240, 95% CI LL −0.348, UL −0.131). BG was related to hunger but only in low disinhibited eaters. Disinhibited eaters were characterised by a reduced HRV which was related to greater BG excursions (B = 0.407, 95% CI LL 0.044, UL 1.134). These findings highlight novel mechanisms by which disinhibited eating leads to obesity and insulin resistance. This trial was registered at clinicaltrials.gov NCT02827318.
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Affiliation(s)
- Hayley A Young
- Department of Psychology, Swansea University Swansea, SA2 8PP Wales, UK
| | - Heather Watkins
- Department of Psychology, Swansea University Swansea, SA2 8PP Wales, UK
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21
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Meyers EE, Kronemberger A, Lira V, Rahmouni K, Stauss HM. Contrasting effects of afferent and efferent vagal nerve stimulation on insulin secretion and blood glucose regulation. Physiol Rep 2016; 4:e12718. [PMID: 26884478 PMCID: PMC4759047 DOI: 10.14814/phy2.12718] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 11/24/2022] Open
Abstract
Parasympathetic activation reduces hepatic glucose release and increases pancreatic insulin secretion in hyperglycemic conditions. Thus, vagal nerve stimulation (VNS) may potentially be effective in treating type II diabetes. To investigate this possibility, we hypothesized that VNS reduces blood glucose concentration [Glu] via insulin secretion. [Glu] together with insulin and glucagon serum concentrations were determined in anesthetized rats during baseline conditions and 120 min of cervical VNS with the nerve left intact for combined afferent and efferent VNS (n = 9) or the nerve sectioned proximal or distal from the stimulation electrode for selective efferent (n = 8) or afferent (n = 7) VNS, respectively. Afferent VNS caused a strong and sustained increase in [Glu] (+108.9 ± 20.9% or +77.6 ± 15.4%, after 120 min of combined afferent and efferent VNS or selective afferent VNS) that was not accompanied by an increase in serum insulin concentration. However, serum insulin levels increased significantly with selective efferent VNS (+71.2 ± 27.0% after 120 min of VNS) that increased [Glu] only temporarily (+28.8 ± 11.7% at 30 min of VNS). Efferent VNS initially increased serum glucagon concentration which remained elevated for 120 min when efferent VNS was combined with afferent VNS, but returned to baseline with selective efferent VNS. These findings demonstrate that afferent VNS causes a marked and sustained increase in [Glu] that is partly mediated by suppression of pancreatic insulin secretion. In contrast, efferent VNS stimulates pancreatic glucagon secretion that appears to be antagonized by insulin secretion in the case of selective efferent VNS. Selective efferent VNS may potentially be effective in treating type II diabetes.
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Affiliation(s)
- Erin E Meyers
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
| | - Ana Kronemberger
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
| | - Vitor Lira
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
| | - Kamal Rahmouni
- Department of Pharmacology, The University of Iowa, Iowa City, Iowa
| | - Harald M Stauss
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
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22
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Val-Laillet D, Aarts E, Weber B, Ferrari M, Quaresima V, Stoeckel L, Alonso-Alonso M, Audette M, Malbert C, Stice E. Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity. Neuroimage Clin 2015; 8:1-31. [PMID: 26110109 PMCID: PMC4473270 DOI: 10.1016/j.nicl.2015.03.016] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 12/11/2022]
Abstract
Functional, molecular and genetic neuroimaging has highlighted the existence of brain anomalies and neural vulnerability factors related to obesity and eating disorders such as binge eating or anorexia nervosa. In particular, decreased basal metabolism in the prefrontal cortex and striatum as well as dopaminergic alterations have been described in obese subjects, in parallel with increased activation of reward brain areas in response to palatable food cues. Elevated reward region responsivity may trigger food craving and predict future weight gain. This opens the way to prevention studies using functional and molecular neuroimaging to perform early diagnostics and to phenotype subjects at risk by exploring different neurobehavioral dimensions of the food choices and motivation processes. In the first part of this review, advantages and limitations of neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), pharmacogenetic fMRI and functional near-infrared spectroscopy (fNIRS) will be discussed in the context of recent work dealing with eating behavior, with a particular focus on obesity. In the second part of the review, non-invasive strategies to modulate food-related brain processes and functions will be presented. At the leading edge of non-invasive brain-based technologies is real-time fMRI (rtfMRI) neurofeedback, which is a powerful tool to better understand the complexity of human brain-behavior relationships. rtfMRI, alone or when combined with other techniques and tools such as EEG and cognitive therapy, could be used to alter neural plasticity and learned behavior to optimize and/or restore healthy cognition and eating behavior. Other promising non-invasive neuromodulation approaches being explored are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS). Converging evidence points at the value of these non-invasive neuromodulation strategies to study basic mechanisms underlying eating behavior and to treat its disorders. Both of these approaches will be compared in light of recent work in this field, while addressing technical and practical questions. The third part of this review will be dedicated to invasive neuromodulation strategies, such as vagus nerve stimulation (VNS) and deep brain stimulation (DBS). In combination with neuroimaging approaches, these techniques are promising experimental tools to unravel the intricate relationships between homeostatic and hedonic brain circuits. Their potential as additional therapeutic tools to combat pharmacorefractory morbid obesity or acute eating disorders will be discussed, in terms of technical challenges, applicability and ethics. In a general discussion, we will put the brain at the core of fundamental research, prevention and therapy in the context of obesity and eating disorders. First, we will discuss the possibility to identify new biological markers of brain functions. Second, we will highlight the potential of neuroimaging and neuromodulation in individualized medicine. Third, we will introduce the ethical questions that are concomitant to the emergence of new neuromodulation therapies.
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Key Words
- 5-HT, serotonin
- ADHD, attention deficit hyperactivity disorder
- AN, anorexia nervosa
- ANT, anterior nucleus of the thalamus
- B N, bulimia nervosa
- BAT, brown adipose tissue
- BED, binge eating disorder
- BMI, body mass index
- BOLD, blood oxygenation level dependent
- BS, bariatric surgery
- Brain
- CBF, cerebral blood flow
- CCK, cholecystokinin
- Cg25, subgenual cingulate cortex
- DA, dopamine
- DAT, dopamine transporter
- DBS, deep brain stimulation
- DBT, deep brain therapy
- DTI, diffusion tensor imaging
- ED, eating disorders
- EEG, electroencephalography
- Eating disorders
- GP, globus pallidus
- HD-tDCS, high-definition transcranial direct current stimulation
- HFD, high-fat diet
- HHb, deoxygenated-hemoglobin
- Human
- LHA, lateral hypothalamus
- MER, microelectrode recording
- MRS, magnetic resonance spectroscopy
- Nac, nucleus accumbens
- Neuroimaging
- Neuromodulation
- O2Hb, oxygenated-hemoglobin
- OCD, obsessive–compulsive disorder
- OFC, orbitofrontal cortex
- Obesity
- PD, Parkinson's disease
- PET, positron emission tomography
- PFC, prefrontal cortex
- PYY, peptide tyrosine tyrosine
- SPECT, single photon emission computed tomography
- STN, subthalamic nucleus
- TMS, transcranial magnetic stimulation
- TRD, treatment-resistant depression
- VBM, voxel-based morphometry
- VN, vagus nerve
- VNS, vagus nerve stimulation
- VS, ventral striatum
- VTA, ventral tegmental area
- aCC, anterior cingulate cortex
- dTMS, deep transcranial magnetic stimulation
- daCC, dorsal anterior cingulate cortex
- dlPFC, dorsolateral prefrontal cortex
- fMRI, functional magnetic resonance imaging
- fNIRS, functional near-infrared spectroscopy
- lPFC, lateral prefrontal cortex
- pCC, posterior cingulate cortex
- rCBF, regional cerebral blood flow
- rTMS, repetitive transcranial magnetic stimulation
- rtfMRI, real-time functional magnetic resonance imaging
- tACS, transcranial alternate current stimulation
- tDCS, transcranial direct current stimulation
- tRNS, transcranial random noise stimulation
- vlPFC, ventrolateral prefrontal cortex
- vmH, ventromedial hypothalamus
- vmPFC, ventromedial prefrontal cortex
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Affiliation(s)
| | - E. Aarts
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - B. Weber
- Department of Epileptology, University Hospital Bonn, Germany
| | - M. Ferrari
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - V. Quaresima
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - L.E. Stoeckel
- Massachusetts General Hospital, Harvard Medical School, USA
| | - M. Alonso-Alonso
- Beth Israel Deaconess Medical Center, Harvard Medical School, USA
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Chronic Electrical Stimulation at Acupoints Reduces Body Weight and Improves Blood Glucose in Obese Rats via Autonomic Pathway. Obes Surg 2014; 25:1209-16. [DOI: 10.1007/s11695-014-1521-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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