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Войти в исследования Neuromodulation : journal of the International Neuromodulation Society · 2026
Neuromodulation of Pancreatic Lymph Nodes as a Therapy for Type 1 Diabetes: An Anatomical Study on the Presence of a Neuro-Immune Link in Human Pancreatic Lymph Nodes and Potential Sites for Electrical Stimulation.
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Koopmans-Lotgerink Bruinenberg Dyonne A M, Mackaaij Claire, Irwin Eric, Chew Daniel J, Gupta Isha, Bleys Ronald L A W, Cleypool Cindy G J
Аннотация
OBJECTIVES: Experimental studies in nonobese diabetic mice show that electrical stimulation of sympathetic nerves innervating pancreatic lymph nodes (LNs) reduces T cell activation through β-2 adrenergic signaling and limits further β-cell destruction. Neuromodulation of pancreatic LNs may therefore represent a novel therapeutic approach for early-stage type 1 diabetes (T1D) in humans. This study aims to explore the presence of a sympathetic neuro-immune link in human pancreatic LNs and to identify surgically accessible neuromodulation sites.
MATERIALS AND METHODS: Upstream pancreatic LNs 8a and 8p were selected as primary targets because they drain lymph from multiple downstream pancreatic LNs. The suitability of two potential stimulation sites to target the sympathetic innervation of these LNs, being the LN capsule and the nerve plexus surrounding the proximal common hepatic artery (CHA), was evaluated. Ten formaldehyde-fixed human cadavers were studied, and various techniques were used to collect macro- and microscopic data on pancreatic LNs and the proximal CHA with its surrounding nerve plexus.
RESULTS: Human pancreatic LNs contain sympathetic nerves in both their capsule and parenchyma, the latter occasionally as discrete nerves located close to T cells. Of the two upstream LNs studied, LN 8a was consistently present, easily accessible, and showed clear sympathetic connections to the celiac and CHA nerve plexuses. However, its position varied, and it was located near the pancreas. The nerve plexus around the CHA was consistently observed and contained predominantly sympathetic nerves, with nerves to LN 8a originating from its anterior-caudal region.
CONCLUSION: Human pancreatic LNs contain a sympathetic neuro-immune link that could be targeted for T1D treatment. The proximal CHA's nerve plexus appears the most promising neuromodulation site owing to its surgical accessibility, sympathetic predominance, and suitability for safe device implantation.
MATERIALS AND METHODS: Upstream pancreatic LNs 8a and 8p were selected as primary targets because they drain lymph from multiple downstream pancreatic LNs. The suitability of two potential stimulation sites to target the sympathetic innervation of these LNs, being the LN capsule and the nerve plexus surrounding the proximal common hepatic artery (CHA), was evaluated. Ten formaldehyde-fixed human cadavers were studied, and various techniques were used to collect macro- and microscopic data on pancreatic LNs and the proximal CHA with its surrounding nerve plexus.
RESULTS: Human pancreatic LNs contain sympathetic nerves in both their capsule and parenchyma, the latter occasionally as discrete nerves located close to T cells. Of the two upstream LNs studied, LN 8a was consistently present, easily accessible, and showed clear sympathetic connections to the celiac and CHA nerve plexuses. However, its position varied, and it was located near the pancreas. The nerve plexus around the CHA was consistently observed and contained predominantly sympathetic nerves, with nerves to LN 8a originating from its anterior-caudal region.
CONCLUSION: Human pancreatic LNs contain a sympathetic neuro-immune link that could be targeted for T1D treatment. The proximal CHA's nerve plexus appears the most promising neuromodulation site owing to its surgical accessibility, sympathetic predominance, and suitability for safe device implantation.