The study was supported by the Swedish Research Council, the Swedish Rheumatism Asociation, Karolinska Institute Foundations, Stockholm County Council, The Wallenberg Foundation, and the GV 80 Years' Foundation for research. The authors would also like to thank Hannah Aucott for proofreading the manuscript.

All animal experiments were performed according to the guidelines for the care and use of animals approved by the local Ethics Committee at Karolinska Institutet, Stockholm. The local Ethics Committee follows the European Union directives on animal care.
NOTE: The main changes from the original protocol are the recovery time after surgery (6 hr versus 1 hr) and the level of LPS injected (2 mg/kg versus 15 mg/kg). Otherwise, the different settings related to the surgery itself have not been changed.
1. Preparing Material for Stimulation
<ol>
	<li>Turn on the computer and the data acquisition system linked to the stimulating electrode (Figure 1A).</li>
	<li>Enter the Acknowledge program.</li>
	<li>Prepare a stock solution of LPS at a concentration of 5 mg/ml in 1x PBS, aliquot it, and store it at -20 &#176;C. On the day of the experiment, thaw an aliquot and prepare an adequate sample of LPS (0.5 mg/ml) in order to inject around 100 &#181;l into the animal, according to the weight.</li>
</ol>
2. Preparing the Animal for Anesthesia
<ol>
	<li>Use C57Bl/6 mice. Maintain them under climate-controlled conditions with a 12-hr light/dark cycle, feed them standard rodent chow, and give them water ad libitum.</li>
	<li>Perform surgery on mice that weigh around 25 g on the day of the experiment. 
	NOTE: When inflammatory reactions are induced, it is particularly important to perform regular checkups and observations of the clinical reactions in the animals. Premature euthanasia by CO2 inhalation is needed if the animal condition does not fulfill the ethical criteria.</li>
	<li>Set the anesthetic machine.
	<ol>
		<li>Make sure that the tubing is properly connected and is not damaged in any way. Make sure that the ventilated area is working properly. Connect the key filter to the isoflurane bottle and fill the vaporizer with a sufficient amount of isoflurane.</li>
		<li>Open the gas supply (air and oxygen) and make sure that the bottles contain enough gas for the experiment. A three-way connector is then able to send the isoflurane flow to the induction chamber or the mask.</li>
	</ol>
	</li>
	<li>Turn the three-way connector to the induction chamber. Pick one mouse from the home cage and insert the animal into the chamber. Adjust the flow regulator to 1.0 L/min oxygen and 1.0 L/min air. Adjust the isoflurane concentration to 4 - 5%.</li>
	<li>When the desired level of anesthesia is reached, When the desired level of anesthesia is reached, shave the surgical area and move the animal from the chamber to the mask.&#160;Turn the three-way connector to the mask flow. Adjust the flow regulator to 0.25 L/min oxygen and 0.25 L/min air.
	<ol>
		<li>Adjust the isoflurane concentration to 1.5 - 2.5%. Check the level of anesthesia by reflex control and respiratory rate before starting the surgical procedure.</li>
	</ol>
	</li>
	<li>Fix the legs of the mouse to the work bench using adhesive tape. Make sure that the nose of the animal is still carefully positioned in the mask.</li>
</ol>
3. Surgery and Stimulation of the Vagus Nerve
<ol>
	<li>Disinfect the surgical area with 70% ethanol.</li>
	<li>Using a scalpel, carefully incise the skin at the level of the neck (incision of around 1 to 1.5 cm). 
	Note: In the protocol, the surgery procedure ends here for SHAM-operated animals. Indeed, it has been shown that just touching the nerve with a metal tool already stimulates it to some extent. Therefore, to get a more accurate surgery control animal when using a small amount of LPS, stop the surgery at this step.</li>
	<li>With the help of a microscope (12.5X objective), isolate the left vagus nerve from the carotid artery using dissecting forceps. First locate the sternocleidomastoid muscle by removing skin and fat layers, and then retract it in order to put the forceps behind both the nerve and the artery. 
	Note: The following step is very tricky, as the nerve and artery are closely adhered to each other. Therefore, it is very easy to cut the vessel and kill the animal. However, by placing the forceps very carefully between the nerve and artery, they eventually separate, and it is possible to isolate the nerve.</li>
	<li>Place the electrode (Figure 1B) under the vagus nerve. The needle electrode is quite long, so even if the nerve moves slightly during the stimulation, it will always be in contact with the electrode.</li>
	<li>Perform an intraperitoneal (i.p.) injection of LPS (2 mg/kg) with the help of a syringe (for the read-out on cytokine levels; i.e., to measure the down-regulating effect).</li>
	<li>Wait 5 min before starting the stimulation.</li>
	<li>Stimulate the vagus nerve for 5 min at 5 V and 1 Hz by pushing the start button in the Acknowledge program.</li>
	<li>Remove the electrode and suture the wound of the animal with surgical suture thread.</li>
	<li>Spray a No Sting Barrier Film (NSBF) on the wound in order to improve healing and to protect from infections.</li>
</ol>
4. Recovery of the Animal
<ol>
	<li>After surgery, move the animal back to its home cage for awakening and recovery. Under infra-red light in order to maintain body temperature, make sure to monitor the animal until full consciousness has been regained.</li>
	<li>Let the animal recover in its cage for 6 hr before sacrifice for analysis. 
	Note: The effect of the vagus nerve stimulation is very fast and has also been shown to be long lasting (up to 48 hr), so the recovery time can be set by the experimenter according to the needs of the study.</li>
</ol>
5. Sacrifice for Further Analysis
<ol>
	<li>Place the animal in a cage linked to a CO2 administration device.</li>
	<li>Set the device on a 5-min cycle of CO2 inhalation.</li>
	<li>When the euthanasia is done, collect the organs of interest and directly freeze them on dry ice for further analysis (e.g., the measurement of cytokine levels in spleen extracts using a mouse TH1/TH2 9-Plex assay)3.</li>
</ol>

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The authors have nothing to disclose.

Since its discovery in the early 2000s, the mechanisms of the CAP have been thoroughly studied. We now have a good picture of the pathway, and in particular, the target organ, the spleen, where NE, memory T cells, Ach, and macrophages work as a very efficient team to down-regulate inflammatory mediators2. We have also recently published data on the importance of a functional prostaglandin system in mice, in particular, PGE2, which is obviously a mandatory component for ACh release in th...

Innate immunity provides an immediate first line of defense against infections and diseases in a wide range of organisms. It not only initiates the primary immune response to eliminate the threat, but it also plays a pivotal role in activating and educating the adaptive immunity that carries out secondary immune responses in a pathogen-specific manner. Inflammation is orchestrated by a plethora of cytokines and chemokines, which in turn have the ability to attract other immune cells to the site of infection and to induce the cardinal signs of inflammation, such as redness, swelling, pain, loss of function, and fever. The duration and intensity of inflammation depend on several factors, but resolving the inflammation and restoring homeostasis is a critical step to avoid the onset of chronic inflammatory diseases. Recent advances in the field of neuroscience and immunology have unraveled specific neural mechanisms with immense therapeutic potential to control inflammation both in the central nervous system and in the periphery. One of these mechanisms is the cholinergic anti-inflammatory pathway (CAP), also known as the inflammatory reflex, which is driven by the autonomic nervous system4,5.
It is currently thought that inflammatory mediators activate sensory nerves and send signals concerning the state of inflammation to the central nervous system. A reflex response is then activated through the efferent vagus nerve. An extensive study on the anatomical details of the CAP has revealed a parasympathetic-sympathetic model composed of two nerves, the vagus nerve and splenic nerve, respectively6. In the CAP, the activated cholinergic efferent vagus nerve ends in the celiac-mesenteric ganglion, resulting in the activation of the adrenergic splenic nerve by a mechanism yet to be explored. The splenic nerve, thus activated, is known to innervate in close proximity to immune cells in the white pulp, marginal zone, and red pulp of the spleen, the principal and mandatory organ of the CAP7,8. Norepinephrine (NE) from the splenic nerve endings binds to the corresponding &#946;2 adrenergic receptors expressed on splenic T lymphocytes. This induces choline acetyl transferase (ChAT)-mediated acetylcholine (ACh) release, which in turn activates &#945;7 nicotinic acetylcholine receptors (&#945;7nACh) on macrophages, thereby limiting cytokine production and inflammation2. Consequently, it is now clear that the nervous system is able to regulate inflammation in peripheral tissues and to restore local immune homeostasis.
As the name of the pathway suggests, the ACh system is of central importance to the functioning of this neuro-immune regulating pathway. Interestingly, the mechanisms involved in the activation of the CAP seem to be different in the periphery and in the central nervous system. While the importance of nicotinic receptors (&#945;7nAChR) in the spleen has been demonstrated earlier9, muscarinic receptors (mAChR) are mandatory for the central activation of the pathway10,11. More recently, peripheral administration of a centrally-acting M1 muscarinic agonist significantly suppressed serum and spleen tumor necrosis factor &#945; (TNF&#945;) during lethal murine endotoxemia, an action that required intact vagus nerve and splenic nerve signaling12. We have also shown recently that mice lacking prostaglandin E2 (PGE2) were not able to respond to vagus nerve stimulation and did not down-regulate the LPS-induced release of cytokines in the serum and spleen3. Therefore, the CAP might also be regulated by systems other than the main ACh pathway.
The vagus nerve has been named as such because of its wandering course in the body, innervating principal organs including the liver, lung, spleen, kidneys, and gut13. Considering this large innervation and the very potent immunosuppressive effect of the vagus nerve, the therapeutic potential of the CAP could cover a wide range of inflammatory conditions. The vagus nerve can be electrically (or mechanically) activated, with control over the voltage and frequency, and contrary to conventional treatment, with no drugs added to the body. Trials are currently underway in rheumatic patients, for instance, to test the clinical significance of VNS in treating chronic inflammation14. Altogether, the neuro-immune communication and regulation of inflammation are currently under investigation, which will provide a possible alternative treatment to conventional therapy. Therefore, analysis of the vagus nerve stimulation effect in the different innervated organs, but also characterization of the potential therapeutic action in animal models of chronic inflammation, would definitely give insights and hope for new potential therapeutic targets.
The original methodology developed by Tracey and colleagues4 could not be transposed to our field of research due to overstimulation of the inflammatory response (by a lethal dose of LPS) and a too-short time range between CAP activation and the read-out. In the present paper, we will present the changes made to the original protocol, compare the two different methodologies on cytokine levels, and highlight a new and opposite observation on the target organ (the spleen).

<table><tbody><tr><td>Computer</td><td>Toshiba</td><td>-</td><td>Any computer is actually compatible</td></tr><tr><td>MP-150 data acquisition system</td><td>Biopac Systems</td><td>MP150WSW</td><td></td></tr><tr><td>Acknowledge software</td><td>Biopac Systems</td><td></td><td></td></tr><tr><td>Mice C57Bl/6</td><td>Charles River</td><td></td><td></td></tr><tr><td>Anesthetic machine</td><td>Simtec Engineering</td><td></td><td></td></tr><tr><td>Medical oxygen bottle</td><td>AGA</td><td>107563</td><td></td></tr><tr><td>Medical air bottle&amp;nbsp;</td><td>AGA</td><td>108639</td><td></td></tr><tr><td>Vetflurane (1,000 mg/g)</td><td>Virbac</td><td>137317</td><td></td></tr><tr><td>LPS</td><td>Sigma-Aldrich</td><td>L2630</td><td></td></tr><tr><td>Saline</td><td>Merck Millipore</td><td>1024060080</td><td></td></tr><tr><td>PBS 10x</td><td>Sigma-Aldrich</td><td>P5493</td><td>Diluted 10 times for used concentration</td></tr><tr><td>Syringe (1 ml)</td><td>BD Plastipak</td><td>303172</td><td></td></tr><tr><td>Needles 23 G</td><td>KD-FINE</td><td>900284</td><td>0.6 x 30 mm (blue)</td></tr><tr><td>Microdissecting forceps (curved)</td><td>Sigma-Aldrich</td><td>F4142</td><td></td></tr><tr><td>Dissecting scissors</td><td>Sigma-Aldrich</td><td>Z265969</td><td></td></tr><tr><td>Surgical suture 4-0</td><td>Ethicon</td><td>G667G</td><td></td></tr><tr><td>Euthanasia unit</td><td>Euthanex Smartbox</td><td>EA-32000</td><td></td></tr><tr><td>Cavilon No Sting Barrier Film</td><td>3M Health Care</td><td>3346N</td><td></td></tr><tr><td>TH1/TH2 9-Plex assay, ultrasensitive kit</td><td>MesoScale Discovery</td><td>K15013C-1</td><td></td></tr><tr><td>Stimulating electrode device</td><td>Biopac Systems</td><td>STIMSOC</td><td></td></tr><tr><td>Aesculap Isis shaver</td><td>Agnthos</td><td>GT420</td><td></td></tr><tr><td>R70</td><td></td><td></td><td>Rodent diet from Lantmannen, Stockholm, Sweden</td></tr></tbody></table>

increased recovery time and decreased lps administration to study the vagus nerve stimulation mechanisms in limited inflammatory responses

Inflammation is a local response to infection and tissue damage mediated by activated macrophages, monocytes, and other immune cells that release cytokines and other mediators of inflammation. For a long time, humoral and cellular mechanisms have been studied for their role in regulating the immune response, but recent advances in the field of immunology and neuroscience have also unraveled specific neural mechanisms with interesting therapeutic potential. The so-called cholinergic anti-inflammatory pathway (CAP) has been described to control innate immune responses and inflammation in a very potent manner. In the early 2000s, Tracey and collaborators developed a technique that stimulates the vagus nerve and mimics the effect of the pathway. The methodology is based on the electrical stimulation of the vagus nerve at low voltage and frequency, in order to avoid any side effects of overstimulation, such as deregulation of heart rate variability. Electrical devices for stimulation are now available, making it easy to set up the methodology in the laboratory. The goal of this research was to investigate the potential involvement of prostaglandins in the CAP. Unfortunately, based on earlier attempts, we failed to use the original protocol, as the induced inflammatory response either was too high or was not suitable for enzymatic metabolism properties. The different settings of the original surgery protocol remained mostly unchanged, but the conditions regarding inflammatory induction and the time point before sacrifice were improved to fit our purposes (i.e., to investigate the involvement of the CAP in more limited inflammatory responses). 
The modified version of the original protocol, presented here, includes a longer time range between vagus nerve stimulation and analysis, which is associated with a lower induction of inflammatory responses. Additionally, while decreasing the level of lipopolysaccharides (LPS) to inject, we also came across new observations regarding mechanistic properties in the spleen.

Level of TNF&#945; and Interleukin-1&#946; (IL-1&#946;) after Increasing the Time Lapse after Surgery and Decreasing the Dose of LPS
As shown previously, using the original protocol, VNS decreased the levels of TNF&#945; (169.3 &#177; 24.9 pg/mg in SHAM versus 39.7 &#177; 10.8 pg/mg in VNS, p &#60; 0.001) and IL-1&#946; (360.0 &#177; 40.21 pg/mg in SHAM versus 191.7 &#177; 27.2 pg/mg in VNS, p &#60; 0.01) in the spleen after intrap...

Watch this Scientific Journal Video about Increased Recovery Time and Decreased LPS Administration to Study the Vagus Nerve Stimulation Mechanisms in Limited Inflammatory Responses at JoVE.com

Increased Recovery Time and Decreased LPS Administration to Study the Vagus Nerve Stimulation Mechanisms in Limited Inflammatory Responses

Vagus nerve stimulation has proven to have a strong efficacy for decreasing peripheral inflammation. Here, we present a modified vagus nerve stimulation protocol that allows for further examinations of the cholinergic anti-inflammatory mechanisms in limited inflammatory responses.

Inflammation is a local response to infection and tissue damage mediated by activated macrophages, monocytes, and other immune cells that release ...

increased-recovery-time-decreased-lps-administration-to-study-vagus

Research

JoVE Journal

Immunology and Infection

9.8K Views.  Karolinska University Hospital. Vagus nerve stimulation has proven to have a strong efficacy for decreasing peripheral inflammation. Here, we present a modified vagus nerve stimulation protocol that allows for further examinations of the cholinergic anti-inflammatory mechanisms in limited inflammatory responses.

Video: Increased Recovery Time and Decreased LPS Administration to Study the Vagus Nerve Stimulation Mechanisms in Limited Inflammatory Responses

Vagus Nerve Stimulation as a Tool to Induce Plasticity in Pathways Relevant for Extinction Learning

Extinction describes the process of attenuating behavioral responses to neutral stimuli when they no longer provide the reinforcement that has been maintaining the behavior. There is close correspondence between fear and human anxiety, and therefore studies of extinction learning might provide insight into the biological nature of anxiety-related disorders such as post-traumatic stress disorder, and they might help to develop strategies to treat them. Preclinical research aims to aid extinction learning and to induce targeted plasticity in extinction circuits to consolidate the newly formed memory. Vagus nerve stimulation (VNS) is a powerful approach that provides tight temporal and circuit-specific release of neurotransmitters, resulting in modulation of neuronal networks engaged in an ongoing task. VNS enhances memory consolidation in both rats and humans, and pairing VNS with exposure to conditioned cues enhances the consolidation of extinction learning in rats. Here, we provide a detailed protocol for the preparation of custom-made parts and the surgical procedures required for VNS in rats. Using this protocol we show how VNS can facilitate the extinction of conditioned fear responses in an auditory fear conditioning task. In addition, we provide evidence that VNS modulates synaptic plasticity in the pathway between the infralimbic (IL) medial prefrontal cortex and the basolateral complex of the amygdala (BLA), which is involved in the expression and modulation of extinction memory.

Vagus nerve stimulation (VNS) has emerged as a tool to induce targeted synaptic plasticity in the forebrain to modify a range of behaviors. This protocol describes how to implement VNS to facilitate the consolidation of fear extinction memory.

Extinction describes the process of attenuating behavioral responses to neutral stimuli when they no longer provide the reinforcement that has been ...

Behavior

Characterization of Inflammatory Responses During Intranasal Colonization with Streptococcus pneumoniae

Nasopharyngeal colonization by Streptococcus pneumoniae is a prerequisite to invasion to the lungs or bloodstream1. This organism is capable of colonizing the mucosal surface of the nasopharynx, where it can reside, multiply and eventually overcome host defences to invade to other tissues of the host. Establishment of an infection in the normally lower respiratory tract results in pneumonia. Alternatively, the bacteria can disseminate into the bloodstream causing bacteraemia, which is associated with high mortality rates2, or else lead directly to the development of pneumococcal meningitis. Understanding the kinetics of, and immune responses to, nasopharyngeal colonization is an important aspect of S. pneumoniae infection models.
Our mouse model of intranasal colonization is adapted from human models3 and has been used by multiple research groups in the study of host-pathogen responses in the nasopharynx4-7. In the first part of the model, we use a clinical isolate of S. pneumoniae to establish a self-limiting bacterial colonization that is similar to carriage events in human adults. The procedure detailed herein involves preparation of a bacterial inoculum, followed by the establishment of a colonization event through delivery of the inoculum via an intranasal route of administration. Resident macrophages are the predominant cell type in the nasopharynx during the steady state. Typically, there are few lymphocytes present in uninfected mice8, however mucosal colonization will lead to low- to high-grade inflammation (depending on the virulence of the bacterial species and strain) that will result in an immune response and the subsequent recruitment of host immune cells. These cells can be isolated by a lavage of the tracheal contents through the nares, and correlated to the density of colonization bacteria to better understand the kinetics of the infection.

Characterization of Inflammatory Responses During Intranasal Colonization with Streptococcus pneumoniae

Colonization of the murine nasopharynx with Streptococcus pneumoniae and the subsequent extraction of adherent or recruited cells is described. This technique involves flushing the nasopharynx and collection of the fluid through the nares and is adaptable for various readouts, including differential cell quantification and analysis of mRNA expression in situ.

Nasopharyngeal colonization by Streptococcus pneumoniae is a prerequisite to invasion to the lungs or bloodstream1. This organism is capable of colonizing ...

A Method of Nodose Ganglia Injection in Sprague-Dawley Rat

Afferent signaling via the vagus nerve transmits important general visceral information to the central nervous system from many diverse receptors located in the organs of the abdomen and thorax. The vagus nerve communicates information from stimuli such as heart rate, blood pressure, bronchopulmonary irritation, and gastrointestinal distension to the nucleus of solitary tract of the medulla. The cell bodies of the vagus nerve are located in the nodose and petrosal ganglia, of which the majority are located in the former. The nodose ganglia contain a wealth of receptors for amino acids, monoamines, neuropeptides, and other neurochemicals that can modify afferent vagus nerve activity. Modifying vagal afferents through systemic peripheral drug treatments targeted at the receptors on nodose ganglia has the potential of treating diseases such as sleep apnea, gastroesophageal reflux disease, or chronic cough. The protocol here describes a method of injection neurochemicals directly into the nodose ganglion. Injecting neurochemicals directly into the nodose ganglia allows study of effects solely on cell bodies that modulate afferent nerve activity, and prevents the complication of involving the central nervous system as seen in systemic neurochemical treatment. Using readily available and inexpensive equipment, intranodose ganglia injections are easily done in anesthetized Sprague-Dawley rats.

Afferent vagal signaling transmits important information to central nervous system from receptors located in organs of the abdomen and thorax. The nodose ganglia of vagus nerves contain many types of receptors that modulate vagal activity. This protocol describes a method of local injections of neurochemicals into the nodose ganglia.

Afferent signaling via the vagus nerve transmits important general visceral information to the central nervous system from many diverse receptors located ...

Neuroscience

Laboratory Administration of Transcutaneous Auricular Vagus Nerve Stimulation (taVNS): Technique, Targeting, and Considerations

Non-invasive vagus nerve stimulation (VNS) may be administered via a novel, emerging neuromodulatory technique known as transcutaneous auricular vagus nerve stimulation (taVNS). Unlike cervically-implanted VNS, taVNS is an inexpensive and non-surgical method used to modulate the vagus system. taVNS is appealing as it allows for rapid translation of basic VNS research and serves as a safe, inexpensive, and portable neurostimulation system for the future treatment of central and peripheral disease. The background and rationale for taVNS is described, along with electrical and parametric considerations, proper ear targeting and attachment of stimulation electrodes, individual dosing via determination of perception threshold (PT), and safe administration of taVNS.

Laboratory Administration of Transcutaneous Auricular Vagus Nerve Stimulation taVNS: Technique, Targeting, and Considerations

A methodological description of the technique, potential targets, and proper administration of transcutaneous auricular vagus nerve stimulation (taVNS) on the human ear is described.

Non-invasive vagus nerve stimulation (VNS) may be administered via a novel, emerging neuromodulatory technique known as transcutaneous auricular vagus ...

Nerve Stimulator-guided Injection of Autologous Stem Cells Near the Equine Left Recurrent Laryngeal Nerve

Recurrent laryngeal neuropathy (RLN) commonly affects horses and is characterized by abnormal respiratory sounds and exercise intolerance. The recurrent laryngeal nerve shows lesions of demyelination. The benefit of applying stem cells to demyelinated nerves has been demonstrated in various animal models. The aim of the study was to test the feasibility and safety of a peri-neuronal injection of autologous muscle-derived mesenchymal stem cells to the left recurrent laryngeal nerve in healthy horses by using an electrical nerve stimulator.
Muscle-derived stems cell are obtained from five healthy Standardbred horses by sampling 20 mg of muscle tissue with a semi-automatic 14 G biopsy needle from the triceps muscle. Movements of the larynx are monitored via upper-airway video endoscopy. The left recurrent laryngeal nerve is approached with an insulated nerve block needle. Nerve stimulation is applied, starting at 2 mA, and the successful abduction of the left arytenoid is monitored. The stimulation intensity is reduced progressively. When a loss of the motor response is observed at 0.5 mA, 107 autologous muscle-derived stem cells are injected. Two examiners, who are blinded to the time point, score the laryngeal function of the horses prior to the treatment and at day 1, day 7, and day 28 after the injection of the cells. In a sixth horse, 1 mL of 2% lidocaine is injected to further confirm the correct positioning of the needle. This leads to a temporary paralysis of the left arytenoid cartilage.
This study proves that the recurrent laryngeal nerve can be approached with the help of an electrical nerve stimulator and that the electrical stimulation of the nerve is well tolerated by the horses. No modification of the laryngeal function was observed in any of the horses after the injection of the stem cells. Further studies should be conducted to describe the effects of a peri-neuronal injection of autologous muscle-derived mesenchymal stem cells to horses suffering from RLN.

Here, we present a protocol to inject autologous muscle-derived stem cells in the proximity to the recurrent laryngeal nerve with the help of an electrical nerve stimulator. This novel technique may become useful for the treatment of equine recurrent laryngeal neuropathy.

Recurrent laryngeal neuropathy (RLN) commonly affects horses and is characterized by abnormal respiratory sounds and exercise intolerance. The recurrent ...

Medicine

Vagus Nerve Stimulation As an Adjunctive Neurostimulation Tool in Treatment-resistant Depression

Vagus nerve stimulation (VNS) is an approved neurostimulation therapy. The purpose of the method is to treat patients with therapy-resistant depression (TRD). VNS exhibits antidepressive and stabilizing effects. This method is particularly useful as a long-term treatment, in which up to two-thirds of patients respond. The vagus nerve stimulator is positioned on the left vagus nerve during a surgical procedure and is activated telemetrically by a wand connected to a handheld computerized device. The treating physician can perform various adjustments of the vagus nerve stimulator during in-office visits (e.g., by modifying stimulation intensity or stimulation frequency) to achieve maximum therapeutic effects with low side effects. Set-up of the device usually takes several months. Typical side effects include wound infection, temporary salivation, coughing, paralysis of the vocal cords, bradycardia, or even asystole. The patient can stop the VNS by placing a magnet over the generator. The current protocol describes delivery of the specific stimulation tool and methods for adjusting the tuning parameters to achieve the best remission rates in patients with TRD.

Vagus nerve stimulation (VNS) has been shown to be effective as an adjunct treatment for treatment-resistant depression (TRD). VNS leads to antidepressive and antisuicidal effects and quality of life improvements. This protocol offers a step-by-step guide to managing and adjusting a vagus nerve stimulator for efficient treatment of TRD.

Vagus nerve stimulation (VNS) is an approved neurostimulation therapy. The purpose of the method is to treat patients with therapy-resistant depression ...

Preparation of Peripheral Nerve Stimulation Electrodes for Chronic Implantation in Rats

Peripheral nerve cuff electrodes have long been used in the neurosciences and related fields for stimulation of, for example, vagus or sciatic nerves. Several recent studies have demonstrated the effectiveness of chronic VNS in enhancing central nervous system plasticity to improve motor rehabilitation, extinction learning, and sensory discrimination. Construction of chronically implantable devices for use in such studies is challenging due to rats&#8217; small size, and typical protocols require extensive training of personnel and time-consuming microfabrication methods. Alternatively, commercially available implantable cuff electrodes can be purchased at a significantly higher cost. In this protocol, we present a simple, low-cost method for construction of small, chronically implantable peripheral nerve cuff electrodes for use in rats. We validate the short and long-term reliability of our cuff electrodes by demonstrating that VNS in ketamine/xylazine anesthetized rats produces decreases in breathing rate consistent with activation of the Hering-Breuer reflex, both at the time of implantation and up to 10 weeks after device implantation. We further demonstrate the suitability of the cuff electrodes for use in chronic stimulation studies by pairing VNS with skilled lever press performance to induce motor cortical map plasticity.

Existing approaches for constructing chronically implantable peripheral nerve cuff electrodes for use in small rodents often require specialized equipment and/or highly trained personnel. In this protocol we demonstrate a simple, low-cost approach for fabricating chronically implantable cuff electrodes, and demonstrate their effectiveness for vagus nerve stimulation (VNS) in rats.

Peripheral nerve cuff electrodes have long been used in the neurosciences and related fields for stimulation of, for example, vagus or sciatic nerves. ...

Measurement of Neuromodulation by Transcutaneous Auricular Vagus Nerve  Stimulation

Understanding the Effects of Non&#45;Invasive Transauricular Vagus Nerve Stimulation on EEG and HRV

Several studies have demonstrated promising results of transcutaneous auricular vagus nerve stimulation (taVNS) in treating various disorders; however, no mechanistic studies have investigated this technique's neural network and autonomic nervous system effects. This study aims to describe how taVNS can affect EEG metrics, HRV, and pain levels. Healthy subjects were randomly allocated into two groups: the active taVNS group and the sham taVNS group. Electroencephalography (EEG) and Heart Rate Variability (HRV) were recorded at baseline, 30 min, and after 60 min of 30 Hz, 200-250 &#181;s taVNS, or sham stimulation, and the differences between the metrics were calculated. Regarding vagal projections, some studies have demonstrated the role of the vagus nerve in modulating brain activity, the autonomic system, and pain pathways. However, more data is still needed to understand the mechanisms of taVNS on these systems. In this context, this study presents methods to provide data for a deeper discussion about the physiological impacts of this technique, which can help future therapeutic investigations in various conditions.

Author Spotlight: Exploring the Effects of Transauricular Vagus Nerve Stimulation

This protocol provides information on how to apply transcutaneous auricular vagus nerve stimulation (taVNS) in a clinical trial, including potential biomarkers such as EEG metrics and heart rate variability (HRV) to measure the effect of this treatment on the autonomic nervous system.

Several studies have demonstrated promising results of transcutaneous auricular vagus nerve stimulation (taVNS) in treating various disorders; however, no ...

Abdominal VNS for Treating Inflammatory Conditions in Rat Models

Implantation Surgery for Abdominal Vagus Nerve Stimulation and Recording Studies in Awake Rats

Abdominal vagus nerve stimulation (VNS) can be applied to the subdiaphragmatic branch of the vagus nerve of rats. Due to its anatomical location, it does not have any respiratory and cardiac off-target effects commonly associated with cervical VNS. The lack of respiratory and cardiac off-target effects means that the intensity of stimulation does not need to be lowered to reduce side effects commonly experienced during cervical VNS. Few recent studies demonstrate the anti-inflammatory effects of abdominal VNS in rat models of inflammatory bowel disease, rheumatoid arthritis, and glycemia reduction in a rat model of type 2 diabetes. Rat is a great model to explore the potential of this technology because of the well-established anatomy of the vagus nerve, the large size of the nerve that allows easy handling, and the availability of many disease models. Here, we describe the methods for cleaning and sterilizing the abdominal VNS electrode array and surgical protocol in rats. We also describe the technology required for confirmation of suprathreshold stimulation by recording evoked compound action potentials. Abdominal VNS has the potential to offer selective, effective treatment for a variety of conditions, including inflammatory diseases, and the application is expected to expand similarly to cervical VNS.

Author Spotlight: Exploring Abdominal VNS for Inflammatory Conditions

The present protocol describes the surgical technique for implanting an electrode array onto the abdominal vagus nerve in rats, along with methods for chronic electrophysiology testing and stimulation using the implanted device.

Abdominal vagus nerve stimulation (VNS) can be applied to the subdiaphragmatic branch of the vagus nerve of rats. Due to its anatomical location, it does ...

Automated Periodic Stimulation Electrode Installation: A Technique to Surgically Implant An Automated Stimulation Device on the Vagus Nerve in a Porcine Model

Source: Wu, C. W., et al. <a href="https://www.jove.com/v/57919">Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model.</a> J. Vis. Exp. (2019).
In this video, we demonstrate the procedure for the installation of an automated periodic stimulation electrode on the vagus nerve for monitoring nerves during thyroid surgeries in a porcine model. This helps in the correct identification of the target nerve during surgical procedures.

Source: Wu, C. W., et al. Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model. J. Vis. Exp. (2019).
In this video, we demonstrate the ...

Increased Recovery Time and Decreased LPS Administration to Study the Vagus Nerve Stimulation Mechanisms in Limited Inflammatory Responses

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