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Towards improved control of inflammatory bowel disease
Author(s) -
Eberhardson Michael,
Hedin Charlotte R. H.,
Carlson Marie,
Tarnawski Laura,
Levine Yaakov A.,
Olofsson Peder S.
Publication year - 2019
Publication title -
scandinavian journal of immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.934
H-Index - 88
eISSN - 1365-3083
pISSN - 0300-9475
DOI - 10.1111/sji.12745
Subject(s) - immunology , inflammation , immune system , medicine , acquired immune system , inflammatory bowel disease , tumor necrosis factor alpha , context (archaeology) , disease , biology , paleontology
Inflammatory bowel disease (IBD) is characterized by activation of both the innate and adaptive immune system in genetically susceptible individuals, resulting in chronic intestinal inflammation. The triggers that initiate and perpetuate this continuous inflammation are the subject of much speculation and research, although the central role of the intestinal microbiota is recognized, and is even a target for treatment in some circumstances. The mainstay of modern IBD treatment is suppression of the immune response towards as yet unspecified antigens, and conventional therapy includes corticosteroids, 5‐aminosalicylic acid (5‐ASA), thiopurines and methotrexate. Reducing activity of specific mediators has proven efficacious, including adhesion molecules, such as the gut‐homing integrin α 4 β 7 expressed on the surface of circulating immune cells, and cytokines, such as tumour necrosis factor α (TNF‐α). This has been achieved using biologic agents including monoclonal antibodies. Recent discoveries in immunology and neuroscience have revealed that signals in the peripheral nervous system regulate inflammation, including levels of TNF‐α. The understanding of the mechanisms of the neuro‐immune communication involved in inflammation control in the gut is evolving, but is as yet incomplete. Clinical studies using implanted vagus nerve stimulators for treatment of IBD show encouraging results. Accordingly, the neural reflex control of inflammation is emerging as a potential therapeutic target in treatment of IBD. Here, we review current therapeutic options and neural reflex control of gut immunity in the context of intestinal inflammation.