Kidney Research and Clinical Practice : eISSN 2211-9140 / pISSN 2211-9132

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Fig. 1. The cholinergic anti-inflammatory pathway.

The cholinergic anti-inflammatory pathway bridges the nervous and immune systems. Afferent vagus nerves are stimulated by proinflammatory cytokines. The signal activates efferent vagus nerves via the nucleus tractus solitarius (NTS) and dorsal motor nucleus of the vagus (DMV) in the brain. Activated efferent vagus nerves stimulate splenic nerves, resulting in release of norepinephrine (NE). CD4-positive T cells in the spleen release acetylcholine (ACh) after NE binds to β2 adrenergic receptors (β2AR). Alpha 7 subunit of the nicotinic acetylcholine receptor (α7nAChR)-positive macrophages receive Ach, leading to anti-inflammatory responses such as release of tumor necrosis factor alpha (TNF-α). The dotted lines are strongly suggested, though not conclusively proven, pathways.

SGN, sympathetic ganglionic neuron; SPGN, sympathetic preganglionic neuron.

Kidney Res Clin Pract 2019;38:282~294
© Kidney Res Clin Pract