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Is Vagus Nerve Stimulation Brain Washing?

View ORCID ProfileKevin P. Cheng, View ORCID ProfileSarah K. Brodnick, Stephan L. Blanz, Weifeng Zeng, Jack Kegel, Jane A. Pisaniello, Jared P. Ness, Erika Ross, View ORCID ProfileEvan N. Nicolai, Megan L. Settell, View ORCID ProfileJames K. Trevathan, Samuel O. Poore, View ORCID ProfileAaron J. Suminski, Justin C. Williams, Kip A. Ludwig
doi: https://doi.org/10.1101/733410
Kevin P. Cheng
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706
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Sarah K. Brodnick
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706
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Stephan L. Blanz
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706
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Weifeng Zeng
Department of Surgery, Division of Plastic and Reconstructive Surgery, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53706
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Jack Kegel
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706
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Jane A. Pisaniello
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706
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Jared P. Ness
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706
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Erika Ross
Mayo Clinic, Department of Neurologic Surgery, Rochester, MN USA 55905
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Evan N. Nicolai
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706Mayo Clinic, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA 55905
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Megan L. Settell
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706Mayo Clinic, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA 55905
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James K. Trevathan
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706Mayo Clinic, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA 55905
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Samuel O. Poore
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706Department of Surgery, Division of Plastic and Reconstructive Surgery, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53706
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Aaron J. Suminski
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53706
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Justin C. Williams
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53706
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Kip A. Ludwig
Department of Biomedical Engineering, University of Wisconsin-Madison, 1550 Engineering Drive, Madison, WI USA 53706Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin Madison, Madison, WI 53706
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  • For correspondence: kip.ludwig@wisc.edu
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Abstract

Vagal nerve stimulation (VNS) is an FDA approved treatment method for intractable epilepsy, treatment resistant depression, cluster headaches and migraine with over 100,000 patients having received vagal nerve implants to date. Moreover, evidence in the literature has led to a growing list of possible clinical indications, with several small clinical trials applying VNS to treat conditions ranging from neurodegenerative diseases to arthritis, anxiety disorders, and obesity. Despite the growing list of therapeutic applications, the fundamental mechanisms by which VNS achieves its beneficial effects are poorly understood and an area of active research. In parallel, the glymphatic and meningeal lymphatic systems have recently been proposed and experimentally validated to explain how the brain maintains a healthy homeostasis without a traditionally defined lymphatic system. In particular, the glymphatic system relates to the interchange of cerebrospinal fluid (CSF) and interstitial fluid (ISF) whose net effect is to wash through the brain parenchyma removing metabolic waste products and misfolded proteins from the interstitium. Of note, clearance is sensitive to adrenergic signaling, and a primary driver of CSF influx into the parenchyma appears to be cerebral arterial pulsations and respiration. As VNS has well-documented effects on cardiovascular and respiratory physiology as well as brain adrenergic signaling, we hypothesized that VNS delivered at clinically derived parameters would increase CSF influx in the brain. To test this hypothesis, we injected a low molecular weight (3 kD) lysine-fixable fluorescent tracer (TxRed) into the CSF system of mice with a cervical vagus nerve cuff implant and measured the amount of CSF penetrance following VNS. We found that the clinical VNS group showed a significant increase in CSF dye penetrance as compared to the naïve control and sham groups. This study demonstrates that VNS therapeutic strategies already being applied in the clinic today may induce intended effects and/or unwanted side effects by altering CSF/ISF exchange in the brain. This may have broad ranging implications in the treatment of various CNS pathologies.

One Sentence Summary Cervical vagus nerve stimulation using clinically derived parameters enhances movement of cerebrospinal fluid into the brain parenchyma presenting a previously unreported effect of vagus nerve stimulation with potential clinical utility.

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Posted August 13, 2019.
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Is Vagus Nerve Stimulation Brain Washing?
Kevin P. Cheng, Sarah K. Brodnick, Stephan L. Blanz, Weifeng Zeng, Jack Kegel, Jane A. Pisaniello, Jared P. Ness, Erika Ross, Evan N. Nicolai, Megan L. Settell, James K. Trevathan, Samuel O. Poore, Aaron J. Suminski, Justin C. Williams, Kip A. Ludwig
bioRxiv 733410; doi: https://doi.org/10.1101/733410
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Is Vagus Nerve Stimulation Brain Washing?
Kevin P. Cheng, Sarah K. Brodnick, Stephan L. Blanz, Weifeng Zeng, Jack Kegel, Jane A. Pisaniello, Jared P. Ness, Erika Ross, Evan N. Nicolai, Megan L. Settell, James K. Trevathan, Samuel O. Poore, Aaron J. Suminski, Justin C. Williams, Kip A. Ludwig
bioRxiv 733410; doi: https://doi.org/10.1101/733410

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