Electrical stimulation of the vagus nerve improves amyloid pathology in delirium superimposed on dementia.
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2026-01
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BACKGROUND: Delirium and delirium superimposed on dementia (DSD) are common complications affecting patients suffering from ongoing neurodegenerative pathologies. Peripheral surgical trauma can trigger neuroinflammation and ensuing DSD via mechanisms that remain poorly understood. Given the multifactorial therapeutic effects of neuromodulation, including vagal nerve stimulation, we have tested a minimally invasive approach to combat DSD following orthopedic surgery. METHODS: We performed orthopedic surgery on 5xFAD and CVN-AD mice and tested the efficacy of minimally invasive percutaneous vagus nerve stimulation (pVNS). We applied immunohistochemical, biochemical, and behavioral assays to evaluate the impact of surgery on postoperative delirium on DSD pathology in Alzheimer’s disease-like mice. To confirm the role of systemic factors in neuroinflammation and amyloid-β dyshomeostasis, we conducted experiments using interleukin-6 (IL-6), a cytokine commonly upregulated in postoperative delirium and in vitro co-culture assays for validation. RESULTS: In AD-like mice surgery induced acute changes in amyloid-β; perioperative treatment with pVNS effectively reduced amyloid-β load, plaque sphericity, and neuronal loss. The rescue of these pathological hallmarks led to improved delirium-like behavior, as demonstrated by the 5-choice serial reaction time task on postoperative days 1 and 2. pVNS improved microglial morphology, particularly near amyloid-β plaques. Acute isolation of microglial cells from 5xFAD mice after surgery indicated that pVNS partially enhanced key Disease-Associated Microglia (DAM) markers. The contribution of pro-inflammatory cytokines to amyloid-β aggregation was validated using an in vitro transwell culture model following Cytomix exposure, which also caused endothelial barrier disruption. Finally, we isolated IL-6 as a well-established biomarker of postoperative delirium and described its role in DSD pathology following systemic administration. CONCLUSION: These findings establish a role for neuromodulation after pVNS in regulating perioperative immunity and advance a new paradigm for perioperative interventions in patients at risk for DSD. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s42234-025-00194-5.
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Song, Chengcheng, Pau Yen Wu, William J Huffman, Jennifer David-Bercholz, Alicia Bedolla, Ravikanth Velagapudi, Ann Njoroge, Ramona M Rodriguiz, et al. (2026). Electrical stimulation of the vagus nerve improves amyloid pathology in delirium superimposed on dementia. Bioelectronic medicine, 12(1). p. 2. 10.1186/s42234-025-00194-5 Retrieved from https://hdl.handle.net/10161/34592.
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Scholars@Duke
William Christopher Wetsel
RESEARCH INTERESTS
Last Updated: 27 October 2020
My laboratory uses genetically-modified mice to study the roles that certain genes and gene products play in the presentation of abnormal neuroendocrine, neurological, and psychiatric responses. Traditionally, the identification of neuroendocrine dysfunction has involved biochemical analyses of hormonal responses, those for neurological disorders have relied upon behavioral and postmortem analyses, and those for psychiatric conditions have depended upon phenomenology. The use of genetic technologies has allowed specific genes in selected cells and in neural pathways to be related to certain molecular, biochemical, cellular, physiological, and behavioral dysfunctions. As the Director of the Mouse Behavioral and Neuroendocrine Analysis Core Facility at Duke University (http://sites.duke.edu/mousebehavioralcore/), we have phenotyped many different lines of inbred and mutant mice for my own work as well as for investigators at Duke and at other research institutions. As a consequence, we have helped to develop many different mouse genetic models of neuroendocrine and neuropsychiatric illness. We are working also with academic medicinal chemists and/or certain pharmacological/biotechnological companies to identify novel compounds that will ameliorate abnormal responses in various mutant mouse models. Some of these preclinical studies have formed a basis for clinical trials in humans.
Staci D. Bilbo
The brain, endocrine, and immune systems are inextricably linked. Immunocompetent cells are located throughout virtually every organ of the body, including the brain and other endocrine tissues, and sophisticated interactions occur among these cells, via hormones, neurotransmitters, and soluble protein messengers called cytokines and chemokines (small chemotactic cytokines). These immune molecules have a powerful impact on neuroendocrine function, including behavior, during health as well as sickness. Similarly, alterations in hormones, such as during stress, can powerfully impact immune function or reactivity. These functional shifts are evolved, adaptive responses that organize changes in behavior and mobilize immune resources but can also lead to pathology or exacerbate disease if prolonged or exaggerated. However, the mechanisms by which such pathology develops, in particular the precipitation of mental health disorders, remain largely misunderstood. The developing brain is exquisitely sensitive to both endogenous and exogenous signals, and increasing evidence suggests the immune system has a critical role in brain development and associated behavioral outcomes for the life of the individual. There is now ample evidence that immune activation during prenatal or early postnatal development can have profound and long-lasting effects on the brain, and I believe the early-life immune history of an individual may indeed be critical to understanding the later-life risk or resilience of developing certain neuropsychiatric disorders.
A particular focus of my research is on microglia, the primary immunocompetent cells of the CNS, which are involved in multiple aspects of brain development and function, including activity-dependent synaptic pruning and stripping, phagocytosis of apoptotic cells, and angiogenesis. Cytokines such as tumor necrosis factor [TNF]a, interleukin [IL]-1b, and IL-6 are produced primarily by glia within the CNS and are implicated in the developing and adult brain in synaptic scaling, long-term potentiation, and neurogenesis. Microglia originate early in the life of the fetus and are very long-lived, meaning they may have the capacity to reside in the brain for most of the life of the animal. Taken together, I have hypothesized that the developing brain is particularly sensitive to early-life immune activation and the associated risk of later-life neuropsychiatric disorders because (1)microglia are long-lived such that previously activated/functionally altered microglia (i.e. microglia exposed to an early-life immune challenge) may remain within the brain into adulthood, (2) immature microglia within the developing brain are functionally and/or immunologically different than microglia within the adult brain such that early-life immune activation can have greater consequences for neuroimmune function when compared to the adult brain, and (3) microglia and their inflammatory products are critical for normal cognitive function and behavior such that neuroimmune dysfunction results in mental health dysfunction.
The simple goal of my research is thus to understand the important role of the immune system during brain development, and thereby the ways in which immune activation during early brain development can affect the later-life outcomes of neural function, immune function, mood and cognition. In concert with this, I am interested in modeling current social and environmental issues (e.g. poverty, pollution, addiction) that impact the developing brain, and thereby how these factors may eventually be mitigated via careful scholarship, education, and engagement with trainees, collaborators, and members of society.
Ting Yang
Warren M. Grill
Our research employs engineering approaches to understand and control neural function. We work on fundamental questions and applied development in electrical stimulation of the nervous system to restore function to individuals with neurological impairment or injury.
Current projects include:
• understanding the mechanisms of and developing advanced approaches to deep brain stimulation to treat movement disorders,
• developing novel approaches to peripheral nerve electrical stimulation for restoration of bladder function,
• understanding the mechanisms of and developing advanced approaches to spinal cord stimulation to treat chronic pain,
• understanding and controlling the cellular effects of transcranial magnetic stimulation, and
• design of novel electrodes and waveforms for selective stimulation of the nervous system.
Niccolò Terrando
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.