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Microbes & Immunity Benefit of noninvasive VNS in vaccine optimization

COVID-19 vaccines or SARS-CoV-2 infection per se can long COVID-19 severity 1.5 years after infection regardless
even trigger the development of autoimmune diseases in of variants of SARS-CoV-2. Therefore, it is of great clinical
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predisposed patients, 74,75 further favoring the emergence importance to immediately consider the adoption of an
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of long COVID-19. The autoimmune vaccine-related inexpensive preventive tool to halt the development of long-
adverse effects are common in vulnerable patients term sequelae. As questioned and commented on by the late
(interestingly, those with lower vagal tone) for whom, as Hal E. Broxmeyer, the father of cord blood transplantation,
it happens, vaccination is currently recommended. One “Will linking the brain with that of hematopoiesis and vice
apparent solution to this would be the removal of mRNA versa be a next frontier to investigate for potential health
sequences coding for peptides homologous to humans’ benefits?. Regardless, work in this direction, no matter how
from the SARS-CoV-2 vaccines. 77 preliminary or simplistic at the beginning, is well-worth the
effort. The longer we wait to start, the longer it will be before
There is a growing line of evidence that microbiome 89
diversity may protect from pathogens, including SARS- we get answers”. His remark has shrewdly attested to an
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old saying that “time is money,” aptly defining the struggle
CoV-2, and from SARS-CoV-2-induced autoimmunity we are confronting now.
alike. 60,78,79 As proven, notably, by vagotomy experiments,
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the vagus nerve naturally links microbiota to the immune Meanwhile, research assessing nVNS coupled to
and the central nervous systems. Interestingly, VNS itself vaccination is aimed to optimize vaccination regimes and
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has been associated with changes in the gut microbiome. cut down the number of injections necessary to confer a
Mere auricular acupressure, known to increase HRV, broad and long-term immune memory, by making the
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demonstrated a significant reduction of early adverse most of the circadian rhythms. 64
events following COVID-19 immunization. Moreover,
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remarkably, a recent study suggested that 4 weeks of 5. Conclusion
at-home self-administered transcutaneous auricular VNS Neuromodulation therapies have become a mainstay in
may have a mild to moderate effect on reducing long healthcare delivery, in areas as diverse as pacemakers for
COVID-19 mental fatigue, supporting the central role of bradycardia, and sacral implants for urinary incontinence.
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autonomic impairment in COVID-19 pathophysiology. 84-87 Noninvasive VNS has been granted approval by U.S. Food
Children affected by long COVID-19 are likely to benefit and Drug Administration (FDA) for primary headaches since
from noninvasive VNS. 2017, and even received an emergency use authorization for
More research and randomized controlled trials difficulty breathing during the recent COVID-19 pandemic.
are definitely needed to assess transcutaneous VNS on The vagus nerve is known to control many of the physiologic
vaccinated patients to determine if it can block the long- functions of the body and there is sound physiologic
term sequelae of COVID-19 and/or enhance vaccine rationale for studying VNS as an adjunctive therapy
facilitating immunization in young children. Additional
efficacy. In the same way, trials of transcutaneous VNS in studies are needed to validate this hypothesis, but with
non-vaccinated individuals are mandatory to determine the growing body of relevant evidence, international and
the efficacy of vagal stimulation, by itself, in the prevention research organizations (WHO, UNICEF, NIH) should pay
of severe viral illnesses. Vulnerable patients should be more attention to the data on noninvasive neuromodulation
stratified according to their HRV as already suggested and support further research in this growing field. Indeed,
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and followed up for a longer term in upcoming larger a new paradigm, including noninvasive neuromodulation
clinical trials to generate more reliable data to inform as an adjunct to care in the treatment of disease is likely to
recommendations. A more thorough evaluation is be both effective and cost-effective in some of humankind’s
definitely a worthwhile endeavor despite the substantial greatest health-care problems.
financial support required to achieve this goal.
Acknowledgments
4.3. Economic issues
Noninvasive VNS provides an avenue to decrease the None.
severity of illnesses (induced by RSV and/or future variants) Funding
and, thus, the number of hospitalizations, potentially
alleviating the financial burden inflicted on the existing None.
healthcare systems. Moreover, long COVID-19 presents
an enormous economic burden likely due to its prolonged Conflict of interest
nature for years as more than half of the infected patients Claire-Marie Rangon declares she has no competing
claimed that post-COVID-19 clinic failed to improve their interests. Peter Staats owns patents on vagus nerve

Volume 1 Issue 1 (2024) 54 doi: 10.36922/mi.2598