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PERSPECTIVE ARTICLE

Is vagus nerve-mediated regulation of immunity an etiological target for therapeutic intervention in endometriosis?

Claire-Marie Rangon1,2†* ,  Shaoyuan Li3 ,  Peter S. Staats2,4† ,  Alba Boluda-Nicola5,6 ,  Jérôme Bouaziz5,6
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1 Department of Pediatrics, One Clinic, Paris, France
2 Vagus Nerve Society, Atlantic Beach, Florida, United States of America
3 Institute of Acupuncture and Moxibustion Academy of Chinese Medical Sciences, Beijing, China
4 National Spine and Pain Centers, Atlantic Beach, Florida, United States of America
5 Department of Gynecology and Obstetrics, One Clinic, Paris, France
6 Department of Research, One Clinic, Paris, France
MI, 4389 https://doi.org/10.36922/mi.4389
Submitted: 31 July 2024 | Accepted: 19 September 2024 | Published: 15 October 2024
(This article belongs to the Special Issue Recent Advances in Immune Regulation by the Vagus Nerve)
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Endometriosis is a complex chronic neuro-inflammatory disorder, affecting roughly 10% of reproductive-age women. It is characterized by the presence of endometrial-like tissue outside the uterus, which induces a chronic inflammatory reaction. This disease can present a wide range of symptoms, including chronic pain and infertility. Despite extensive research, the exact pathogenesis of endometriosis remains incompletely understood. New strategies and paradigms on pathogenesis and treatment are needed. Schematic factors contributing to the development of endometriosis lesions include genetic, hormonal, and immunological factors. Although genetics may contribute to the epidemiologically suggested heritability of endometriosis, epigenetics has gained an increasing consideration in research. Remarkably, microbiota dysbiosis, acting as a catalyst for the main acknowledged epigenetic etiologies (locally produced estradiol, pro-inflammatory cytokines, and hypoxic stress) demands further attention. Indeed, over the past 10 years, it has become clear that the vagus nerve, the fastest component of the microbiota-gut-brain axis, can efficiently control inflammation through the cholinergic anti-inflammatory pathway. Therefore, stimulation of the vagus nerve could be a good candidate for modulating the severity of endometriosis. The detrimental consequences of microbiome dysbiosis and the estrobolome activity on the initiation of the disease as well as counterpart dysfunctions in the central nervous system will be focused on, both supporting a key role of the vagus nerve since the early stage of endometriosis. Consequently, the rationale for using non-invasive vagus nerve stimulation will be discussed, introducing a fruitful shift of paradigm in this still enigmatic disease.

Keywords
Endometriosis
Pathophysiology
Epigenetics
Immunity
Microbiota-gut-brain axis
Non-invasive vagus nerve stimulation
Funding
None.
Conflict of interest
Claire-Marie Rangon and Peter S. Staats are the Guest Editors of this special issue but were not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. Peter S. Staats is the founder of the ElectroCore company which sells nVNS device called gammaCore. Separately, other authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.
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Microbes & Immunity, Electronic ISSN: 3029-2883 Print ISSN: 3041-0886, Published by AccScience Publishing
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