From CNI‐1493 to the immunological homunculus: physiology of the inflammatory reflex

The inflammatory reflex is a neurophysiological mechanism that regulates the immune system. The efferent branch of the reflex the cholinergic anti‐inflammatory pathway, which inhibits inflammation by suppressing cytokine synthesis via release of acetylcholine in organs of the reticuloendothelial system, including the spleen, liver, and gastrointestinal tract. Acetylcholine binds to α7 nicotinic acetylcholine receptors expressed by macrophages and other cytokine‐producing cells. Receptor‐ligand engagement suppresses proinflammatory cytokines and prevents tissue damage. Herein is a review of some of the experimental studies that define the inflammatory reflex and its anatomic and physiologic components.