Figure 2

Neurostimulation of the cholinergic antiinflammatory pathway with an implantable medical device: A potential alterative therapeutic approach for RA and IBD. Signals from the device pass through the efferent vagus nerve and are relayed directly to the intestine, and across the celiac ganglion, traversing the splenic nerve to terminate in the spleen (panel 1). Neurotransmitter release in the end organs results in reduced activation of resident immune cells (panel 1), as well as reduced production of inflammatory mediators and activation of circulating immune cells (panel 2). These effects should result in attenuation of inflammation with improvement in signs and symptoms, and reduction in joint and intestinal mucosal damage (panels 3 and 4).