The participation of the hypothalamus in the action mechanisms and therapeutic effects of acupuncture: a narrative review
DOI:
https://doi.org/10.34119/bjhrv8n4-375Keywords:
acupuncture, hypothalamus, therapeutic effect, basic researchAbstract
The hypothalamus controls homeostasis through the regulation of the autonomic and endocrine nervous system. Dysregulation of the hypothalamus leads to the emergence of a wide variety of disorders that can profoundly impact people's physical and mental health. Several studies indicate that one of the mechanisms of action of acupuncture in some diseases occurs through the modulation of hypothalamic activity. Therefore, the aim of this article is to present and discuss the therapeutic effect of acupuncture through hypothalamic modulation. The present review focuses on discussing basic research studies that evaluated the effect of acupuncture on hypothalamic activity, analyzing biological variables, such as modulation of neurotransmitters, neurohormones and blood pressure. The selection of articles was made in the Pubmed, ScienceDirect, and Scielo databases until February 2024. The studies found were on obesity, insomnia and systemic arterial hypertension, which demonstrated that acupuncture significantly decreases symptoms by modulating hypothalamic activity. According to the reviewed data, it can be concluded that the mechanisms of action of acupuncture are related, at least in part for the conditions analyzed, to its modulating effect on the hypothalamus. However, more studies should be done to clarify the involvement of the hypothalamus in the effect of acupuncture in other diseases.
References
ABARCA-GÓMEZ, Leandra et al. Worldwide Trends in Body-Mass Index, Underweight, Overweight, and Obesity from 1975 to 2016: A Pooled Analysis of 2416 Population-Based Measurement Studies in 128·9 Million Children, Adolescents, and Adults. The Lancet, v. 390, n. 10113, p. 2627–42, dez. 2017. DOI: https://doi.org/10.1016/S0140-6736(17)32129-3.
BERNARDIS, Lee L.; BELLINGER, Larry L. The Dorsomedial Hypothalamic Nucleus Revisited: 1986 Update. Brain Research Reviews, v. 12, n. 3, p. 321–81, jul. 1987. DOI: https://doi.org/10.1016/0165-0173(87)90004-X.
BERNARDO, W.M. et al (2004). A prática clínica baseada em evidências. Parte II: buscando as evidências em fontes de informação. Rev Assoc Med
Bras, 50(1), 104-108.DOI:https://doi.org/10.1590/S0104-42302004000100045
BLÜHER, Matthias. Obesity: Global Epidemiology and Pathogenesis. Nature Reviews Endocrinology, v. 15, n. 5, p. 288–98, maio 2019. DOI: https://doi.org/10.1038/s41574-019-0176-8.
BRAAK, Heiko; BRAAK, Eva. Chapter 1 Anatomy of the Human Hypothalamus (Chiasmatic and Tuberal Region). In: Progress in Brain Research. [s. l.]: Elsevier, 1992. v. 93, p. 3–16. DOI: https://doi.org/10.1016/S0079-6123(08)64559-8.
BUYSSE, D. J. Insomnia. JAMA, v. 309, n. 7, p. 706–16, 2013.
CHEN, Q.-H.; TONEY, G. M. In vivo discharge properties of hypothalamic paraventricular nucleus neurons with axonal projections to the rostral ventrolateral medulla. Journal of Neurophysiology, v. 103, n. 1, p. 4–15, 2010.
CHENG, G. L. et al. Review about the mechanism of insomnia. World J Sleep Med, v. 3, p. 174–9, 2016.
CHROUSOS, George P. The Hypothalamic–Pituitary–Adrenal Axis and Immune-Mediated Inflammation. New England Journal of Medicine, v. 332, n. 20, p. 1351–63, maio 1995. DOI: https://doi.org/10.1056/NEJM199505183322008.
COMAI, S.; DE GREGORIO, D. Hypnotic effects of melatonergic compounds measured in mice or rats. Methods Mol Biol, v. 2550, p. 443–52, 2022.
DALEY, M. et al. The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep, v. 32, p. 55–64, 2009.
ELDER, G. J. et al. The cortisol awakening response Applications and implications for sleep medicine. Sleep Med Rev, v. 18, n. 3, p. 215–24, 2014.
FARSANG, C. et al. Where are we with the management of hypertension? From science to clinical practice. Journal of Clinical Hypertension, v. 11, n. 2, p. 66–73, 2009.
FEIG, J. E.; FEIG, J. L.; KINI, A. S. Statins, atherosclerosis regression and HDL: insights from within the plaque. International Journal of Cardiology, v. 189, n. 1, p. 168, 2015.
GONZÁLEZ-GONZÁLEZ, Roberto; GARCÍA-VIVAS, Jessica. Effects of Acupuncture on Obesity and Adipokines Involved in Body Weight Control. Journal of Homeopathy & Ayurvedic Medicine, v. 2, n. 3, 2013. DOI: https://doi.org/10.4172/2167-1206.1000129.
GUO, Z.; LONGHURST, J. Expression of c-Fos in arcuate nucleus induced by electroacupuncture: relations to neurons containing opioids and glutamate. Brain Res, v. 1166, p. 65–76, 2007.
HAJJAR, I.; KOTCHEN, T. A. Trends in prevalence, awareness, treatment, and control of hypertension in the United States. 1988–2000. JAMA, v. 290, p. 199, 2003.
JOLY-AMADO, Aurélie et al. The Hypothalamic Arcuate Nucleus and the Control of Peripheral Substrates. Best Practice & Research Clinical Endocrinology & Metabolism, v. 28, n. 5, p. 725–37, out. 2014. DOI: https://doi.org/10.1016/j.beem.2014.03.003.
KAVOUSSI, Ben; ROSS, B. Evan. The Neuroimmune Basis of Anti-Inflammatory Acupuncture. Integrative Cancer Therapies, v. 6, n. 3, p. 251–57, set. 2007. DOI: https://doi.org/10.1177/1534735407305892.
KAWABE, T.; KAWABE, K.; SAPRU, H. N. Cardiovascular responses to chemical stimulation of the hypothalamic arcuate nucleus in the rat: role of the hypothalamic paraventricular nucleus. PLoS ONE, v. 7, n. 9, 2012.
KIM, S. Y. et al. Effect of Acupuncture and Intervention Types on Weight Loss: A Systematic Review and Meta-analysis. Obesity Reviews, v. 19, n. 11, p. 1585–96, nov. 2018. DOI: https://doi.org/10.1111/obr.12747.
KIMURA, M. et al. Conditional corticotropin-releasing hormone overexpression in the mouse forebrain enhances rapid eye movement sleep. Mol Psychiatry, v. 15, n. 2, p. 154–65, 2010.
KING, Bruce M. The Rise, Fall, and Resurrection of the Ventromedial Hypothalamus in the Regulation of Feeding Behavior and Body Weight. Physiology & Behavior, v. 87, n. 2, p. 221–44, fev. 2006. DOI: https://doi.org/10.1016/j.physbeh.2005.10.007.
LI, J. H. et al. Effect of acupuncture with Tiaoshen method on plasma melatonin and cortisol in patients with chronic insomnia. Acupunct Res, v. 46, n. 8, p. 690–4, 2021.
LI, P.; LONGHURST, J. C. Long-lasting inhibitory effect of EA on blood pressure in patients with mild to moderate hypertension. Soc Neurosci, v. 37, 2007.
LIU, Q. et al. Evaluate efficacy, intervention-level of acupuncture therapy based on meta-analysis of ordinal data: primary insomnia. Liaoning J Trad Chin Med, v. 1, p. 134–7, 2017.
LIU, X. et al. Effects of electroacupuncture on insulin resistance and hypothalamic insulin signal molecule in rats with diet-induced obesity. Zhongguo Zhen Jiu, v. 36, n. 9, p. 957–961, set. 2016. DOI: 10.13703/j.0255-2930.2016.09.019.
MORIN, C. M. Chronic insomnia. Lancet, v. 379, n. 9821, p. 1129–41, 2012.
MORRISON, Christopher D. et al. Leptin Inhibits Hypothalamic Npy and Agrp Gene Expression via a Mechanism That Requires Phosphatidylinositol 3-OH-Kinase Signaling. American Journal of Physiology-Endocrinology and Metabolism, v. 289, n. 6, p. E1051–57, dez. 2005. DOI: https://doi.org/10.1152/ajpendo.00094.2005.
NAKAMURA, S.; BHATT, H. N.; SAPRU, H. N. Cardiovascular responses to hypothalamic arcuate nucleus stimulation in the rat: role of sympathetic and vagal eferents. Hypertension, v. 54, n. 6, p. 1369–1375, 2009.
NISHIJIMA, H. et al. Asymmetric posterior reversible encephalopathy syndrome due to hypertensive encephalopathy. Internal Medicine, v. 54, n. 8, p. 993-994, 2015.
OPARIL, Suzanne; ZAMAN, M. Amin; CALHOUN, David A. Pathogenesis of hypertension. Annals of Internal Medicine, v. 139, n. 9, p. 761–76, 2003.
PALKOVITS, M. Hypothalamic regulation of food intake. Ideggyogy Sz, v. 56, n. 9-10, p. 288–302, set. 2003.
PANDI-PERUMAL, S. R. et al. Role of the melatonin system in the control of sleep: therapeutic implications. CNS Drugs, v. 21, n. 12, p. 995–1018, 2007.
PARTHASARATHY, S. et al. Persistent insomnia is associated with mortality risk. Am J Med, v. 128, n. 3, p. 268–75, 2015.
PHILIPS, B.; MANNINO, D. M. Do insomnia complaints cause hypertension or cardiovascular disease? J Clin Sleep Med, v. 3, n. 5, p. 489, 2007.
RUAN, S. et al. Inhaled nitric oxide therapy and risk of renal dysfunction: a systematic review and meta-analysis of randomized trials. Critical Care, v. 19, n. 1, p. 137, 2015.
SAPRU, H. N. Role of the hypothalamic arcuate nucleus in cardiovascular regulation. Autonomic Neuroscience: Basic and Clinical, v. 175, n. 1-2, p. 38–50, 2013.
SATO, A.; SCHIMDT, R. The modulation of visceral functions by somatic afferent activity. Jpn J Physiol, v. 337, p. 1–17, 1987.
SCALO, J. et al. Insomnia, hypnotic use, and health-related quality of life in a nationally representative sample. Qual Life Res, v. 24, n. 5, p. 1223–33, 2015.
SCHWARTZ, Michael W. et al. Central Nervous System Control of Food Intake. Nature, v. 404, n. 6778, p. 661–71, abr. 2000. DOI: https://doi.org/10.1038/35007534.
SHU, Qing et al. Acupuncture Targeting SIRT1 in the Hypothalamic Arcuate Nucleus Can Improve Obesity in High-Fat-Diet-Induced Rats with Insulin Resistance via an Anorectic Effect. Obesity Facts, v. 13, n. 1, p. 40–57, 2020. DOI: https://doi.org/10.1159/000503752.
SOBRINO CRESPO, Carmen et al. Peptides and Food Intake. Frontiers in Endocrinology, v. 5, abr. 2014. DOI: https://doi.org/10.3389/fendo.2014.00058.
TAM, Charmaine S. et al. Novel Strategy for the Use of Leptin for Obesity Therapy. Expert Opinion on Biological Therapy, v. 11, n. 12, p. 1677–85, dez. 2011. DOI: https://doi.org/10.1517/14712598.2011.619974.
TIAN, D. et al. Electroacupuncture up-regulated arcuate nucleus alpha-MSH expression
in the rat of diet-induced obesity. J Peking Univ (Health Sci), v. 35, n. 5, p. 458–61, 2003. DOI: 10.1023/A:1022865704606.
TIAN, Nan et al. Electroacupuncture Suppresses Expression of Gastric Ghrelin and Hypothalamic NPY in Chronic Food Restricted Rats. Peptides, v. 27, n. 9, p. 2313–20, set. 2006. DOI: https://doi.org/10.1016/j.peptides.2006.03.010.
TIAN, D. R. et al. Up-regulation of the expression of cocaine and amphetamine-regulated transcript peptide by electroacupuncture in the arcuate nucleus of diet-induced obese rats. Neurosci Lett, v. 383, n. 1-2, p. 17–21, 2005. DOI: 10.1016/j.neulet.2005.03.039.
TIMPER, Katharina; BRÜNING, Jens C. Hypothalamic Circuits Regulating Appetite and Energy Homeostasis: Pathways to Obesity. Disease Models & Mechanisms, v. 10, n. 6, p. 679–89, jun. 2017. DOI: https://doi.org/10.1242/dmm.026609.
WANG, F. et al. Arcuate nucleus of hypothalamus is involved in mediating the satiety effect of electroacupuncture in obese rats. Peptides, v. 32, n. 12, p. 2394–9, 2011. DOI: 10.1016/j.peptides.2011.10.019.
WANG, X. Q. et al. Effect of electroacupuncture on serum melatonin and dopamine in aged insomnia [in Chinese]. Zhongguo Zhen Jiu, v. 41, n. 5, p. 501–4, maio 2021. DOI: 10.13703/j.0255-2930.20200404-k0001.
WHELTON, P. K. et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the american college of cardiology/american heart association task force on clinical practice guidelines. Journal of the American College of Cardiology, v. 71, n. 19, p. e13–e15, 2017.
WILDING, J. P. H. Neuropeptides and Appetite Control. Diabetic Medicine, v. 19, n. 8, p. 619–27, ago. 2002. DOI: https://doi.org/10.1046/j.1464-5491.2002.00790.x.
WINN, Philip. The Lateral Hypothalamus and Motivated Behavior: An Old Syndrome Reassessed and a New Perspective Gained. Current Directions in Psychological Science, v. 4, n. 6, p. 182–87, dez. 1995. DOI: https://doi.org/10.1111/1467-8721.ep10772629.
WREN, A. M. et al. Ghrelin Enhances Appetite and Increases Food Intake in Humans. The Journal of Clinical Endocrinology & Metabolism, v. 86, n. 12, p. 5992–5992, dez. 2001. DOI: https://doi.org/10.1210/jcem.86.12.8111.
WU, X. F. et al. Effects of acupuncture on HPA axis-related hormones in insomnia rats. Chin J Inf Tradit Chin Med, v. 24, n. 11, p. 53–7, 2017.
XIE, C. et al. Effects of electroacupuncture on seep via the dopamine system of the HPA axis in rats after cage change. Evid Based Complement Alternat Med, v. 2021, p. 5527060, 2021.
YOON, S.; GILLESPIE, C. D.; GEORGE, M. G.; WALL, H. K. Control of hypertension among adults-national health and nutrition examination survey, United States, 2005-2008. MMWR Supplements, v. 61, n. 2, p. 19–25, 2005.
ZHAO, Fei-Yi et al. Acupuncture for Primary Insomnia: Effectiveness, Safety, Mechanisms and Recommendations for Clinical Practice. Sleep Medicine Reviews, v. 74, p. 101892, abr. 2024. DOI: https://doi.org/10.1016/j.smrv.2023.101892.
ZHONG, Yu-Mei et al. Acupuncture versus Sham Acupuncture for Simple Obesity: A Systematic Review and Meta-Analysis. Postgraduate Medical Journal, v. 96, n. 1134, p. 221–27, abr. 2020. DOI: https://doi.org/10.1136/postgradmedj-2019-137221.
