indings are that VNS could be employed in the treatment of lupus, RA, and other autoimmune diseases. VNS is currently in use as an adjunctive treatment for certain PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/19836572 types of intractable epilepsy and major depression.203 VNS uses an implanted stimulator that sends electric impulses to the left vagus nerve in the neck via a lead wire implanted under the skin. VNS implantation devices consist of a titanium-encased generator about the size of a pocket watch with a lithium battery to fuel the generator, a lead wire system with electrodes, and an anchor tether to secure leads to the vagus nerve. The battery life for the pulse generator is between 1 and 16 years, depending on the settings, ie, how strong the signal being sent is, the length of time the device stimulates the nerve each time, and how frequently the device stimulates the nerve. Implantation of the VNS device is usually done as an outpatient procedure. Insulin has anti-inflammatory actions Marker of inflammation and disease activity These are anti-inflammatory cytokines, and their increase suggests a decrease in the activity of the disease and possible impending remission These are anti-inflammatory lipid molecules; their measurement prior to disease and after institution of therapy may indicate remission or progression of disease. Their increase suggests a decrease or resolution of inflammation Inhibits eNO, and its levels are increased in CHD, metabolic syndrome, and rheumatological conditions Pyruvate is an antioxidant and suppresses IL-6, TNF-, and MIF production Has immunosuppressive and anti-inflammatory properties and levels are low in metabolic syndrome and rheumatological conditions Their activity indicates the vagal tone and the amount of acetylcholine released and indirectly serve as markers of inflammation as acetylcholine is an antiinflammatory molecule a7nAChR expression may indicate the status of cholinergic anti-inflammatory pathway and could be used to assess response to therapy as prognostic marker Catecholamines have proinflammatory action and suggest their role and contribution to inflammation a7nAChR expression on peripheral macrophages and synovial fibroblasts Catecholamines in peripheral leukocytes deficiency could lead to unabated inflammation. Hence, methods designed to enhance their formation, such as coadministration of aspirin with PUFAs and/or development and use of their stable synthetic analogs, may prove to be useful in various rheumatological conditions. Such an approach is urgently needed. Ghrelin Ghrelin is a growth hormone secretagogue produced by the gut and is expressed in the hypothalamus and other tissues as well. Ghrelin not only plays an important role in the regulation of appetite, energy balance, and glucose homeostasis but also shows Pyrroloquinolinequinone disodium salt antibacterial activity, suppresses proinflammatory cytokine production, and restores gut barrier function. Ghrelin inhibits proinflammatory cytokine production, mononuclear cell binding, and nuclear factor-B activation in human endothelial cells in vitro and endotoxin-induced cytokine production in vivo.204 Ghrelin stimulates the vagus nerve. Experimental studies revealed that vagotomy prevented ghrelin’s downregulatory effect on TNF- and IL-6 production, confirming that ghrelin downregulates proinflammatory cytokines in sepsis through activation of the vagus nerve.205 Ghrelin has sympathoinhibitory properties that are mediated by 
central ghrelin receptors involving a NPY/Y1-receptor-dependent pathway.206 Gh
