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This concept proposes that efferent parasympathetic nerve fibers in the vagus directly innervate the adrenal glands to influence catecholamine secretion. Here, we discuss evidence for anatomical and functional links between the vagi and adrenal glands that may be relevant in the context of inflammation and its neural control by factors, including acupuncture. First, we find that evidence for any direct vagal parasympathetic efferent innervation of the adrenal glands is weak and likely artifactual. Second, we find good evidence that vagal afferent fibers directly innervate the adrenal gland, although their function is uncertain. Third, we highlight a wealth of evidence for indirect pathways, whereby vagal afferent signals act via the central nervous system to modify adrenal\u2010dependent anti\u2010inflammatory responses. Vagal afferents, not efferents, are thus the likely key to these phenomena.<\/jats:p>","DOI":"10.1002\/cne.25656","type":"journal-article","created":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T08:52:35Z","timestamp":1720515155000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["What is the Vagal\u2013Adrenal Axis?"],"prefix":"10.1002","volume":"532","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2915-3337","authenticated-orcid":false,"given":"Pedro","family":"Trevizan\u2010Ba\u00fa","sequence":"first","affiliation":[{"name":"The Florey Institute of Neuroscience and Mental Health The University of Melbourne  Parkville Victoria Australia"},{"name":"Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity The University of Melbourne  Melbourne Victoria Australia"},{"name":"Department of Physiological Sciences University of Florida  Gainesville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7979-5656","authenticated-orcid":false,"given":"Robin M.","family":"McAllen","sequence":"additional","affiliation":[{"name":"The Florey Institute of Neuroscience and Mental Health The University of Melbourne  Parkville Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,7,9]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20120571"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0306-4522(84)90154-4"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mce.2021.111258"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autneu.2014.01.006"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.2443979"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpregu.1991.260.1.R200"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0165-1838(93)90046-W"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.3014662"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0008-8749(79)90129-1"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001756-199611040-00083"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42234-018-0004-9"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1113\/expphysiol.2011.061531"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/nri.2017.1"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-1716.1993.tb09588.x"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-1716.1992.tb09300.x"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2017.06.008"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnbeh.2012.00035"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2021.695152"},{"key":"e_1_2_12_20_1","first-page":"173","article-title":"The Innervation of the Adrenal Gland. 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