PainRelief.com Interview with:
QIUFU MA, PhD
Professor, Neurobiology, Cancer Biology
Harvard Medical School
Dana-Farber Cancer Institute
PainRelief.com: What is the background for this study? What are the main findings?
Response: This study aimed to understand the biological basis behind acupuncture practice. Modern randomized clinical trials have demonstrated the efficacy of acupuncture practice in treating certain human diseases, such as gastrointestinal disorders and chronic pain, but the underlying biological basis still poorly understood.
Our hypothesis is that acupuncture can drive the somatosensory autonomic pathways to modulate body physiology. A key innovation of this study is the development of new genetic tools to manipulate different autonomic nervous pathways, and we then used the severe systemic inflammation (cytokine storms) induced by bacterial endotoxins as the experimental model.
We found that electroacupuncture stimulation (ES) can drive distinct autonomic pathways in acupoint- and stimulation-intensity-dependent manners. Low intensity ES at hindlimb regions drives the vagal-adrenal axis, producing anti-inflammatory effects that depend on adrenal chromaffin cells. High intensity ES at the abdomen activates splenic noradrenergic neurons via the spinal-sympathetic axis, and this activation produces either anti- or pro-inflammatory effects, dependent on adrenergic receptor profiles under different diseases states
PainRelief.com: What should readers take away from your report?
Response: Our studies suggest that acupuncture does have a modern neuroanatomical basis, and there is a way to improve its practice in treating systemic inflammation. There is an acupoint selectivity: the vagal-adrenal anti-inflammatory axis can be activated by ES at the hind leg acupoints, but not at the abdominal regions. There is also an intensity dependence, with high-intensity ES required to activate the spinal sympathetic axis, whereas low intensity ES sufficient to drive the vagal-adrenal axis. More importantly, there is a safety issue. After animals have developed cytokine storms, low intensity ES at the hind leg acupoints, which drives the vagal-adrenal axis, can still attenuate the cytokine storm and promote animal survival. In contrast, high intensity ES at either the abdominal or the high leg region, which drives the spinal-sympathetic axis, can make inflammation worsened and survival rates reduced. These findings suggest that stimulation parameters need to be optimized if acupuncture is used to treat severe systemic inflammation.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: Severe systemic inflammation or cytokine storms are frequently seen in sepsis patients with bacterial or viral infections, including some COVID-19 patients, or in cancer patients receiving immune checkpoint therapy. There is no effective and safe drugs available yet for treating severe cytokine storm, leading to high fatality rates for sepsis patients. Future studies in animals and in humans will be warranted to determine if acupuncture stimulation, particularly the low intensity stimulation at the hind leg acupoint, can be beneficial for human patients. From the basic science point of view, we still do not know the neural basis behind acupoint selectivity or intensity dependence. We also do not know if and how acupuncture can be used to treat chronic inflammatory disorders, such as colitis and arthritis. We have a long way to go.
I have no conflict of interest to declare.
Shenbin Liu, Zhi-Fu Wang, Yang-Shuai Su, Russell S. Ray, Xiang-Hong Jing, Yan-Qing Wang, Qiufu Ma. Somatotopic Organization and Intensity Dependence in Driving Distinct NPY-Expressing Sympathetic Pathways by Electroacupuncture. Neuron, 2020; DOI: 10.1016/j.neuron.2020.07.015
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