从“分子药”到“电子药”:SPARC计划和针刺研究
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摘要
2016年10月美国国立卫生院(NIH)启动的"刺激外周神经缓解疾病症状(SPARC)"计划,目的在于开发新的神经刺激装置和刺激方案,通过对终末器官系统功能的精准神经控制来治疗疾病和病症。这一计划对国内外针灸从业者和研究者带来不小的触动。SPARC计划到底是针灸研究的推手还是挑战?本文介绍了SPARC计划,并将它和针灸作用机制的研究做了比较。SPARC重在绘制出支配内脏的神经图谱,揭示调节内脏功能的神经编码。而针刺研究也希望找到针刺刺激的神经编码和对内脏调控过程的解码,从而调节刺激参数,达到对内脏功能的精准调节。二者的科学基础在外周调控的机制上是一致的。不同之处在于针灸治疗通过寻找和刺激内脏病变的反应点(穴位),调节内脏的功能,其间要经过多重神经环路,有多个神经反馈参与,是基于体表刺激调动机体内稳态的调节,调节效应安全却有限;SPARC直接作用于外周神经,可以达到精准高效的调节,但是没有反馈的环路调控,难免会产生机体耐受或者不良反应。因此,在触发刺激这一始动环节和靶器官效应的反馈抑制等方面,还有很多的工作要做。SPARC计划一定是揭示针灸作用机制的一个强有力的推手。
The NIH-funded"Stimulating Peripheral Activity to Relieve Conditions(SPARC)"program has been initiated in Octomber 2016,aiming at developing high resolution neural circuit maps and next generation neural modulation devices.This program has brought great stimulus to acupuncturists and acupuncture researchers both at home and abroad.Is the SPARC program a driving force or a challenge of acupuncture research?In the present study,we introduced the SPARC program and compared it with current acupuncture research.The first step of SPARC is to better map neural circuits associated with disease on the anatomical level so as to identify the best points for intervention,and to decode the neural language at these intervention points for developing a dictionary of patterns associated with health and disease states on the signaling level.Similarly,our acupuncture research also focuses on revealing the neural encoding of acupuncture stimulation and its effect on visceral function,seeking suitable stimulation parameters to regulate the abnormal visceral activity precisely.Therefore,the common point of SPARC program and acupuncture research is the scientific basis of peripheral somatic neuronal regulation,and their difference is that acupuncture regulates the visceral function through multiple neural circuits and neural feedbacks by stimulating the sensitized points or acupoints,achieving homeostasis at last.Acupuncture-induced regulation effect is limited and the therapy is safe.Whereas,"stimulating peripheral activity(SPA)"can regulate the visceral organs precisely but without neural feedback.Inevitably,SPA will produce tolerance or side effects.Therefore,there is still much work to be done in terms of the initiation of trigger stimulation and the feedback inhibition of target organ effects.The SPARC program is definitely apowerful force in revealing the mechanisms by which acupuncture works.
The NIH-funded"Stimulating Peripheral Activity to Relieve Conditions(SPARC)"program has been initiated in Octomber 2016,aiming at developing high resolution neural circuit maps and next generation neural modulation devices.This program has brought great stimulus to acupuncturists and acupuncture researchers both at home and abroad.Is the SPARC program a driving force or a challenge of acupuncture research?In the present study,we introduced the SPARC program and compared it with current acupuncture research.The first step of SPARC is to better map neural circuits associated with disease on the anatomical level so as to identify the best points for intervention,and to decode the neural language at these intervention points for developing a dictionary of patterns associated with health and disease states on the signaling level.Similarly,our acupuncture research also focuses on revealing the neural encoding of acupuncture stimulation and its effect on visceral function,seeking suitable stimulation parameters to regulate the abnormal visceral activity precisely.Therefore,the common point of SPARC program and acupuncture research is the scientific basis of peripheral somatic neuronal regulation,and their difference is that acupuncture regulates the visceral function through multiple neural circuits and neural feedbacks by stimulating the sensitized points or acupoints,achieving homeostasis at last.Acupuncture-induced regulation effect is limited and the therapy is safe.Whereas,"stimulating peripheral activity(SPA)"can regulate the visceral organs precisely but without neural feedback.Inevitably,SPA will produce tolerance or side effects.Therefore,there is still much work to be done in terms of the initiation of trigger stimulation and the feedback inhibition of target organ effects.The SPARC program is definitely apowerful force in revealing the mechanisms by which acupuncture works.
引文
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[12]RONG P J,FANG J L,WANG L P,et al.Transcutaneous vagus nerve stimulation for the treatment of depression:a study protocol for a double blinded randomized clinical trial[J].BMC Complement Altern Med,2012,12:255.
[2]WALTZ E.A spark at the periphery[J].Nat Biotechnol,2016,34(9):904-908.
[3]National Institutes of Health.Stimulating perpheral activity to relieve conditions[EB/OL].http://commonfund.nih.gov/sparc.
[4]ELLIOTT R E,MORSI A,KALHORN S P,et al.Vagus nerve stimulation in 436consecutive patients with treatmentresistant epilepsy:long-term outcomes and predictors of response[J].Epilepsy Behav,2011,20(1):57-63.
[5]SADLER R M,PURDY R A,RAHEY S.Vagal nerve stimulation aborts migraine in patient with intractable epilepsy[J].Cephalalgia,2002,22:482-484.
[6]BONAZ B,SINNIGER V,HOFFMANN D,et al.Chronic vagus nerve stimulation in Crohn’s disease:a 6-month followup pilot study[J].Neurogastroenterol Motil,2016,28(6):948-953.
[7]KOOPMAN F A,CHAVAN S S,MILJKO S,et al.Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis[J].Proc Natl Acad Sci USA,2016,113(29):8284-8289.
[8]FOX D.The shock tactics set to shake up immunology[J].Nature,2017,545(7652):20-22.
[9]吴章,张树剑.海外古典针灸流派述略[J].中华医史杂志,2017,47(3):156-159.
[10]何伟,朱兵,喻晓春,等.西方针灸和中医针灸的比较与启示[J].中国针灸,2015,35(2):105-108.
[11]HE W,JING X H,ZHU B,et al.The auriculo-vagal afferent pathway and its role in seizure suppression in rats[J].BMC Neurosci,2013,14:85.
[12]RONG P J,FANG J L,WANG L P,et al.Transcutaneous vagus nerve stimulation for the treatment of depression:a study protocol for a double blinded randomized clinical trial[J].BMC Complement Altern Med,2012,12:255.