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The vagus nerve as a neurovisceral interface: a comprehensive review
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DOI：10.3389/fnins.2026.1878765.png)
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Abstract
En 中文
The vagus nerve is the longest cranial nerve and a key component of the autonomic nervous system; functioning as a neurovisceral interface between the brain and peripheral organs. Despite well-defined anatomy; the mechanisms underlying its integrative roles in cardiovascular; metabolic; and neuropsychiatric regulation remain incompletely understood. This narrative review synthesizes current evidence on the anatomical organization; physiological functions; and clinical relevance of the vagus nerve; focusing on cardiac autonomic control; gastrointestinal and metabolic regulation; the gut–brain axis; and vagus nerve stimulation. In the cardiovascular system; it interacts with sympathetic pathways within the cardiac plexus and intrinsic cardiac nervous system to regulate heart rate and conduction. In the gastrointestinal system; it coordinates motility; secretion; and metabolic homeostasis through nutrient- and hormone-sensitive pathways. Within the gut–brain axis; emerging evidence highlights rapid neuroepithelial signaling and microbiota-dependent modulation mediated by vagal circuits. The vagus nerve stimulation represents a promising therapeutic strategy for restoring autonomic balance; although challenges remain in fiber selectivity and clinical variability. Advances in multi-omics approaches are beginning to reveal the molecular heterogeneity of vagal neurons; but significant gaps persist due to limited human anatomical data. In conclusion; the vagus nerve functions as a multidimensional integrative system; and a deeper understanding of its structure and molecular organization is essential for developing precise neuromodulatory therapies.
Keywords:
gut-brain axis
cardiovascular system
vagus nerve
vagus nerve stimulation
autonomic system
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