Closed-loop bioelectronic medicine for diabetes management

Abstract

Modulation of the nervous system by delivering electrical or pharmaceutical agents has contributed to the development of novel treatments to serious health disorders. Recent advances in multidisciplinary research has enabled the emergence of a new powerful therapeutic approach called bioelectronic medicine. Bioelectronic medicine exploits the fact that every organ in our bodies is neurally innervated and thus electrical interfacing with peripheral nerves can be a potential pathway for diagnosing or treating diseases such as diabetes. In this context, a plethora of studies have confirmed the important role of the nervous system in maintaining a tight regulation of glucose homeostasis. This has initiated new research exploring the opportunities of bioelectronic medicine for improving glucose control in people with diabetes, including regulation of gastric emptying, insulin sensitivity, and secretion of pancreatic hormones. Moreover, the development of novel closed-loop strategies aims to provide effective, specific and safe interfacing with the nervous system, and thereby targeting the organ of interest. This is especially valuable in the context of chronic diseases such as diabetes, where closed-loop bioelectronic medicine promises to provide real-time, autonomous and patient-specific therapies. In this article, we present an overview of the state-of-the-art for closed-loop neuromodulation systems in relation to diabetes and discuss future related opportunities for management of this chronic disease.

Overview of therapeutic applications of non-invasive vagus nerve stimulation: a motivation for novel treatments for systemic lupus erythematosus

“…Therefore, this review motivates the use of bioelectronic medicine through neuro-modulation as a promising new pathway to treat a number of serious chronic inflammatory diseases. The therapeutic impact of bioelectronic medicine can be boosted by replicating the body’s closed-loop mechanisms: metabolic and neuro-physiological biomarkers can be recorded and analyzed in real-time to accordingly adjust the characteristics of the electrical stimulation delivered to the peripheral nerves or directly to the organs to modulate their function ( Güemes Gonzalez et al 2020 ). Advances in bioelectronic medicine towards these closed-loop systems are supported by the development of new non-invasive or minimally invasive technology and algorithms, which enable a safe and effective interface with the nervous system.…”

A Fully Implantable Wireless Bidirectional Neuromodulation System for Mice

“…The need for closed-loop approaches in clinical applications has long been recognized [1][2][3]. Recent indications under active research include spinal cord injury [4,5], psychiatric disorders and neurodegenerative diseases [6,7], bladder dysfunction [8], diabetes management [9], hypertension [10], and pain relief [11]. In some applications, the closed-loop algorithm is relatively simple, e.g.…”

Blood glucose modulation and safety of efferent vagus nerve stimulation in a type 2 diabetic rat model

“…Bionic medicine is used to alter the activity of peripheral nerves to treat conditions and is emerging as a promising treatment for many chronic diseases (Alliance for Advancing Bioelectronic Medicine, 2020 ; Malbert, 2018 ; Vitale & Litt, 2018 ). Electrical modulation of the vagus nerve to lower high glucose levels has been the focus of bionic medicine research (Guemes Gonzalez et al, 2020 ; Malbert, 2018 ) as this autonomic nerve is involved in the regulation of food intake, glucose metabolism, and homeostasis and influences the overall dynamics of insulin secretion (Travagli & Browning, 2011 ; Waise et al, 2018 ). However, exactly how to modulate the activity of the vagus nerve to achieve optimal, glycemic control is yet to be determined.…”