Presentation on bioelectronic medicine

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2. Introduction
 Bioelectronics is an emerging branch of
medical science dealing with combined
application of the principles of biology
and electrical engineering
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3.  Bioelectronic medicine is an emerging
field of medicine which combines
neuroscience, molecular biology and
bioengineering to tap into the nervous
system to treat disease and injury
without the use of pharmaceuticals."We have long known that the nervous
system communicates with the body. We
can now learn the language by which it
communicates, which enables us to fine
tune how we help the body heal itself.“
- Kevin J. Tracey3

4. Definition
“Bio electronic medicines are a tiny
implanted device treating disease by
changing the electric pulses in nerves to
and from specific organs.”
 The vision for bio electronic medicines is
one of miniature, implantable devices
that can be attached to individual
peripheral nerves anywhere in the
viscera4

5. The leading figure in the research has been Dr.
Kevin Tracey of the Feinstein Institute in New
York who discovered around 15 years ago the
inflammatory reflex, a neural circuit between the
brain and the vagus nerve regulating the immune5

6. TNF
Cytokine involved in
inflammation reflex
Produced chiefly by
activated macrophages, although it can
be produced by many other cell types
such as lymphocytes, neutrophils, mast
cells, eosinophils, and neurons.6

7. TNF
In small
quantities,
its beneficial,
in regulating
immune
system
In excess, it
damages organ,
causes blood
pressure to
plummet and
cause lethal shock7

8.  There was development of monoclonal
Anti TNF antibodies.
 For the first time they were given to
baboons in septic shock and they
recovered
 Monoclonal Anti TNF was then approved
by FDA
 Now, millions of patients of Rheumatoid
arthritis have gained benefit.8

9. Why TNF was
produced in
some conditions
and not all?
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10.  For this, there was further study on
rats.
 Drugs was injected in the brains of
the animals
 As expected TNF was blocked in the
brain
 TNF also got blocked in Heart, gut,10

11. VAGUS
NERVE
-10th cranial nerve.
-Mixed nerve
- It is the longest and
most widely distributed
cranial nerve.
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 Vagus nerve controlled TNF
 Proved in rats by electrically stimulating
vagus nerve
 That turned off the production of TNF.
 Later used in the patients, where a small
stimulator was put in the neck of the
patients

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-Electrons in the
stimulator would
send signals in the
patients to turn
TNF off.
-Potential
replacement for
monoclonal anti
TNF

14. Mechanism
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The nerve signals from vagus nerve were converted
to chemical signals in spleen
Chemical signal activated the white blood cell
called T-cell
T-cells responded by making Acetylcholine
Acetylcholine targeted the macrophages
producing TNF
Acetylcholine turned TNF off

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16. Future of bioelectronics:
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 The therapeutic approaches currently available
for metabolic diseases do not provide long-term
control of the disease, combined with significant
side effects
 A bioelectronic medicine approach could bring
significant improvement in the standard of care
for type 2 diabetes by targeting nodal metabolic
pathways and avoiding systemic effects.
 Implantable devices, which can be attached to
peripheral nerves anywhere in the viscera, are
used to treat hypertension and sleep apnea.

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 there is now greater potential for high
precision approaches to treat patients
through specific neuromodulation
 Study demonstrates that specific
intervention and stimulation of the SLN
can selectively modify hormonal release
from the parathyroid/thyroid glands,
which has a potential application in
patients
 e.g., increasing endogenous calcitonin

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Condition Clinical
Result
Mechanism
Rheumatoid
Arthritis
RA disease
severity,
improved
significantly after
vagus
nerve stimulation
(VNS).
Activation of the
neural circuit
converging on the
spleen to inhibit the
production of TNF
and other pro-
inflammatory
cytokines by
macrophages
Crohn’s
disease
In this pilot VNS
study, five of
seven
participants
evolved
In this pilot VNS
study, five of
seven
participants
evolved

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Condition Clinical
Result
Mechanism
Paralysis Motor impairment
level improved,
allowing participant
to grasp and
manipulate different
size objects with
different grips.
Muscle activation via
neuromuscular
stimulation
Parkinson’s comparisons
showed that
neurostimulation,
as compared with
medication alone,
caused greater
improvements from
Unknown;
hypotheses include
suppression of
abnormal activity
and reinforcement of
dynamic
modulation of

20. Examples of Bioelectronics
 Pace makers
 Artificial
Limbs
 Bio Sensors
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21. Also called artificial pacemakers,
have been a boon to patients by
regulating their heart beats.
For people who have lost their limbs
in accidents artificial limbs are used.
Bioelectronics is used to power them,
control them, modify and manipulate
their structure as per the needs.
Sensors are attached to the body to
monitor the body temperature and
measure stress and strain in specific
parts of the body.21

22. Bioelectronics and implanted
devices- i-limb ultra
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 vari-grip mode, allowing variable digit-
bydigit grip strength
 Gesture selection allows users to create
custom gestures
 Auto grasp feature to prevent objects
slipping
 Hand automatically moves to a natural
position after period of inactivity
 Low battery warning audio signal

23. Bioelectronics and implanted
devices- Hepalife’s Bioreactor
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 Kidneys remove metabolic wastes from the
body and regulate fluid volume and
distribution on a continuous, around the
clock basis
 With traditional hemodialysis, patients are
hooked up to a machine for four hours, three
times a week
 provide cleansing and fluid balance on a

24. Restore movement in a paralysed
human
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 Neural decoding was combined with
functional electrical stimulation to allow
volitional control of temporarily paralysed
muscles
 ‘Neural bypass’ technology was
developed and demonstrated in a first-
inhuman study involving a 23-year-old
male quadriplegic participant.
 The study participant was able to move

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NEURAL BYPASS system
in use
Neuromuscular
Electrical
stimulation
sleeve
Green: Location of
microelectrode
Red: Active brain
areas during
movements
Yellow:
overlapping region
between location
of both

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27. AbioCor Artificial Heart
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 Would be used only in patients who are close
to death and have no other treatment options
 Tested in only 14 men
 Two died from the operation, and another
never regained consciousness
 The rest survived only an average of five
months, with one exception:
 A man who lived 17 months, until the
mechanical heart wore out.
 Sept. 6, 2006 —A Massachusetts company
received federal approval Tuesday to sell up
to 4,000 artificial hearts a year

28. Bioelectronics and implanted
devices-Eyes
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 Restore vision to patients with certain
forms of retinal blindness
 This happens when rods and cone
degenerate, but nerve cells that connect
the eye to the brain remains healthy

29. Bioelectronics and implanted
devices-Lungs.
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 BioLung
 Artificial lung that can replace the gas
exchange function of a person’s native
lungs during recovery from injury or
illness, or until donor lungs are available
for transplantation.
 Currently undergoing testing for FDA
submission.

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Defence advanced research
project Agency
-Mainly focus on
Humans and
machine teaming
-Bioelectronics for
Tissue regeneration

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 GSK have an exploratory funding
program which supports more than 30
projects, across more than 25
institutions around the world.
 Particular focus on neural signal
analysis for recording data-sets,
higher resolution interfacing for the
targeted disease nerves, and circuit
mapping / tracing
 GSK have also created Action Potential
Venture Capital (APVC) Limited, a new
$50m strategic venture capital fund that
invests in companies that pioneer

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 GSK in 2016 announced an agreement
with Verily Life Sciences LLC (formerly
Google Life Sciences), an Alphabet
company, to form Galvani Bioelectronics
to enable the research, development
and commercialisation of
bioelectronic medicines
 The agreement to establish Galvani
Bioelectronics represents an important
next step in GSK’s bioelectronics
research.

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 The new company will bring together
GSK’s world class drug discovery
and development expertise and deep
understanding of disease biology with
Verily’s world leading technical
expertise in the miniaturisation of low
power electronics, device development,
data analytics and software
development for clinical applications.

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 In 2013 the NIH, DARPA, and GSK held a
joint summit consisting of leading
researchers in academia and industry to
create a research roadmap to realize 'the
vision of a new class of medicines based
on modulating the electrical signaling
patterns of the peripheral (autonomic)
nervous system'.
 A 'research imperative' identified through
this planning effort was to develop 'in vivo
sensors for molecular and physiological

36. References:
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 Research articles:
 Bouton X, Cracking the neural code, treating paralysis
and the future of bioelectronic medicine In.,
Bioelectronic Medicine: Technology Targeting
Molecular Mechanisms, Key Symposium
 Pavlov Valentin A. and Tracey Kevin, Bioelectronic
medicine: updates, challenges and paths forward,
Pavlov and Tracey Bioelectronic Medicine, Editorial
 P. S. Olofsson & K. J. Tracey, Bioelectronic medicine:
technology targeting molecular mechanisms for
therapy, Bioelectronic Medicine technology Targeting
Molecular Mechanisms. Key Syposium
 Birmingham Karen, Gradinaru Viviana, Anikeeva
Polina, Grill Warren M., Pikov Victor, McLaughlin
Bryan , Pasricha Pankaj, Weber Douglas, Ludwig Kip
and Famm Kristoffer, Bioelectronic medicines: a
research roadmap,VOLUME 13, JUNE 2014,399

37. Video links.
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 https://www.youtube.com/watch?v=69Yi9Lxh5c8
 https://www.youtube.com/watch?v=TW_5RYHbto
g
 https://www.youtube.com/watch?v=NhXtSy-
Ccvg&t=80s
 https://www.youtube.com/watch?v=DfrZJO2FerM
 https://www.technologynetworks.com/neuroscienc
e/news/first-bioelectronic-medicine-is-unveiled-
310523
 https://feinstein.northwell.edu/institutes-
researchers/bioelectronic-medicine

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