NIH to Feinstein: Stick out that chest (bioelectrically)

Middle ground: The Feinstein Institute is tunneling in on new nerve-stimulation targets in the abdominal region.
By GREGORY ZELLER //

With new treatments for obesity, heart failure and a host of other conditions in sight, a Feinstein Institute researcher will zero in on specific abdominal targets in a new “precision bioelectronic medicine” study.

North Shore University Hospital and Long Island Jewish Medical Center Chief of Gastroenterology Larry Miller, who also directs the Gastroenterology Laboratory at the Feinstein Institute for Medical Research, has received a $1.4 million National Institutes of Health grant that builds on recent progress in nerve-stimulation therapy – much of it achieved at Northwell Health’s R&D headquarters, which is recognized as a cornerstone of the emerging bioelectronic medicine field.

Following two primary discoveries – that inflammation plays a role in virtually every known disease, and that inflammation can be modulated by electric nerve stimulation – researchers have focused on implanting devices on the neck area, where tiny electric shocks can be delivered directly to the critical vagus nerve.

Early returns are promising, as evidenced by numerous grants, copious accolades for Feinstein Institute President and CEO Kevin Tracey – recognized as the preeminent pioneer of the field – and loads of studies exploring potential applications for diabetes, postpartum hemorrhaging, hypertension and a triage of other conditions.

Miller’s high ambitions aim lower. His plan is to access branches of the vagus nerve – the longest and most complex of the 12 cranial nerves that plug together body and brain – closer to the organs in the chest and abdomen.

The idea is to deliver those bioelectronic bolts from the cutting edge of neuroscience and bioengineering with more precision – ground zero of the targeted medical issue.

This would be achieved through non-invasive endoscopic methods – essentially, wiring up the nerves near the organs sans surgery – and that would clear a major hurdle. The idea of directly stimulating nerves in the chest has surfaced before, but the need for invasive surgery to access those nerves was a persistent roadblock.

Larry Miller: Tunnel vision.

Miller’s endoscopic solution is a transmural endoscopy, which tunnels in through the stomach or esophagus, and his $1.4 million will be spent figuring out how to implant the tiny nerve-stimulation device using this procedure, and where.

Non-invasive access to the nerves would create “the potential to drive development of bioelectronic medicine devices for treatment of conditions like obesity, heart failure and pulmonary hypertension,” according to the Feinstein Institute.

And, potentially, many conditions beyond those: The vagus nerve runs along the esophagus and stomach before branching out to the lungs, heart, liver, pancreas, small intestine and colon – a virtual vagus strip of potential targets for precision bioelectronic stimulation.

Miller agrees that taking the fight to the abdomen just makes sense.

“Many of the conditions bioelectronic medicine targets, like Crohn’s disease and diabetes, are caused by malfunctions of organs in the abdomen,” the researcher said Thursday. “With the support of the NIH, my team will explore how we can access branches of the vagus nerve near these organs … and develop stimulation devices that are implanted using this non-invasive technique.”

Miller’s NIH award is the latest in a long line of bioelectronic-based grants and awards flowing Feinstein’s way. The Manhasset-based institute announced in August that Professor Valentin Pavlov had received a five-year, $1.65 million NIH grant to examine the vagus nerve’s role in the inflammation and metabolism associated with sepsis.

The Feinstein Institute’s vagus research has also spun off into Sangusiat, a 2016 nerve-stimulation startup now based in Connecticut. The company – which focuses its electrostimulation tech on chronic bleeding issues – boasts Tracey as chairman and Northwell Health Senior Vice President for Clinical Strategy and Development Martin Doerfler among several experienced directors.

Noting that bioelectronic breakthroughs are starting to pile up, Tracey praised Miller’s plan to endoscopically deliver miniaturized nerve-stimulation devices.

“Advances in bioelectronic medicines … are occurring at a rapid pace,” the Feinstein CEO said in a statement “Dr. Miller’s proposed solutions … represent an extraordinary opportunity to accelerate development of future cures for patients.”