Strategies for precision vagus neuromodulation


Author: Umair Ahmed#1, Yao-Chuan Chang#1, Stefanos Zafeiropoulos1, Zeinab Nassrallah2, Larry Miller1, Stavros Zanos3,4

Affiliation: <sup>1</sup> Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA.

<sup>2</sup> Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.

<sup>3</sup> Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA. szanos@northwell.edu.

<sup>4</sup> Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA. szanos@northwell.edu.
Conference/Journal: Bioelectron Med
Date published: 2022 May 30
Other:
 Volume ID: 8   ,  Issue ID: 1   ,  Pages: 9   ,  Special Notes: doi: 10.1186/s42234-022-00091-1.   ,  Word Count: 199  
    The vagus nerve is involved in the autonomic regulation of physiological homeostasis, through vast innervation of cervical, thoracic and abdominal visceral organs. Stimulation of the vagus with bioelectronic devices represents a therapeutic opportunity for several disorders implicating the autonomic nervous system and affecting different organs. During clinical translation, vagus stimulation therapies may benefit from a precision medicine approach, in which stimulation accommodates individual variability due to nerve anatomy, nerve-electrode interface or disease state and aims at eliciting therapeutic effects in targeted organs, while minimally affecting non-targeted organs. In this review, we discuss the anatomical and physiological basis for precision neuromodulation of the vagus at the level of nerve fibers, fascicles, branches and innervated organs. We then discuss different strategies for precision vagus neuromodulation, including fascicle- or fiber-selective cervical vagus nerve stimulation, stimulation of vagal branches near the end-organs, and ultrasound stimulation of vagus terminals at the end-organs themselves. Finally, we summarize targets for vagus neuromodulation in neurological, cardiovascular and gastrointestinal disorders and suggest potential precision neuromodulation strategies that could form the basis for effective and safe therapies.



Keywords: Bioelectronic medicine; Branches; Fascicles; Neuromodulation; Noninvasive; Selective vagus nerve stimulation; Ultrasound; Vagus fibers.



PMID: 35637543 PMCID: PMC9150383 DOI: 10.1186/s42234-022-00091-1