Towards an electrical cure for chronic diseases
Active implantable devices have been used for years to treat chronic conditions with minimal side effects: pacemakers and defibrillators (cardiac rhythm management), cochlear implants (deafness), deep brains stimulation (Parkinson), spinal cord stimulation (chronic pain) etc. Recently the interest in nerve stimulation has surged because it has been found that mild vagal nerve stimulation can be used as a complementary, or even replacement treatment for (chronic) autoimmune diseases such as, rheumatoid arthritis, Crohn’s disease, colitis, congestive heart failure, psoriasis, multiple sclerosis, asthma, Alzheimer, Parkinson etc.
To make bioelectronic medicines a practical reality, the next generation of smart implantable devices will need to be high miniaturized and autonomous and cost effective so that they can be implanted on the selected nerve with a simple minimally invasive procedure.
With an increasingly aging population, the (cost) effective treatment of chronic diseases is becoming increasingly important to curb the burden of the cost of healthcare. It is widely recognized that many chronic diseases find their roots in inflammatory abnormalities, often involving an over active immune system.
Today, the treatment of chronic autoimmune related diseases with biological cytokine suppressors places a heavy impact on our healthcare systems. Therapies with modern biological compounds such as Etanercept, Adalimumab, and Infliximab cost between $15,000 and $25,000 a year per patient, and even these are effective in only 40% of the cases.
The prospect of a therapy that can be administered with less side effects, lower total costs and with higher efficacy is daunting. Based on the preliminary results obtained so far, it is even justified to consider bioelectronic medicines not only as a last resort, but as a second or first line of therapy.
Relevance for the Electronic Components and Systems (ECS) industry
The prospect of bioelectronic medicines that can be deployed on a large scale for the treatment of a wide variety of chronic diseases poses an enormous opportunity for the electronic industry with its expertise and miniaturization, assembly, encapsulation, low power processing, wireless communication and high volume low-cost manufacturing. To enable this, the ECS industry will need to take the initiative in the development of the next generation of implantable neuromodulator devices that will be:
Highly miniaturized to that the can be precisely delivered on target nerves with minimally invasive procedures;
Specific to that the precisely target specific groups of neurons (fascicles) with minimal side effects;
Wirelessly powered by RF, ultrasound or energy harvesting;
Active only when needed through closed loop operation.
Enabling technology platforms
The development of the emerging field of bioelectronic medicines can be significantly accelerated by the development of a number of open technology platforms that address common technological challenges that will serve a variety of bioelectronic medicine devices. These include platforms for:
Miniaturization of complex heterogeneous systems to allow for minimally invasive device delivery on the target nerve;
Power management covering storage (battery or capacitor) and remote charging (inductive, ultrasound, scavenging);
Low-power edge AI computing for autonomous closed loop operation;
Encapsulation in relation to reliability, bio-stability, weight, manufacturability and cost.
Emily Waltz, “A spark at the periphery,” Nature Biotechnology, vol.34, no. 9, September 2016
Douglas Fox, “The electric cure,” Nature 545, p 20–22, 4 May 2017
Anthony Arnold, “The evolution of bioelectronic medicine, Reprogramming the body to fight disease with electricity,” a whitepaper by Setpoint Medical.