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Tu L, Gharibani P, Yang Y, Zhang B, Ji F, Yin J, Chen JDZ. A Novel Approach in Spinal Cord Stimulation for Enhancing Gastric Motility: A Preliminary Study on Canines. J Neurogastroenterol Motil 2020; 26:147-159. [PMID: 31917917 PMCID: PMC6955191 DOI: 10.5056/jnm19101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/19/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022] Open
Abstract
Background/Aims Gastroparesis is commonly seen in patients with diabetes and functional dyspepsia with no satisfactory therapies. Dysautonomia is one of the main reasons for the imbalanced motility. We hypothesized that spinal cord stimulation (SCS) is a viable therapy for gastroparesis via the autonomic modulation to improve gastric motility. The aim is to find an optimal method of SCS for treating gastroparesis. Methods Eight healthy-female dogs were implanted with a gastric cannula, a duodenal cannula, 2 multi-electrode spinal leads, and an implantable pulse generator. Gastric motility index (MI) was used to determine the best stimulation location/parameters of SCS. Optimized SCS was used to improve glucagon-induced gastroparesis. Results With fixed parameters, SCS at Thoracic 10 (T10) was found most effective for increasing gastric MI (37.8%, P = 0.013). SCS was optimized with different parameters (pulse width: 0.05–0.6 msec, frequency: 5–500 Hz, motor threshold: 30–90%) on T10. Our findings revealed that 0.5 msec, 20 Hz with 90% motor threshold at T10 were the best parameters in increasing MI. Glucagon significantly delayed gastric emptying, and this inhibitory effect was partially blocked by SCS. Gastric emptying at 120 minutes was 25.6% in the control session and 15.7% in glucagon session (P = 0.007 vs control), while it was 22.9% with SCS session (P = 0.041 vs glucagon). SCS with the optimal parameters was found to maximally enhance vagal activity and inhibit sympathetic activity assessed by the spectral analysis of heart rate variability. Conclusions SCS with optimized stimulation location and parameters improves gastric motility in healthy-dogs and accelerates gastric emptying impaired by glucagon via enhancing vagal activity.
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Affiliation(s)
- Lei Tu
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD , USA
| | - Payam Gharibani
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD , USA
| | - Yi Yang
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD , USA
| | - Bo Zhang
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD , USA
| | - Feng Ji
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD , USA
| | - Jieyun Yin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD , USA
| | - Jiande D Z Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD , USA
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Miller L, Farajidavar A, Vegesna A. Use of Bioelectronics in the Gastrointestinal Tract. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a034165. [PMID: 30249600 DOI: 10.1101/cshperspect.a034165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gastrointestinal (GI) motility disorders are major contributing factors to functional GI diseases that account for >40% of patients seen in gastroenterology clinics and affect >20% of the general population. The autonomic and enteric nervous systems and the muscles within the luminal GI tract have key roles in motility. In health, this complex integrated system works seamlessly to transport liquid, solid, and gas through the GI tract. However, major and minor motility disorders occur when these systems fail. Common functional GI motility disorders include dysphagia, gastroesophageal reflux disease, functional dyspepsia, gastroparesis, chronic intestinal pseudo-obstruction, postoperative ileus, irritable bowel syndrome, functional diarrhea, functional constipation, and fecal incontinence. Although still in its infancy, bioelectronic therapy in the GI tract holds great promise through the targeted stimulation of nerves and muscles.
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Affiliation(s)
- Larry Miller
- Division of Gastroenterology, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New York, New York 11040
| | - Aydin Farajidavar
- School of Engineering & Computing Sciences, New York Institute of Technology (NYIT), Old Westbury, New York 11568
| | - Anil Vegesna
- Division of Gastroenterology, Department of Medicine, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York 11030
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Abstract
Gastrointestinal (GI) motility disorders are common in clinical settings, including esophageal motility disorders, gastroesophageal reflux disease, functional dyspepsia, gastroparesis, chronic intestinal pseudo-obstruction, post-operative ileus, irritable bowel syndrome, diarrhea and constipation. While a number of drugs have been developed for treating GI motility disorders, few are currently available. Emerging electrical stimulation methods may provide new treatment options for these GI motility disorders. Areas covered: This review gives an overview of electrical therapies that have been, and are being developed for GI motility disorders, including gastroesophageal reflux, functional dyspepsia, gastroparesis, intestinal motility disorders and constipation. Various methods of gastrointestinal electrical stimulation are introduced. A few methods of nerve stimulation have also been described, including spinal cord stimulation and sacral nerve stimulation. Potentials of electrical therapies for obesity are also discussed. PubMed was searched using keywords and their combinations: electrical stimulation, spinal cord stimulation, sacral nerve stimulation, gastrointestinal motility and functional gastrointestinal diseases. Expert commentary: Electrical stimulation is an area of great interest and has potential for treating GI motility disorders. However, further development in technologies (devices suitable for GI stimulation) and extensive clinical research are needed to advance the field and bring electrical therapies to bedside.
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Affiliation(s)
- Jiande D Z Chen
- a Division of Gastroenterology and Hepatology, Department of Medicine , Johns Hopkins University , Baltimore , MD , USA.,b Department of Medicine , VA Medical Center , Oklahoma City , OK , USA
| | - Jieyun Yin
- a Division of Gastroenterology and Hepatology, Department of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Wei Wei
- c Division of Gastroenterology , Wangjing Hospital of Chinese Medical Academy , Beijing , China
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Shinko A, Agari T, Kameda M, Yasuhara T, Kondo A, Tayra JT, Sato K, Sasaki T, Sasada S, Takeuchi H, Wakamori T, Borlongan CV, Date I. Spinal cord stimulation exerts neuroprotective effects against experimental Parkinson's disease. PLoS One 2014; 9:e101468. [PMID: 25009993 PMCID: PMC4092020 DOI: 10.1371/journal.pone.0101468] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/05/2014] [Indexed: 01/19/2023] Open
Abstract
In clinical practice, deep brain stimulation (DBS) is effective for treatment of motor symptoms in Parkinson’s disease (PD). However, the mechanisms have not been understood completely. There are some reports that electrical stimulation exerts neuroprotective effects on the central nervous system diseases including cerebral ischemia, head trauma, epilepsy and PD, although there are a few reports on neuroprotective effects of spinal cord stimulation (SCS). We investigated the neuroprotective effects of high cervical SCS on PD model of rats. Adult female Sprague-Dawley rats received hour-long SCS (2, 50 or 200 Hz) with an epidural electrode at C1–2 level for 16 consecutive days. At 2 days after initial SCS, 6-hydroxydopamine (6-OHDA) was injected into the right striatum of rats. Behavioral evaluations of PD symptoms were employed, including cylinder test and amphetamine-induced rotation test performed at 1 and 2 weeks after 6-OHDA injection. Animals were subsequently euthanized for immunohistochemical investigations. In order to explore neurotrophic and growth factor upregulation induced by SCS, another cohort of rats that received 50 Hz SCS was euthanized at 1 and 2 weeks after lesion for protein assays. Behavioral tests revealed that the number of amphetamine-induced rotations decreased in SCS groups. Immunohistochemically, tyrosine hydroxylase (TH)-positive fibers in the striatum were significantly preserved in SCS groups. TH-positive neurons in the substantia nigra pars compacta were significantly preserved in 50 Hz SCS group. The level of vascular endothelial growth factor (VEGF) was upregulated by SCS at 1 week after the lesion. These results suggest that high cervical SCS exerts neuroprotection in PD model of rats, at least partially by upregulation of VEGF. SCS is supposed to suppress or delay PD progression and might become a less invasive option for PD patients, although further preclinical and clinical investigations are needed to confirm the effectiveness and safety.
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Affiliation(s)
- Aiko Shinko
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Takashi Agari
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
- * E-mail:
| | - Masahiro Kameda
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Akihiko Kondo
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Judith Thomas Tayra
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Kenichiro Sato
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Tatsuya Sasaki
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Susumu Sasada
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hayato Takeuchi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Takaaki Wakamori
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Cesario V. Borlongan
- Department of Neurosurgery, University of South Florida College of Medicine, Tampa, Florida, United States of America
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
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Song GQ, Sun Y, Foreman RD, Chen JDZ. Therapeutic potential of spinal cord stimulation for gastrointestinal motility disorders: a preliminary rodent study. Neurogastroenterol Motil 2014; 26:377-84. [PMID: 24341686 DOI: 10.1111/nmo.12273] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 11/08/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Spinal cord electrical stimulation (SCS) has been applied for the management of chronic pain. Most of studies have revealed a decrease in sympathetic activity with SCS. The aim of this study was to investigate the effects and mechanisms of SCS on gastrointestinal (GI) motility in healthy and diabetic rats. METHODS Male rats chronically implanted with a unipolar electrode at T9/T10 were studied. The study included four experiments to assess the effects of SCS on (1) gastric tone; (2) gastric emptying of liquids and intestinal transit; (3) gastric emptying of solids; and (4) sympathovagal balance in healthy rats and/or in Streptozotocin (STZ)-induced diabetic rat. KEY RESULTS (1) Spinal cord stimulation intensity dependently increased gastric tone in healthy rats. The gastric volume was 0.97 ± 0.15 mL at baseline, and decreased to 0.92 ± 0.16 mL with SCS of the 30% motor threshold (MT; p = 0.13 vs baseline), 0.86 ± 0.14 mL with 60% MT (p = 0.045 vs baseline), and 0.46 ± 0.19 mL with 90% MT (p = 0.0050 vs baseline). (2) Spinal cord stimulation increased gastric emptying of liquids by about 17% and accelerated small intestinal transit by about 20% in healthy rats (p < 0.001). (3) Spinal cord stimulation accelerated gastric emptying of solids by about 24% in healthy rats and by about 78% in diabetic rats. (4) Spinal cord stimulation decreased sympathetic activity (1.13 ± 0.18 vs 0.68 ± 0.09, p < 0.04) and sympathovagal balance (0.51 ± 0.036 vs 0.40 ± 0.029, p = 0.028). CONCLUSIONS & INFERENCES Spinal cord stimulation accelerates gastric emptying of liquids and solids, and intestinal transit, probably by inhibiting the sympathetic activity. Spinal cord stimulation may have a therapeutic potential for treating GI motility disorders.
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Affiliation(s)
- G-Q Song
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA; Department of Internal Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA
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Foreman RD, Linderoth B. Neural mechanisms of spinal cord stimulation. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013. [PMID: 23206679 DOI: 10.1016/b978-0-12-404706-8.00006-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Neuromodulation, specifically spinal cord stimulation (SCS), relieves pain and improves organ function. This chapter discusses the limited information presently available about the underlying mechanisms that explain the beneficial effects of treating patients with SCS. Where applicable, information is presented about translational research that illustrates the importance of collaboration between clinicians, basic scientists, and engineers. This chapter presents the infant stage of studies that attempt to explain the mechanisms which come into play for treating neuropathic pain, ischemic pain in peripheral vascular disease, and diseases of the visceral organs, specifically the gastrointestinal tract and the heart. The basic science studies will demonstrate how SCS acts on various pain syndromes and diseases via multiple pathways in the central nervous system as well as in somatic structures and visceral organs.
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Affiliation(s)
- Robert D Foreman
- Department of Physiology, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
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Qin C, Martinez M, Tang R, Huynh J, Goodman Keiser M, Farber JP, Carman JC, Wienecke GM, Niederauer G, Foreman RD. Is Constant Current or Constant Voltage Spinal Cord Stimulation Superior for the Suppression of Nociceptive Visceral and Somatic Stimuli? A Rat Model. Neuromodulation 2012; 15:132-42; discussion 143. [DOI: 10.1111/j.1525-1403.2012.00431.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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De Winter BY, De Man JG. Interplay between inflammation, immune system and neuronal pathways: Effect on gastrointestinal motility. World J Gastroenterol 2010; 16:5523-35. [PMID: 21105185 PMCID: PMC2992670 DOI: 10.3748/wjg.v16.i44.5523] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Sepsis is a systemic inflammatory response representing the leading cause of death in critically ill patients, mostly due to multiple organ failure. The gastrointestinal tract plays a pivotal role in the pathogenesis of sepsis-induced multiple organ failure through intestinal barrier dysfunction, bacterial translocation and ileus. In this review we address the role of the gastrointestinal tract, the mediators, cell types and transduction pathways involved, based on experimental data obtained from models of inflammation-induced ileus and (preliminary) clinical data. The complex interplay within the gastrointestinal wall between mast cells, residential macrophages and glial cells on the one hand, and neurons and smooth muscle cells on the other hand, involves intracellular signaling pathways, Toll-like receptors and a plethora of neuroactive substances such as nitric oxide, prostaglandins, cytokines, chemokines, growth factors, tryptases and hormones. Multidirectional signaling between the different components in the gastrointestinal wall, the spinal cord and central nervous system impacts inflammation and its consequences. We propose that novel therapeutic strategies should target inflammation on the one hand and gastrointestinal motility, gastrointestinal sensitivity and even pain signaling on the other hand, for instance by impeding afferent neuronal signaling, by activation of the vagal anti-inflammatory pathway or by the use of pharmacological agents such as ghrelin and ghrelin agonists or drugs interfering with the endocannabinoid system.
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Qualls-Creekmore E, Tong M, Holmes GM. Gastric emptying of enterally administered liquid meal in conscious rats and during sustained anaesthesia. Neurogastroenterol Motil 2010; 22:181-5. [PMID: 19735361 PMCID: PMC2806511 DOI: 10.1111/j.1365-2982.2009.01393.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastric motility studies are frequently conducted with anaesthetized animal models. Some studies on the same animal species have reported differences in vagal control of the stomach that could not be explained solely by slightly different experimental conditions. A possible limitation in the comparison between similar studies relates to the use of different anaesthetic agents. Furthermore, anaesthetic effects may also limit generalizations between mechanistic studies of gastric function and the gastric function of conscious animals. In the present study, we used the [(13)C]-breath test following a liquid mixed-nutrient test meal (Ensure), 1 ml) with the aim to investigate the rate of gastric emptying in animals that were either conscious or anaesthetized with either Inactin or urethane. METHODS One week after determining the maximum (13)CO(2) concentration, time to peak [(13)C] recovery and gastric half emptying time in control, conscious rats, we repeated the experiment in the same rats anaesthetized with Inactin or urethane. KEY RESULTS Our data show that Inactin anaesthesia prolonged the time to peak [(13)C] recovery but did not significantly reduce the maximum (13)CO(2) concentration nor delay gastric half emptying time. Conversely, urethane anaesthesia resulted in a significant slowing of all parameters of gastric emptying as measured by the maximum (13)CO(2) concentration, time to peak [(13)C] recovery and half emptying time. CONCLUSIONS & INFERENCES Our data indicate that Inactin(R) anaesthesia does not significantly affect gastric emptying while urethane anaesthesia profoundly impairs gastric emptying. We suggest that Inactin(R), not urethane, is the more suitable anaesthetic for gastrointestinal research.
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Affiliation(s)
- E Qualls-Creekmore
- Neurotrauma and Nutrition Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA 70808, USA
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