The future of bioelectronic medicine is bright

Bioelectric Medicine

The future of bioelectronic medicine

Neurosurgeon and immunologist Kevin Tracey shares the frontiers of a new, hybrid field - bioelectronic medicine.

Kevin Tracey has been championing the practice of using electric signals for purposes of neuromodulation, with the ultimate goal of maintaining immunological homeostasis. 

I have been revisiting my notes on neuromodulation after his group released a very promising research study that looked at the effects of vagus nerve stimulation for Rheumatoid Arthritis. This was a landmark study that demonstrated for the first time that vagus nerve stimulation inhibits Tumor Necrosis Factor (TNF) production and attenuates inflammation in humans. 

This gets me excited for upcoming technological advances, that may change the way we view and treat diseases. Essentially, this paper proposes that action potentials carried in the vagus nerve suppress cytokine production, this is termed the "inflammatory reflex". This study uses an invasive devise to activate this inflammatory response, but Tracey has also been looking at using electro-acupuncture to activate this response through auricular branches of the vagus nerve.

The future of bioelectronic medicine

The future of bioelectric medicine is bright - This may have implications for medical acupuncture, a therapeutic approach in which acupuncture needles are inserted into anatomically defined sites, and stimulated manually or with electricity.

Treatment targets are based on patient presentation, but preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia).

Researchers have demonstrated the effect of electro-acupuncture for a number of conditions including but not limited to:
• Migraine Prophylaxis (Zhao et al. 2017)
• Carpal Tunnel Syndrome (Maeda et al. 2017)
• Urinary Leakage Among Women With Stress Urinary Incontinence (Liu et al. 2017)

More to Explore

Babygirija, R., Sood, M., Kannampalli, P., Sengupta, J.N., Miranda, A. (2017). Percutaneous electrical nerve field stimulation modulates central pain pathways and attenuates post-inflammatory visceral and somatic hyperalgesia in rats. Neuroscience.

Bonaz, B., Sinniger, V., & Pellissier, S. (2016). Anti-inflammatory properties of the vagus nerve: Potential therapeutic implications of vagus nerve stimulation. The Journal of Physiology.

Chakravarthy, K., Nava, A., Christo, P.J., Williams, K. (2016). Review of Recent Advances in Peripheral Nerve Stimulation (PNS). Curr Pain Headache Rep.

Chavan, S. S., & Tracey, K. J. (2014). Regulating innate immunity with dopamine and electroacupuncture. Nature Medicine.

Chavan, S.S., Pavlov, V.A., Tracey, K.J. (2017). Mechanisms and Therapeutic Relevance of Neuro-immune Communication. Immunity.

Chavan, S.S., Tracey, K.J. (2017). Essential Neuroscience in Immunology. J Immunol.

Hua, S. (2016). Neuroimmune Interaction in the Regulation of Peripheral Opioid-Mediated Analgesia in Inflammation. Front Immunol.

Ji, R.R., Chamessian, A., Zhang, Y.Q. (2016). Pain regulation by non-neuronal cells and inflammation. Science. (OPEN ACCESS)

Koopman, F. A., Chavan, S. S., Miljko, S., Grazio, S., Sokolovic, S., Schuurman, P. R., . . . Tak, P. P. (2016). Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis. Proceedings of the National Academy of Sciences. (OPEN ACCESS)

Kovacic, K., Hainsworth, K., Sood, M., ... Miranda, A. (2017). Neurostimulation for abdominal pain-related functional gastrointestinal disorders in adolescents: a randomised, double-blind, sham-controlled trial. Lancet Gastroenterol Hepatol.

Lim, H., Kim, M., Lee, C., & Namgung, U. (2016). Anti-Inflammatory Effects of Acupuncture Stimulation via the Vagus Nerve. PLoS ONE.  (OPEN ACCESS)

Liu, Z., Liu, Y., ... Liu, B. (2017).  Effect of Electroacupuncture on Urinary Leakage Among  Women With Stress Urinary Incontinence: A Randomized Clinical Trial. JAMA.

Macdonald, A. J. (1993). A brief review of the history of electrotherapy and its union with acupuncture. Acupuncture in Medicine. (OPEN ACCESS)

Maeda, Y., Kim, H., Kettner, N., Kim, J., Cina, S., .... Napadow, V. (2017). Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain.

Pavlov, V. A., & Tracey, K. J. (2015). Neural circuitry and immunity. Immunologic Research. (OPEN ACCESS)

Pavlov, V.A., Tracey, K.J. (2017). Neural regulation of immunity: molecular mechanisms and clinical translation. Nat Neurosci.

Pelletier, R., Higgins, J., Bourbonnais, D. (2015). Addressing Neuroplastic Changes in Distributed Areas of the Nervous System Associated With Chronic Musculoskeletal Disorders. Phys Ther.

Pereira, M. R., & Leite, P. E. (2016). The Involvement of Parasympathetic and Sympathetic Nerve in the Inflammatory Reflex. Journal of Cellular Physiology.

Qiao, L.N., Liu, J.L., Tan, L.H., Yang, H.L., Zhai, X., Yang, Y.S. (2017). Effect of electroacupuncture on thermal pain threshold and expression of calcitonin-gene related peptide, substance P and γ-aminobutyric acid in the cervical dorsal root  ganglion of rats with incisional neck pain. Acupunct Med.

Salazar, T.E., Richardson, M.R., Beli, E., ... Grant, M.B. (2017). Electroacupuncture Promotes CNS-Dependent Release of Mesenchymal Stem Cells. Stem Cells.

Torres-Rosas, R., Yehia, G., ... Ulloa, L. (2014). Dopamine mediates vagal modulation of the immune system by electroacupuncture. Nat Med. (OPEN ACCESS)

Tracey, K. J. (2016). Reflexes in Immunity. Cell. (OPEN ACCESS) 

Waki, H., Suzuki, T., Hisajima, T. (2017). Effects of electroacupuncture to the trigeminal nerve area on the autonomic nervous system and cerebral blood flow in the prefrontal cortex. Acupunct Med.

White, A. (2009). Western medical acupuncture: a definition. Acupunct Med.

White, A. & Ernst, E. (2004). A brief history of acupuncture. Rheumatology.

Yin, C., Buchheit, T.E., Park, J.J. (2017). Acupuncture for chronic pain: an update and critical overview. Curr Opin Anaesthesiol.

Zhang, R., Lao, L., Ren, K., & Berman, B. M. (2014). Mechanisms of Acupuncture–Electroacupuncture on Persistent Pain. Anesthesiology. (OPEN ACCESS)

Zhou, S.L., Zhang, X.L., Wang, J.H. (2017). Comparison of electroacupuncture and medical treatment for functional constipation: a systematic review and meta-analysis. Acupunct Med.

Zhao, L., Chen, J., Li, Y., ... Liang, F. (2017). The Long-term Effect of Acupuncture for Migraine Prophylaxis A Randomized Clinical Trial. JAMA Intern Med.