Cholinergic control of inflammation

J Intern Med. 2009 Jun;265(6):663-79. doi: 10.1111/j.1365-2796.2009.02098.x.


Cytokine production is necessary to protect against pathogens and promote tissue repair, but excessive cytokine release can lead to systemic inflammation, organ failure and death. Inflammatory responses are finely regulated to effectively guard from noxious stimuli. The central nervous system interacts dynamically with the immune system to modulate inflammation through humoral and neural pathways. The effect of glucocorticoids and other humoral mediators on inflammatory responses has been studied extensively in the past decades. In contrast, neural control of inflammation has only been recently described. We summarize autonomic regulation of local and systemic inflammation through the 'cholinergic anti-inflammatory pathway', a mechanism consisting of the vagus nerve and its major neurotransmitter, acetylcholine, a process dependent on the nicotinic acetylcholine receptor alpha7 subunit. We recapitulate additional sources of acetylcholine and their contribution to the inflammatory response, as well as acetylcholine regulation by acetylcholinesterase as a means to attenuate inflammation. We discuss potential therapeutic applications to treat diseases characterized by acute or chronic inflammation, including autoimmune diseases, and propose future research directions.

Publication types

  • Review

MeSH terms

  • Acetylcholine / immunology*
  • Animals
  • Brain / metabolism*
  • Cholinergic Agents / immunology
  • Inflammation / immunology*
  • Mice
  • Mice, Knockout
  • Neural Pathways / metabolism
  • Receptors, Cholinergic / immunology*
  • Receptors, Cholinergic / metabolism
  • Receptors, Nicotinic / metabolism
  • Sepsis / immunology
  • Tumor Necrosis Factor-alpha / metabolism
  • Vagus Nerve / immunology*
  • Vagus Nerve / physiology


  • Cholinergic Agents
  • Receptors, Cholinergic
  • Receptors, Nicotinic
  • Tumor Necrosis Factor-alpha
  • Acetylcholine