Transcutaneous auricular vagal nerve stimulation (taVNS) is a non-invasive method of activating axons in the auricular branch of the vagus nerve through the concha of the outer ear. taVNS is under investigation as an alternative treatment option for a wide range of disorders. Vagal afferent fibers terminate in the nucleus of the solitary tract (NTS) where information is processed and relayed to higher brain regions influencing sympathetic and parasympathetic systems. Due to extensive neuronal connections, it is likely that taVNS could serve as a treatment option for many disorders, specifically cardiac, migraine, and gastric motility disorders. Human fMRI studies have indicated that taVNS elicits neuronal responses within NTS and spinal trigeminal nucleus (Sp5c). Studies have indicated that caudal NTS (cNTS) has substantial connections with the cardiac system, rostral NTS (rNTS) is relevant for gastric motility, and Sp5c is likely involved in migraine disorders due to meningeal connections. Aberrant neuronal signaling is likely responsible for the development of these disorders, and taVNS has the potential to modulate neuronal activity to reestablish homeostatic signaling. In this study, electrophysiological methods were used to interrogate neuronal activity of 50-70 neurons within cNTS, rNTS, and Sp5c following taVNS. A high-impedance tungsten electrode was placed stereotaxically in 15 male Sprague-Dawley rats anesthetized with chloralose. Changes in neuronal firing rates were investigated during and immediately following taVNS by comparing changes in neuronal activity to baseline levels using the software Spike 2 v9.14. Neurons were classified as negative responders if activity decreased more than 20%, positive responders if activity increased more than 20%, or non-responders if activity changes were less than 20%. Six different taVNS parameters were investigated using three frequencies (20, 100, 250Hz) at two intensity levels (0.5, 1.0mA). Data from this study suggest that taVNS can modulate neuronal activity in a frequency and intensity-dependent manner. The greatest positive activation for all 3 brain regions occurred at 20Hz, 1.0mA stimulation where an average of 46% ± 9% neurons showed increased firing compared to 29% ± 2% positive responders for other paradigms. The greatest negative activation for all 3 regions occurred at 100Hz, regardless of intensity, where an average of 33% ± 1% neurons showed reduced firing compared to 15% ± 2% negative responders for remaining paradigms. Based on what is known about cardiac, migraine, and gastric motility disorders, it is likely that taVNS can be used to modulate activity in NTS and Sp5c to provide beneficial treatment options to patients. Specifically, using paradigms yielding decreased activity in Sp5c could improve migraine symptoms, and paradigms increasing activity in cNTS and rNTS could improve cardiac and gastric motility disorders, respectively.

Vagus nerve stimulation (VNS) is a promising neuromodulatory therapy under investigation for a range of disorders, including heart failure, gastric dysmotility, and migraine. Two primary forms of VNS are currently investigated: cervical VNS (cVNS), involving surgically implantation to activate vagal afferents in the cervical branch in the neck and transcutaneous auricular VNS (taVNS) which subcutaneously stimulates the auricular branch in the outer ear. The nucleus of the solitary tract (NTS) serves as a relay-station receiving 90% of vagal afferents, enabling connections with higher-order brain regions and other brainstem nuclei like the spinal trigeminal nucleus (Sp5) and locus coeruleus (LC), facilitating neuromodulation through VNS. Research has established the efficacy of VNS at 20–30 Hz for disorders like depression, but the impact of alternative stimulation parameters on medullary nuclei neuromodulation remains unclear. These studies used anesthetized rats to extracellularly record neuronal activity across varying VNS parameters within NTS, Sp5, and LC. Neuronal responses were classified as positive (increased activity), negative (decreased activity), or non-responders (no response). In LC, cVNS at standard paradigms (≥ 10 Hz) and bursting paradigms with shorter interburst intervals or increased pulses induced more positive responders, while standard 5 Hz generated more negative responders. Additionally, a build-up effect was observed in LC, with increased responders over consecutive VNS cycles. In NTS and Sp5, taVNS evoked comparable activation, with more positive responders at 20 Hz and 100 Hz and stronger responses at higher intensities. However, Sp5 responses were twice as strong compared to NTS. Furthermore, comparative analysis between taVNS and cVNS revealed similar overall activation in NTS, but distinct activation profiles in individual neurons indicate different pathways. Finally, the therapeutic efficacy of VNS therapy was evaluated in heart failure using a pressure-overload rat model. A 60-day cVNS treatment restored adverse cardiac remodeling and dysfunction, mitigated cardiac molecular changes, and prevented neuroinflammatory responses within brainstem nuclei. The findings presented herein demonstrated differential parameter-specific and nuclei-specific responses to taVNS and cVNS, investigated the mechanisms responsible for taVNS modulation, and confirmed that VNS therapy, when initiated early, can mitigate heart failure development and restore multiorgan homeostasis in a PO model.