Could Bioelectronics Replace Medications?

Imagine a future where, instead of reaching for a pill to soothe your pain or offset a disease symptom, you press a button (or more likely, an app on your phone) that triggers a tiny, implantable device in your body, stimulating a nerve, which targets the same molecular pathway as a medication—correcting the problem without drugs.

That future is much closer than it may appear. This new field of medicine, known as bioelectronics, has many pioneers, but none are so well-known as neurosurgeon Kevin Tracey, who is president and CEO of the Feinstein Institute for Medical Research. He has been studying inflammation and the nervous system for most of his career and has contributed to several major breakthroughs in the field.

His most lauded discovery was that by interfering with, or stimulating, nerves in the central nervous system, they could instigate the body’s inflammatory reflex, in which acetylcholine (a neurotransmitter) is released, inhibiting the pro-inflammatory cytokines (a type of protein released by immune cells) that cause inflammation in the body. He specifically homed in on the Vagus nerve—the widely reaching nerve bundle considered the “captain” of the parasympathetic nervous system, which communicates directly to the brain and with all organ systems via nerve impulses called action potentials. 

THE FIRST DEVICE

In bioelectronic medicine, “you begin with a molecular mechanism—such as the inflammatory response in an autoimmune disease—and build a device to control that mechanism,” Tracey explains to mental_floss. Instead of screening for chemicals that control the target, you screen for nerves. Every organ in the body is under the control of a nerve. Tracey points out that the nervous system and the immune system “co-evolved, not one before the other." As one became more complicated, so did the other. He says, “If we can develop devices that restore the healthy balance between the two, there won’t be any side effects."

Tracey’s research with rheumatoid arthritis (RA) patients led to the creation of a small, implantable Vagal nerve stimulator that dramatically reduced inflammation in patients. Clinical trials on humans have been so successful that several of the 18 patients in the trial have seen complete remission of their RA, allowing them to go off all medications. However, it may still be another three to five years before you can obtain one of these devices in the U.S. “I conceived these trials on the back of a napkin in 1998 using materials that were FDA-approved at the time,” Tracey laments. “It shouldn’t take this long, but that’s another story.”

The problem with drugs, when swallowed or injected, is that they “go everywhere, and even the best drugs have side effects,” he says. “Nerves go to a specific place and deliver a specific payload that lasts for a short period of time without side effects.”

HITTING THE TARGET

If targeting nerve cells seems like an unlikely way to treat many diseases, Tracey points to research by Paul Frenette, a stem-cell researcher at the Albert Einstein College of Medicine, done on prostate and breast cancer. Frenette’s study showed in mouse models that nerve cells release molecules that “control the ability of the cancer cells to grow or metastasize,” says Tracey.

Research of this kind is guiding the direction of the bioelectronics field, Tracey says: “What are the diseases where we either have data or a good hypothesis that we can hit the target of the disease through a nerve?” He believes that such diseases as cancer, diabetes, inflammatory bowel disease, hypertension, Alzheimer’s, and even hypertensive shock may all be treatable one day through bioelectronic medicine.

Of course, to make these devices as effective as possible requires refining their size and precision. This is where Chad Bouton, the division leader of neurotechnology and analytics at Feinstein, comes in. “I spend most of my time figuring out how to decode and reroute nervous system signals,” he tells mental_floss. “Why couldn’t we reroute or stimulate a system to strengthen the immune system, since it can go the other way and be weakened?” 

REFINING THE STIMULATION

Bouton is working on not only making more sophisticated electrodes, but refining the methods of stimulation. “We want to know exactly what the stimulation waveform looks like, and how this can effect which fibers you’re affecting or modulating in the Vagus nerve. We’re also investigating how long you do it [and] when you do it. There might be an effect at a certain time of day, or in response to something happening in the body.”

Bouton is most proud of a device they’ve created called the neural tourniquet, which can slow blood loss from injury or during surgery. The device sends a signal via the Vagus nerve to the spleen, priming it to produce the platelets needed for coagulation. “Both bleeding time and volume can be reduced on order of roughly 40 percent,” Bouton says. “In preclinical studies, it looks like the effect could last for quite a few hours.” 

Tracey is hopeful about the potential of bioelectronics medicine. “Scientists get nervous about predicting the future, but when I look at the fact that for 100 years we’ve been making drugs based on molecular mechanisms—and in bioelectronics, we’re studying molecular mechanisms and capitalizing on advances in computerized miniaturizations—I see objective findings that we can build devices to replace many drugs in the future."

Editor's note: This post has been updated.