Nutritional modulation of immune response via vagus nerve:Preclinical studies and future perspectives

Abstract

The immune response is influenced by the autonomic nervous system, that in turn receives continuous input from the digestivetract. Enriched enteral nutrition inhibits the acute inflammatory response and preserves organ integrity via activation of peripheral cholecystokinin receptors on the vagus nerve.Importantly, nutritional stimulation of the vagus nerve is protective both when initiated before inflammation develops or tissue damage is present and when initiated during an unfolding inflammatory response. Beneficial effects of enriched enteral nutrition were shown in several experimental settings including hemorrhagic shock, exposure to bacterial DNA, endotoxemia, acute hemolysis, postoperative ileus, and polymicrobial sepsis. Also in a human model of endotoxemia, the acute inflammatory response was inhibited by continuous delivery of enriched enteral nutrition in the proximal small intestine. Specific nutritional intervention aimed at the modulation of the inflammatory response via parasympathetic signaling is in line with present nutritional guidelines that recommend timely administration of enteral nutrition in critically ill and postoperative patients. Currently, clinical trials are set up to investigate the applicability of nutritional stimulation of the autonomic nervous system in critical care and surgical settings.