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Comment by pazimzadeh | Hacker News Reader

This paper seems to describe the general strategy:

Neuronal regulation of the gut immune system and neuromodulation for treating inflammatory bowel disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8565205/

It would be incredible if it works, since it would avoid treatment with systemic immunosuppresives which can promote infection/cancer. However maybe there is still a local risk of the above?

I would also be concerned about the implant getting covered in nasty biofilms over time.

If this type of thing works, does that mean that medication that target the nerves might work against inflammatory disease?

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> can promote infection/cancer

Note that while TNF inhibitors like adalimumab (Humira) have a black box cancer warning in the US, this was based on assessing a small number of studies early on. We now have more than 20 years of studies and patient registry data, and later studies, including meta-analyses, have concluded that there is no additional risk of cancer with these TNF inhibitors.

E.g. see:

https://pubmed.ncbi.nlm.nih.gov/24361468/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770105/

A co-author of the first study is employed by Humira's maker; the second study was funded by it. Doesn't mean they are wrong, but it does suggest some skepticism is due.

Those were only the first two studies that came up on PubMed. There are a number of studies that support the same conclusions.

Yes but that's one drug, which does increase your risk of infection according to your links. There are other newer drugs for which we don't have 20 years of data.

The best thing is if we could target these drugs to only be activated in areas of active inflammation.

Yes, we have less data on newer drugs, but TNF inhibitors are currently the go-to medication for many autoimmune disorders, including Crohn's and UC.

Infection risk is currently the case with all current medications that act on the immune system. In all cases we are merely suppressing some pathway where the end goal is to reduce the immune response.

ThatMs really the best we can do until we actually identify the causes, and can address that rather than "dialing down" our immune systems.

Yes. My point is that we should try to get the drugs to home to the inflamed regions somehow.

I think most of these claims are BS, but I've met several people who have claimed to heal their own inflammatory diseases through non-medical practice to help regulate their vagus nerve. I know for me, these types of practices seem to help manage my symptoms. So maybe there is some connection.

What claims are BS. What did your friends do wrt their vagal nerve

That’s wishful thinking. Please don’t go off your IBD meds or you will regret it some day.

The vagus nerve sits inside the collarbone right next to the carotid artery. As a doctor told me once, if you're able to physically stimulate your vagus nerve, you need to get to A&E posthaste, lol

Look up vagal maneuvers. Used by a subset of tachycardia patients to reset to a typical heartbeat.

https://en.m.wikipedia.org/wiki/Vagal_maneuver

What's A&E? Googling only shows the cable network

Accidents & Emergency is what the Brits call the Emergency Room

"Accident & Emergency" - you may know it as the Emergency Room, but it's commonly called A&E in the UK

British for "emergency room."

IIRC there's a stage 2 Test device that uses vagus nerve stimulation through the tongue to attenuate tinnitus:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120162/

I think it's called the Susan Shore device, and nowadays is the main hope for curing tinnitus to some degree.

That makes more sense for IBS (irritable bowel syndrome) than it does for IBD (inflammatory bowel disease). IBS is caused by the gut-brain nervous system acting up due to stress, and vagal maneuvers forcibly turn off the fight-or-flight response from the nervous system. On the other hand, IBD is caused by your immune system attacking itself in the gut, and the T cells aren't really connected to the nervous system in any physiologically relevant way. So your friends were probably talking about IBS, not IBD.

Vagus nerve stimulation can help IBD

> The vagus nerve regulates inflammation and cytokine release through the inflammatory reflex. Recent pilot clinical trials using implantable bioelectronic devices have demonstrated the efficacy of vagus nerve stimulation (VNS) in adult patients with inflammatory bowel diseases (IBD) as an alternative to drug treatments.

https://bioelecmed.biomedcentral.com/articles/10.1186/s42234...

There could still be a link between the nervous system and IBD, too.

When I was diagnosed with UC, the inflammation perfectly correlated with a portion of the colon that was connected to a particular nerve (I can remember which - it was a few years ago by now).

I dismissed it as BS at the time, but a physiologist once asked me where I feel the physical sensation when I am stressed or anxious, and I said my gut. He thought that was very interesting (since I had recently been diagnosed with UC). I thought nothing of it, but maybe there is a link. (My wife, in contrast, feels anxiety and stress as a feeling in her chest.)

More and more, scientific research is pointing towards how all the systems in the body are connected one way or another, so I wouldn't be at all surprised if there is also a link between IBD and the nervous system.

> I would also be concerned about the implant getting covered in nasty biofilms over time.

The implant doesn't necessarily sit inside the gut though does it ? Just somewhere it can ping the relevant nerve.

I don't have the citation for this, but I learned in a class long ago that most implanted devices end up covered in biofilms, it's only a matter of time. Especially if it's plastic. e.g. breast implants, catheters, etc.

Bacterial biofilms? On implanted implants? How do they get there?

Your bodhi is filled with bacterial and archae, if they create a localized stronghold they'll form a protective biofilm.

I highly doubt that this would obviate the need for biologics, but I think it would probably work very well in combination.

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