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Immunoautonomics: Can We Hack the Power of the Autonomic Nervous System?
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I am extremely excited to showcase our roundtable on immunoautonomics this month. Our thought leaders — including Mark C. Genovese, MD, David N. Chernoff, MD, and Ronald van Vollenhoven, MD, PhD — have given us a glimpse of the intersection of our autonomic nervous system and immune system, which is leading to exciting new nonpharmacological therapeutics of great potential.
A generation ago, who would have imagined that modulation of our autonomic nervous system would have such far reaching effects on our integrated immune response? At that time, we thought the brain and immune system were separated by a barrier, whereas we now recognize there is an intimate relationship between brain and immunity. I routinely tell my patients that “your brain and immune system are one,” trying to make the point that how we think and feel are important to our immune health.
Calabrese
Some now call our immune system our seventh sense, integrating afferent signals from outside the central nervous system — such as those generated by microbes, food and our environment — by labeling them as either safe or possibly dangerous.
Simultaneously, it appears that our brain also then sends efferent signals to the periphery, which can then generate inflammatory signals contributing ideally to host defense or alternatively by generating anti-inflammatory signals leading to the resolution of inflammation. The current data clearly demonstrate that tweaking the vagus nerve can produce potent anti-inflammatory signals with therapeutic potential to ameliorate diseases, such as rheumatoid arthritis and other immune-mediated inflammatory diseases (IMIDs).
Based on these observations, what is the potential to modulate this system noninvasively using our thoughts and behaviors, namely bypassing the electronics and hacking the system with our mind? I know this sounds a bit far out, so let me start with a disclosure. First let it be known, if you are not aware, that I am a supporter of employing mindfulness training as an adjunct for health and wellness in my patients and routinely recommend it in the form of a number of online mindfulness meditation apps that I like. Second, I am also a strong advocate for health care providers to employ these same mindfulness techniques to improve our care and caring of our patients as well as ourselves.
I admit I am biased. Not wanting to be a blind zealot, however, I share with you that I have just completed a randomized controlled study of mindfulness training in a cohort of stressed health care workers and currently await the data on whether low-dose online mindfulness techniques can lower inflammatory biomarkers. To read more on this study, search “Online Mindfulness Program for Stress Management” at www.clinicaltrials.gov or go to https://clinicaltrials.gov/ct2/show/NCT03753360.
Taking this reasoning one step further, consider how acute stress may be good for “fight or flight,” but really lousy for us when we are sitting at our desks fretting over what just happened or what will happen in the future. This creates a stress response with significant physiologic consequences and can be monitored in real time by assessing something as simple as heart rate variability.
Personally, I use the HeartMath app on my phone and frequently plug in to see where my balance of stress and relaxation is — either in my office or when I travel. Others have suggested that mindfulness training can augment vagal tone, which correlates with enhanced emotional regulation, less egocentric-bias and higher levels of empathy.
I close with a word of caution: if you’re considering trying your hand at some mindfulness training, there are a number of potential side effects. You must first be aware that you might become calmer and less stressed, in addition to gaining a greater awareness of your daily activities and quite possibly gaining greater empathy and compassion. So please weigh these effects in making your decision. Your well-being may depend on it.
Let me know how you are staying mindful through Twitter at @LCalabreseDO or email me at calabrl@ccf.org.
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- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
Disclosure: Calabrese reports serving as an investigator and a consultant to Horizon Pharmaceuticals.