1
|
Zafeiropoulos S, Ahmed U, Bekiaridou A, Jayaprakash N, Mughrabi IT, Saleknezhad N, Chadwick C, Daytz A, Kurata-Sato I, Atish-Fregoso Y, Carroll K, Al-Abed Y, Fudim M, Puleo C, Giannakoulas G, Nicolls M, Diamond B, Zanos S. Ultrasound Neuromodulation of an Anti-Inflammatory Pathway at the Spleen Improves Experimental Pulmonary Hypertension. Circ Res 2024. [PMID: 38712557 DOI: 10.1161/circresaha.123.323679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Inflammation is pathogenically implicated in pulmonary arterial hypertension; however, it has not been adequately targeted therapeutically. We investigated whether neuromodulation of an anti-inflammatory neuroimmune pathway involving the splenic nerve using noninvasive, focused ultrasound stimulation of the spleen (sFUS) can improve experimental pulmonary hypertension. METHODS Pulmonary hypertension was induced in rats either by Sugen 5416 (20 mg/kg SQ) injection, followed by 21 (or 35) days of hypoxia (sugen/hypoxia model), or by monocrotaline (60 mg/kg IP) injection (monocrotaline model). Animals were randomized to receive either 12-minute-long sessions of sFUS daily or sham stimulation for 14 days. Catheterizations, echocardiography, indices of autonomic function, lung and heart histology and immunohistochemistry, spleen flow cytometry, and lung single-cell RNA sequencing were performed after treatment to assess the effects of sFUS. RESULTS Splenic denervation right before induction of pulmonary hypertension results in a more severe disease phenotype. In both sugen/hypoxia and monocrotaline models, sFUS treatment reduces right ventricular systolic pressure by 25% to 30% compared with sham treatment, without affecting systemic pressure, and improves right ventricular function and autonomic indices. sFUS reduces wall thickness, apoptosis, and proliferation in small pulmonary arterioles, suppresses CD3+ and CD68+ cell infiltration in lungs and right ventricular fibrosis and hypertrophy and lowers BNP (brain natriuretic peptide). Beneficial effects persist for weeks after sFUS discontinuation and are more robust with early and longer treatment. Splenic denervation abolishes sFUS therapeutic benefits. sFUS partially normalizes CD68+ and CD8+ T-cell counts in the spleen and downregulates several inflammatory genes and pathways in nonclassical and classical monocytes and macrophages in the lung. Differentially expressed genes in those cell types are significantly enriched for human pulmonary arterial hypertension-associated genes. CONCLUSIONS sFUS causes dose-dependent, sustained improvement of hemodynamic, autonomic, laboratory, and pathological manifestations in 2 models of experimental pulmonary hypertension. Mechanistically, sFUS normalizes immune cell populations in the spleen and downregulates inflammatory genes and pathways in the lung, many of which are relevant in human disease.
Collapse
Affiliation(s)
- Stefanos Zafeiropoulos
- Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, NY (S. Zafeiropoulos, A.B., Y.A.-A., G.G., S. Zanos)
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (S. Zafeiropoulos, U.A., A.B., N.J., I.T.M., N.S., A.D., Y.A.-A., S. Zanos)
| | - Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (S. Zafeiropoulos, U.A., A.B., N.J., I.T.M., N.S., A.D., Y.A.-A., S. Zanos)
| | - Alexandra Bekiaridou
- Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, NY (S. Zafeiropoulos, A.B., Y.A.-A., G.G., S. Zanos)
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (S. Zafeiropoulos, U.A., A.B., N.J., I.T.M., N.S., A.D., Y.A.-A., S. Zanos)
| | - Naveen Jayaprakash
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (S. Zafeiropoulos, U.A., A.B., N.J., I.T.M., N.S., A.D., Y.A.-A., S. Zanos)
| | - Ibrahim T Mughrabi
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (S. Zafeiropoulos, U.A., A.B., N.J., I.T.M., N.S., A.D., Y.A.-A., S. Zanos)
| | - Nafiseh Saleknezhad
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (S. Zafeiropoulos, U.A., A.B., N.J., I.T.M., N.S., A.D., Y.A.-A., S. Zanos)
| | | | - Anna Daytz
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (S. Zafeiropoulos, U.A., A.B., N.J., I.T.M., N.S., A.D., Y.A.-A., S. Zanos)
| | - Izumi Kurata-Sato
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (I.K.-S., Y.A.-F., K.C., B.D.)
| | - Yemil Atish-Fregoso
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (I.K.-S., Y.A.-F., K.C., B.D.)
| | - Kaitlin Carroll
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (I.K.-S., Y.A.-F., K.C., B.D.)
| | - Yousef Al-Abed
- Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, NY (S. Zafeiropoulos, A.B., Y.A.-A., G.G., S. Zanos)
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (S. Zafeiropoulos, U.A., A.B., N.J., I.T.M., N.S., A.D., Y.A.-A., S. Zanos)
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC (M.F.)
- Duke Clinical Research Institute, Durham, NC (M.F.)
| | | | - George Giannakoulas
- Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, NY (S. Zafeiropoulos, A.B., Y.A.-A., G.G., S. Zanos)
- Department of Cardiology, AHEPA University Hospital, Aristotle University School of Medicine, Thessaloniki, Greece (G.G.)
| | - Mark Nicolls
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University, CA (M.N.)
| | - Betty Diamond
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (I.K.-S., Y.A.-F., K.C., B.D.)
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY (B.D., S. Zanos)
| | - Stavros Zanos
- Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, NY (S. Zafeiropoulos, A.B., Y.A.-A., G.G., S. Zanos)
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY. (S. Zafeiropoulos, U.A., A.B., N.J., I.T.M., N.S., A.D., Y.A.-A., S. Zanos)
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY (B.D., S. Zanos)
| |
Collapse
|
2
|
Kurata-Sato I, Mughrabi IT, Rana M, Gerber M, Al-Abed Y, Sherry B, Zanos S, Diamond B. Vagus nerve stimulation modulates distinct acetylcholine receptors on B cells and limits the germinal center response. Sci Adv 2024; 10:eadn3760. [PMID: 38669336 PMCID: PMC11051663 DOI: 10.1126/sciadv.adn3760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Acetylcholine is produced in the spleen in response to vagus nerve activation; however, the effects on antibody production have been largely unexplored. Here, we use a chronic vagus nerve stimulation (VNS) mouse model to study the effect of VNS on T-dependent B cell responses. We observed lower titers of high-affinity IgG and fewer antigen-specific germinal center (GC) B cells. GC B cells from chronic VNS mice exhibited altered mRNA and protein expression suggesting increased apoptosis and impaired plasma cell differentiation. Follicular dendritic cell (FDC) cluster dispersal and altered gene expression suggested poor function. The absence of acetylcholine-producing CD4+ T cells diminished these alterations. In vitro studies revealed that α7 and α9 nicotinic acetylcholine receptors (nAChRs) directly regulated B cell production of TNF, a cytokine crucial to FDC clustering. α4 nAChR inhibited coligation of CD19 to the B cell receptor, presumably decreasing B cell survival. Thus, VNS-induced GC impairment can be attributed to distinct effects of nAChRs on B cells.
Collapse
Affiliation(s)
- Izumi Kurata-Sato
- Center for Autoimmune Musculoskeletal and Hematopoietic Diseases, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Ibrahim T. Mughrabi
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Minakshi Rana
- Center for Autoimmune Musculoskeletal and Hematopoietic Diseases, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Michael Gerber
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Barbara Sherry
- Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Immunology and Inflammation, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
| | - Betty Diamond
- Center for Autoimmune Musculoskeletal and Hematopoietic Diseases, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| |
Collapse
|
3
|
Zafeiropoulos S, Farmakis IT, Milioglou I, Doundoulakis I, Gorodeski EZ, Konstantinides SV, Cooper L, Zanos S, Stavrakis S, Giamouzis G, Butler J, Giannakoulas G. Pharmacological Treatments in Heart Failure With Mildly Reduced and Preserved Ejection Fraction: Systematic Review and Network Meta-Analysis. JACC Heart Fail 2024; 12:616-627. [PMID: 37656079 DOI: 10.1016/j.jchf.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Medical treatment for heart failure with preserved ejection (HFpEF) and heart failure with mildly reduced ejection fraction (HFmrEF) has weaker evidence compared with reduced ejection fraction, despite recent trials with an angiotensin receptor neprilysin inhibitor (ARNI) and sodium glucose co-transporter 2 inhibitors (SGLT2is). OBJECTIVES The authors aimed to estimate the aggregate therapeutic benefit of drugs for HFmrEF and HFpEF. METHODS The authors performed a systematic review of MEDLINE, CENTRAL, and Web of Science for randomized trials including patients with heart failure (HF) and left ventricular ejection fraction (LVEF) >40%, treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (analyzed together as renin-angiotensin system inhibitors [RASi]), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), digoxin, ARNI, and SGLT2i. An additive component network meta-analysis was performed. The primary outcome was a composite of cardiovascular (CV) death and first hospitalization for heart failure (HHF); secondary outcomes were CV death, total HHF, and all-cause mortality. RESULTS The authors identified 13 studies with a total of 29,875 patients and a mean LVEF of 56.3% ± 8.7%. ARNI, MRA, and SGLT2i separately, but not RASi, BB, or digoxin, reduced the primary composite outcome compared with placebo. The combination of ARNI, BB, MRA, and SGLT2i was the most effective (HR: 0.47 [95% CI: 0.31-0.70]); this was largely explained by the triple combination of ARNI, MRA, and SGLT2i (HR: 0.56 [95% CI 0.43-0.71]). Results were similar for CV death (HR: 0.63 [95% CI 0.43-0.91] for ARNI, MRA, and SGLT2i) or total HHF (HR: 0.49 [95% CI 0.33-0.71] for ARNI, MRA, and SGLT2i) alone. In a subgroup analysis, only SGLT2i had a consistent benefit among all LVEF subgroups, whereas the triple combination had the greatest benefit in HFmrEF, robust benefit in patients with LVEF 50% to 59%, and a statistically marginal benefit in patients with LVEF ≥60%. CONCLUSIONS In patients with HF and LVEF>40%, the quadruple combination of ARNI, BB, MRA, and SGLT2i provides the largest reduction in the risk of CV death and HHF; driven by the robust effect of the triple combination of ARNI, MRA, and SGLT2i. The benefit was more pronounced in HFmrEF patients.
Collapse
Affiliation(s)
- Stefanos Zafeiropoulos
- Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, New York, USA; Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA
| | - Ioannis T Farmakis
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany; Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Ioannis Milioglou
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Ioannis Doundoulakis
- Athens Heart Center, Athens Medical Center, Athens, Greece; First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Eiran Z Gorodeski
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupoli, Greece
| | - Lauren Cooper
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA; Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York, USA
| | - Stavros Zanos
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA
| | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Grigorios Giamouzis
- Department of Cardiology, University of Thessaly, Larissa, Greece; Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA; Baylor Scott and White Research Institute, Dallas, Texas, USA
| | | |
Collapse
|
4
|
Mao X, Chang YC, Zanos S, Lajoie G. Personalized inference for neurostimulation with meta-learning: a case study of vagus nerve stimulation. J Neural Eng 2024; 21:016004. [PMID: 38131193 DOI: 10.1088/1741-2552/ad17f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/21/2023] [Indexed: 12/23/2023]
Abstract
Objective. Neurostimulation is emerging as treatment for several diseases of the brain and peripheral organs. Due to variability arising from placement of stimulation devices, underlying neuroanatomy and physiological responses to stimulation, it is essential that neurostimulation protocols are personalized to maximize efficacy and safety. Building such personalized protocols would benefit from accumulated information in increasingly large datasets of other individuals' responses.Approach. To address that need, we propose a meta-learning family of algorithms to conduct few-shot optimization of key fitting parameters of physiological and neural responses in new individuals. While our method is agnostic to neurostimulation setting, here we demonstrate its effectiveness on the problem of physiological modeling of fiber recruitment during vagus nerve stimulation (VNS). Using data from acute VNS experiments, the mapping between amplitudes of stimulus-evoked compound action potentials (eCAPs) and physiological responses, such as heart rate and breathing interval modulation, is inferred.Main results. Using additional synthetic data sets to complement experimental results, we demonstrate that our meta-learning framework is capable of directly modeling the physiology-eCAP relationship for individual subjects with much fewer individually queried data points than standard methods.Significance. Our meta-learning framework is general and can be adapted to many input-response neurostimulation mapping problems. Moreover, this method leverages information from growing data sets of past patients, as a treatment is deployed. It can also be combined with several model types, including regression, Gaussian processes with Bayesian optimization, and beyond.
Collapse
Affiliation(s)
- Ximeng Mao
- Mila-Quebec Artificial Intelligence Institute, 6666 St-Urbain, Montréal, QC H2S 3H1, Canada
- Department of Computer Science and Operations Research, University of Montréal, 2920 chemin de la Tour, Montréal, QC H3T 1J4, Canada
| | - Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030, United States of America
- Medtronic, 710 Medtronic Parkway, Minneapolis, MN 55432, United States of America
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030, United States of America
| | - Guillaume Lajoie
- Mila-Quebec Artificial Intelligence Institute, 6666 St-Urbain, Montréal, QC H2S 3H1, Canada
- Department of Mathematics and Statistics, University of Montréal, 2920 chemin de la Tour, Montréal, QC H3T 1J4, Canada
- Canada CIFAR AI Chair, Toronto, ON M5G 1M1, Canada
| |
Collapse
|
5
|
Mughrabi IT, Gerber M, Jayaprakash N, Palandira SP, Al-Abed Y, Datta-Chaudhuri T, Smith C, Pavlov VA, Zanos S. Voltammetry in the spleen assesses real-time immunomodulatory norepinephrine release elicited by autonomic neurostimulation. J Neuroinflammation 2023; 20:236. [PMID: 37848937 PMCID: PMC10583388 DOI: 10.1186/s12974-023-02902-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND The noradrenergic innervation of the spleen is implicated in the autonomic control of inflammation and has been the target of neurostimulation therapies for inflammatory diseases. However, there is no real-time marker of its successful activation, which hinders the development of anti-inflammatory neurostimulation therapies and mechanistic studies in anti-inflammatory neural circuits. METHODS In mice, we performed fast-scan cyclic voltammetry (FSCV) in the spleen during intravenous injections of norepinephrine (NE), and during stimulation of the vagus, splanchnic, or splenic nerves. We defined the stimulus-elicited charge generated at the oxidation potential for NE (~ 0.88 V) as the "NE voltammetry signal" and quantified the dependence of the signal on NE dose and intensity of neurostimulation. We correlated the NE voltammetry signal with the anti-inflammatory effect of splenic nerve stimulation (SpNS) in a model of lipopolysaccharide- (LPS) induced endotoxemia, quantified as suppression of TNF release. RESULTS The NE voltammetry signal is proportional to the estimated peak NE blood concentration, with 0.1 μg/mL detection threshold. In response to SpNS, the signal increases within seconds, returns to baseline minutes later, and is blocked by interventions that deplete NE or inhibit NE release. The signal is elicited by efferent, but not afferent, electrical or optogenetic vagus nerve stimulation, and by splanchnic nerve stimulation. The magnitude of the signal during SpNS is inversely correlated with subsequent TNF suppression in endotoxemia and explains 40% of the variance in TNF measurements. CONCLUSIONS FSCV in the spleen provides a marker for real-time monitoring of anti-inflammatory activation of the splenic innervation during autonomic stimulation.
Collapse
Affiliation(s)
- Ibrahim T Mughrabi
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Michael Gerber
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Naveen Jayaprakash
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Santhoshi P Palandira
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Corey Smith
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, OH, USA
| | - Valentin A Pavlov
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, USA.
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA.
| |
Collapse
|
6
|
Chang EH, Gabalski AH, Huerta TS, Datta-Chaudhuri T, Zanos TP, Zanos S, Grill WM, Tracey KJ, Al-Abed Y. The Fifth Bioelectronic Medicine Summit: today's tools, tomorrow's therapies. Bioelectron Med 2023; 9:21. [PMID: 37794457 PMCID: PMC10552422 DOI: 10.1186/s42234-023-00123-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
The emerging field of bioelectronic medicine (BEM) is poised to make a significant impact on the treatment of several neurological and inflammatory disorders. With several BEM therapies being recently approved for clinical use and others in late-phase clinical trials, the 2022 BEM summit was a timely scientific meeting convening a wide range of experts to discuss the latest developments in the field. The BEM Summit was held over two days in New York with more than thirty-five invited speakers and panelists comprised of researchers and experts from both academia and industry. The goal of the meeting was to bring international leaders together to discuss advances and cultivate collaborations in this emerging field that incorporates aspects of neuroscience, physiology, molecular medicine, engineering, and technology. This Meeting Report recaps the latest findings discussed at the Meeting and summarizes the main developments in this rapidly advancing interdisciplinary field. Our hope is that this Meeting Report will encourage researchers from academia and industry to push the field forward and generate new multidisciplinary collaborations that will form the basis of new discoveries that we can discuss at the next BEM Summit.
Collapse
Affiliation(s)
- Eric H Chang
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA.
- The Elmezzi Graduate School of Molecular Medicine, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA.
| | - Arielle H Gabalski
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA
| | - Tomas S Huerta
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Timir Datta-Chaudhuri
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA
- The Elmezzi Graduate School of Molecular Medicine, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Theodoros P Zanos
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA
- The Elmezzi Graduate School of Molecular Medicine, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Stavros Zanos
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA
- The Elmezzi Graduate School of Molecular Medicine, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Warren M Grill
- Department of Biomedical Engineering, Fitzpatrick CIEMAS, Duke University, Room 1427, 101 Science Drive, Box 90281, Durham, NC, 27708, USA
| | - Kevin J Tracey
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA
- The Elmezzi Graduate School of Molecular Medicine, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Yousef Al-Abed
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA
- The Elmezzi Graduate School of Molecular Medicine, Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| |
Collapse
|
7
|
Song W, Jayaprakash N, Saleknezhad N, Puleo C, Al-Abed Y, Martin JH, Zanos S. Transspinal Focused Ultrasound Suppresses Spinal Reflexes in Healthy Rats. Neuromodulation 2023:S1094-7159(23)00649-9. [PMID: 37530695 DOI: 10.1016/j.neurom.2023.04.476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES Low-intensity, focused ultrasound (FUS) is an emerging noninvasive neuromodulation approach, with improved spatial and temporal resolution and penetration depth compared to other noninvasive electrical stimulation strategies. FUS has been used to modulate circuits in the brain and the peripheral nervous system, however, its potential to modulate spinal circuits is unclear. In this study, we assessed the effect of trans-spinal FUS (tsFUS) on spinal reflexes in healthy rats. MATERIALS AND METHODS tsFUS targeting different spinal segments was delivered for 1 minute, under anesthesia. Monosynaptic H-reflex of the sciatic nerve, polysynaptic flexor reflex of the sural nerve, and withdrawal reflex tested with a hot plate were measured before, during, and after tsFUS. RESULTS tsFUS reversibly suppresses the H-reflex in a spinal segment-, acoustic pressure- and pulse-repetition frequency (PRF)-dependent manner. tsFUS with high PRF augments the degree of homosynaptic depression of the H-reflex observed with paired stimuli. It suppresses the windup of components of the flexor reflex associated with slower, C-afferent, but not faster, A- afferent fibers. Finally, it increases the latency of the withdrawal reflex. tsFUS does not elicit neuronal loss in the spinal cord. CONCLUSIONS Our study provides evidence that tsFUS reversibly suppresses spinal reflexes and suggests that tsFUS could be a safe and effective strategy for spinal cord neuromodulation in disorders associated with hyperreflexia, including spasticity after spinal cord injury and painful syndromes.
Collapse
Affiliation(s)
- Weiguo Song
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Naveen Jayaprakash
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Nafiseh Saleknezhad
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Chris Puleo
- General Electric Research, Niskayuna, NY, USA
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - John H Martin
- Department of Molecular, Cellular, and Biomedical Sciences, Center for Discovery and Innovation, City University of New York School of Medicine, New York, NY, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY.
| |
Collapse
|
8
|
Zafeiropoulos S, Ahmed U, Bikou A, Mughrabi IT, Stavrakis S, Zanos S. Vagus nerve stimulation for cardiovascular diseases: Is there light at the end of the tunnel? Trends Cardiovasc Med 2023:S1050-1738(23)00064-6. [PMID: 37506989 DOI: 10.1016/j.tcm.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
Autonomic dysfunction and chronic inflammation contribute to the pathogenesis and progression of several cardiovascular diseases (CVD), such as heart failure with preserved ejection fraction, atherosclerotic CVD, pulmonary arterial hypertension, and atrial fibrillation. The vagus nerve provides parasympathetic innervation to the heart, vessels, and lungs, and is also implicated in the neural control of inflammation through a neuroimmune pathway involving the spleen. Stimulation of the vagus nerve (VNS) can in principle restore autonomic balance and suppress inflammation, with potential therapeutic benefits in these diseases. Although VNS ameliorated CVD in several animal models, early human studies have demonstrated variable efficacy. The purpose of this review is to discuss the rationale behind the use of VNS in the treatment of CVD, to critically review animal and human studies of VNS in CVD, and to propose possible means to overcome the challenges in the clinical translation of VNS in CVD.
Collapse
Affiliation(s)
- Stefanos Zafeiropoulos
- Elmezzi Graduate School of Molecular Medicine at Northwell Health, Manhasset, NY, USA; Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Alexia Bikou
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Ibrahim T Mughrabi
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Stavros Zanos
- Elmezzi Graduate School of Molecular Medicine at Northwell Health, Manhasset, NY, USA; Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA.
| |
Collapse
|
9
|
Qin P, Lin Q, Xie Y, Chang YC, Zanos S, Wang H, Payne S, Shivdasani MN, Tsai D, Lovell NH, Dokos S, Guo T. Modulating functionally-distinct vagus nerve fibers using microelectrodes and kilohertz frequency electrical stimulation. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38082599 DOI: 10.1109/embc40787.2023.10340796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Modulation of functionally distinct nerve fibers with bioelectronic devices provides a therapeutic opportunity for various diseases. In this study, we began by developing a computational model including four major subtypes of myelinated fibers and one unmyelinated fiber. Second, we used an intrafascicular electrode to perform kHz-frequency electric stimulation to preferentially modulate a population of fibers. Our model suggests that fiber physical properties and electrode-to-fascicle distance severely impacts stimulus-response relationships. Large diameter fibers (Aα- and Aβ-) were only minimally influenced by the fascicle size and electrode location, while smaller diameter fibers (Aδ-, B- and C-) indicated a stronger dependency.Clinical Relevance- Our findings support the possibility of selectively modulating functionally-distinct nerve fibers using electrical stimulation in a small, localized region. Our model provides an effective tool to design next-generation implantable devices and therapeutic stimulation strategies toward minimizing off-target effects.
Collapse
|
10
|
Zanos S, Ntiloudi D, Pellerito J, Ramdeo R, Graf J, Wallace K, Cotero V, Ashe J, Moon J, Addorisio M, Shoudy D, Coleman TR, Brines M, Puleo C, Tracey KJ, Chavan SS. Focused ultrasound neuromodulation of the spleen activates an anti-inflammatory response in humans. Brain Stimul 2023; 16:703-711. [PMID: 37055009 PMCID: PMC10330863 DOI: 10.1016/j.brs.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
Focused ultrasound stimulation (FUS) activates mechanosensitive ion channels and is emerging as a method of noninvasive neuromodulation. In preclinical studies, FUS of the spleen (sFUS) activates an anti-inflammatory neural pathway which suppresses acute and chronic inflammation. However, the relevance of sFUS for regulating inflammatory responses in humans is unknown. Here, we used a modified diagnostic ultrasound imaging system to target the spleen of healthy human subjects with 3 min of continuously swept or stationary focused pulsed ultrasound, delivered at three different energy levels within allowable safety exposure limits. Potential anti-inflammatory effects of sFUS were assessed by measuring sFUS-elicited changes in endotoxin-induced tumor necrosis factor (TNF) production in whole blood samples from insonified subjects. We found that stimulation with either continuously swept or focused pulsed ultrasound has an anti-inflammatory effect: sFUS lowers TNF production for >2 h, with TNF returning to baseline by 24 h following sFUS. This response is independent of anatomical target (i.e., spleen hilum or parenchyma) or ultrasound energy level. No clinical, biochemical, or hematological parameters are adversely impacted. This is the first demonstration that sFUS suppresses the normal inflammatory response in humans, with potential implications for noninvasive bioelectronic therapy of inflammatory disorders.
Collapse
Affiliation(s)
- Stavros Zanos
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Despoina Ntiloudi
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - John Pellerito
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Radiology, Northwell Health, Manhasset, NY, 11030, USA
| | - Richard Ramdeo
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - John Graf
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | - Kirk Wallace
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | | | - Jeff Ashe
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | - Jessica Moon
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Meghan Addorisio
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - David Shoudy
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | - Thomas R Coleman
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Michael Brines
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Chris Puleo
- General Electric (GE) Research, Niskayuna, NY, USA, 12309
| | - Kevin J Tracey
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Sangeeta S Chavan
- Institute for Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| |
Collapse
|
11
|
Zafeiropoulos S, Doundoulakis I, Bekiaridou A, Farmakis I, Coleman KM, Giannakoulas G, Zanos S, Mountantonakis SE, Stavrakis S. A SYSTEMATIC REVIEW AND META-ANALYSIS OF RHYTHM- VS RATE- CONTROL STRATEGIES IN ATRIAL FIBRILLATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
12
|
Jayaprakash N, Song W, Toth V, Vardhan A, Levy T, Tomaio J, Qanud K, Mughrabi I, Chang YC, Rob M, Daytz A, Abbas A, Nassrallah Z, Volpe BT, Tracey KJ, Al-Abed Y, Datta-Chaudhuri T, Miller L, Barbe MF, Lee SC, Zanos TP, Zanos S. Organ- and function-specific anatomical organization of vagal fibers supports fascicular vagus nerve stimulation. Brain Stimul 2023; 16:484-506. [PMID: 36773779 DOI: 10.1016/j.brs.2023.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Vagal fibers travel inside fascicles and form branches to innervate organs and regulate organ functions. Existing vagus nerve stimulation (VNS) therapies activate vagal fibers non-selectively, often resulting in reduced efficacy and side effects from non-targeted organs. The transverse and longitudinal arrangement of fibers inside the vagal trunk with respect to the functions they mediate and organs they innervate is unknown, however it is crucial for selective VNS. Using micro-computed tomography imaging, we tracked fascicular trajectories and found that, in swine, sensory and motor fascicles are spatially separated cephalad, close to the nodose ganglion, and merge caudad, towards the lower cervical and upper thoracic region; larynx-, heart- and lung-specific fascicles are separated caudad and progressively merge cephalad. Using quantified immunohistochemistry at single fiber level, we identified and characterized all vagal fibers and found that fibers of different morphological types are differentially distributed in fascicles: myelinated afferents and efferents occupy separate fascicles, myelinated and unmyelinated efferents also occupy separate fascicles, and small unmyelinated afferents are widely distributed within most fascicles. We developed a multi-contact cuff electrode to accommodate the fascicular structure of the vagal trunk and used it to deliver fascicle-selective cervical VNS in anesthetized and awake swine. Compound action potentials from distinct fiber types, and physiological responses from different organs, including laryngeal muscle, cough, breathing, and heart rate responses are elicited in a radially asymmetric manner, with consistent angular separations that agree with the documented fascicular organization. These results indicate that fibers in the trunk of the vagus nerve are anatomically organized according to functions they mediate and organs they innervate and can be asymmetrically activated by fascicular cervical VNS.
Collapse
Affiliation(s)
| | - Weiguo Song
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Viktor Toth
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Todd Levy
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Khaled Qanud
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Yao-Chuan Chang
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Moontahinaz Rob
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Anna Daytz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Adam Abbas
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Zeinab Nassrallah
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Bruce T Volpe
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Kevin J Tracey
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Yousef Al-Abed
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Larry Miller
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Sunhee C Lee
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Stavros Zanos
- Feinstein Institutes for Medical Research, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA.
| |
Collapse
|
13
|
Jayaprakash N, Toth V, Song W, Rob M, Daytz A, Lee S, Zanos T, Al-Abed Y, Zanos S. Organ- and function-specific anatomical organization of the vagus nerve. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
|
14
|
Altiti A, He M, VanPatten S, Cheng KF, Ahmed U, Chiu PY, Mughrabi IT, Jabari BA, Burch RM, Manogue KR, Tracey KJ, Diamond B, Metz CN, Yang H, Hudson LK, Zanos S, Son M, Sherry B, Coleman TR, Al-Abed Y. Thiocarbazate building blocks enable the construction of azapeptides for rapid development of therapeutic candidates. Nat Commun 2022; 13:7127. [PMID: 36443291 PMCID: PMC9705435 DOI: 10.1038/s41467-022-34712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/03/2022] [Indexed: 11/29/2022] Open
Abstract
Peptides, polymers of amino acids, comprise a vital and expanding therapeutic approach. Their rapid degradation by proteases, however, represents a major limitation to their therapeutic utility and chemical modifications to native peptides have been employed to mitigate this weakness. Herein, we describe functionalized thiocarbazate scaffolds as precursors of aza-amino acids, that, upon activation, can be integrated in a peptide sequence to generate azapeptides using conventional peptide synthetic methods. This methodology facilitates peptide editing-replacing targeted amino acid(s) with aza-amino acid(s) within a peptide-to form azapeptides with preferred therapeutic characteristics (extending half-life/bioavailability, while at the same time typically preserving structural features and biological activities). We demonstrate the convenience of this azapeptide synthesis platform in two well-studied peptides with short half-lives: FSSE/P5779, a tetrapeptide inhibitor of HMGB1/MD-2/TLR4 complex formation, and bradykinin, a nine-residue vasoactive peptide. This bench-stable thiocarbazate platform offers a robust and universal approach to optimize peptide-based therapeutics.
Collapse
Affiliation(s)
- Ahmad Altiti
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
| | - Mingzhu He
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Sonya VanPatten
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Kai Fan Cheng
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Pui Yan Chiu
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Ibrahim T Mughrabi
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Bayan Al Jabari
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | | | - Kirk R Manogue
- Center for Molecular Innovation, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Betty Diamond
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Christine N Metz
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Huan Yang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - LaQueta K Hudson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Myoungsun Son
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Barbara Sherry
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Thomas R Coleman
- Center for Molecular Innovation, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
- Center for Molecular Innovation, Feinstein Institutes for Medical Research, Manhasset, NY, USA.
| |
Collapse
|
15
|
Chang YC, Ahmed U, Jayaprakash N, Mughrabi I, Lin Q, Wu YC, Gerber M, Abbas A, Daytz A, Gabalski AH, Ashville J, Dokos S, Rieth L, Datta-Chaudhuri T, Tracey KJ, Guo T, Al-Abed Y, Zanos S. kHz-frequency electrical stimulation selectively activates small, unmyelinated vagus afferents. Brain Stimul 2022; 15:1389-1404. [PMID: 36241025 PMCID: PMC10164362 DOI: 10.1016/j.brs.2022.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Vagal reflexes regulate homeostasis in visceral organs and systems through afferent and efferent neurons and nerve fibers. Small, unmyelinated, C-type afferents comprise over 80% of fibers in the vagus and form the sensory arc of autonomic reflexes of the gut, lungs, heart and vessels and the immune system. Selective bioelectronic activation of C-afferents could be used to mechanistically study and treat diseases of peripheral organs in which vagal reflexes are involved, but it has not been achieved. METHODS We stimulated the vagus in rats and mice using trains of kHz-frequency stimuli. Stimulation effects were assessed using neuronal c-Fos expression, physiological and nerve fiber responses, optogenetic and computational methods. RESULTS Intermittent kHz stimulation for 30 min activates specific motor and, preferentially, sensory vagus neurons in the brainstem. At sufficiently high frequencies (>5 kHz) and at intensities within a specific range (7-10 times activation threshold, T, in rats; 15-25 × T in mice), C-afferents are activated, whereas larger, A- and B-fibers, are blocked. This was determined by measuring fiber-specific acute physiological responses to kHz stimulus trains, and by assessing fiber excitability around kHz stimulus trains through compound action potentials evoked by probing pulses. Aspects of selective activation of C-afferents are explained in computational models of nerve fibers by how fiber size and myelin shape the response of sodium channels to kHz-frequency stimuli. CONCLUSION kHz stimulation is a neuromodulation strategy to robustly and selectively activate vagal C-afferents implicated in physiological homeostasis and disease, over larger vagal fibers.
Collapse
Affiliation(s)
- Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Naveen Jayaprakash
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Ibrahim Mughrabi
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Qihang Lin
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2052, Australia
| | - Yi-Chen Wu
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Michael Gerber
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Adam Abbas
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Anna Daytz
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Arielle H Gabalski
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Jason Ashville
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Socrates Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2052, Australia
| | - Loren Rieth
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, 26506, United States
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Tianruo Guo
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, 2052, Australia
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, United States; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
| |
Collapse
|
16
|
Zafeiropoulos S, Ahmed U, Giannakoulas G, Puleo C, Zanos S. Focused ultrasound stimulation of the inflammatory reflex at the spleen ameliorates pulmonary arterial hypertension in rodents. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Inflammation is a major contributor in pulmonary arterial hypertension (PAH) pathogenesis. Non-invasive, focused ultrasound stimulation (FUS) of the spleen activates the neuroimmune inflammatory reflex (IR) and suppresses systemic inflammation [1].
Purpose
We aimed to explore whether daily FUS of the spleen improves haemodynamics and biomarkers by modulating the IR, in a rat model of PAH.
Methods
Sprague-Dawley rats (n=12) were injected s.c. with Sugen5416 (VEGF receptor inhibitor) and then, were placed in a hypoxic chamber (FiO2=10%) for 21 days, followed by 14 days of re-exposure to normoxia (FiO2=10%). At day 21, rats were randomized to either FUS (n=6) or sham-stimulation of the spleen (n=6). Each FUS- or sham-stimulation session consisted of 12 minutes. After 14 days of treatment, in a terminal experiment, right ventricular systolic pressure (RVSP) and arterial pressure were measured invasively, as well as biomarkers, in each animal (Figure 1A).
Results
FUS significantly reduced RVSP compared with the sham-stimulation (Mean±SEM, 50.83±3.57 mmHg vs 72.50±5.81; p=0.009), resulting in a 30% relative reduction (Figure 1B). Mean systemic arterial pressure was similar in the 2 groups (Mean±SEM, 79.83±3.73 mmHg vs. 87.00±2.95; p=0.137) (Figure 1C), as was the change in heart rate between day 1 and day 14 of treatment period (−19.53±5.36% vs. −16.79±3.1, p=0.61) (Figure 1D). Consistently, plasma brain natriuretic peptide (BNP) levels are reduced in the FUS group (119.45±19.93 ng/μl vs. 319.39±91.85; p=0.019), indicative of reduced myocardial wall stress in the FUS group (Figure 1E).
Conclusion
Non-invasive FUS of the spleen reduced RVSP by ∼30% and BNP without significantly affecting systemic pressure or heart rate, in rats with severe PAH. Non-invasive FUS, by modulating the IR, may exert an anti-inflammatory effect in PAH. FUS of the spleen is noninvasive, safe, widely available and easy to perform, and should be further explored as a possible therapeutic option in PAH.
Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Northwell Health
Collapse
Affiliation(s)
- S Zafeiropoulos
- The Feinstein Institutes for Medical Research , Manhasset , United States of America
| | - U Ahmed
- The Feinstein Institutes for Medical Research , Manhasset , United States of America
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology Department , Thessaloniki , Greece
| | - C Puleo
- General Electric Global Research Center , Niskayuna , United States of America
| | - S Zanos
- The Feinstein Institutes for Medical Research , Manhasset , United States of America
| |
Collapse
|
17
|
Zafeiropoulos S, Bikou A, Farmakis IT, Doundoulakis I, Giannakoulas G, Zanos S. Stellate ganglion blockade for treatment of ventricular arrhythmia storm: a meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Autonomic neuromodulation and particularly stellate ganglion blockade (SGB) has been tested in ventricular arrhythmia (VA) storm, but there is so far no robust evidence to inform clinical practice and its use remains limited.
Purpose
We aimed to summarize the efficacy and safety of SGB in patients with VA storm.
Methods
We searched PubMed, the Cochrane Library and Scopus from inception to 15th March 2022, for studies performing either pharmacological or electrical SGB in the context of drug-refractory VA storm. Case series with less than 10 patients were excluded. We performed a single-arm random effects meta-analysis of studies to calculate the pooled proportion estimate of freedom from VA recurrence after SBG and the overall mean change of VA burden from baseline.
Results
Of 409 articles identified and screened, we considered eligible six studies comprising a total of 106 patients. The mean age was 61.6±13.9 years, 79.2% were male, the mean left ventricular ejection fraction was 28.8±12.7%, and 47.1% had underlying ischemic cardiomyopathy. In five trials the patients received pharmacological SGB with bupivacaine, ropivacaine, or/and lidocaine (left-sided or bilateral), while in one study transcutaneous magnetic stimulation of the left stellate ganglion was used. The pooled proportion of patients free of VA recurrences was 65% (95% CI 51–78%, I2=46%) at the first 24 hours post-SGB (Figure 1A), and 54% (95% CI 43–64%, I2=0%) at 72 hours (Figure 1B). The number of VA episodes was significantly reduced from a mean baseline of 7.01±8.34 episodes/24h before SGB to 0.93±1.64 episodes/24h after SGB. The mean absolute reduction of VA episodes was 5.44 (95% CI 2.83–8.05, I2=88%) (Figure 1C) while the mean absolute reduction of external or internal defibrillation events was 3.36 (95% CI 0.62–6.09, I2=84%) (Figure 1D). No serious procedure-related complications were reported. The overall in-hospital mortality was 28.4%.
Conclusions
SGB appears an effective and safe treatment in patients with VA storm with approximately 1 in 2 patients exhibiting complete suppression of VA for 72 hours and an approximately 80% mean relative reduction in VA burden.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- S Zafeiropoulos
- The Feinstein Institutes for Medical Research , Manhasset , United States of America
| | - A Bikou
- Ahepa University Hospital, 1st Cardiology Department , Thessaloniki , Greece
| | - I T Farmakis
- Center for Thrombosis and Hemostasis , Mainz , Germany
| | - I Doundoulakis
- Ahepa University Hospital, 1st Cardiology Department , Thessaloniki , Greece
| | - G Giannakoulas
- Ahepa University Hospital, 1st Cardiology Department , Thessaloniki , Greece
| | - S Zanos
- The Feinstein Institutes for Medical Research , Manhasset , United States of America
| |
Collapse
|
18
|
Abidoye O, Johnson A, Cho YM, Ogbuagu H, Choudhury H, Takegawa R, Hayashida K, Shinozaki K, Aoki T, Okuma Y, Zanos S, Zafeiropoulos S, Giannis D, Pipolo DO, Becker LB, Miyara SJ, Guevara S, Molmenti EP. Upper-Extremity Deep Venous Thrombosis after Whole Blood Donation—A Case Report. Int J Angiol 2022. [DOI: 10.1055/s-0042-1756216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractUpper-extremity deep venous thrombosis (UEDVT) after whole blood donation is rarely reported. Blood donation has a low rate of complications and is typically safe. A small percentage of blood donors experience donation-related events such as UEDVT, which are extremely rare. We are reporting a rare case of a UEDVT following blood donation. This is an extremely rare event; only five cases were reported to our knowledge. A 22-year-old Caucasian woman with a past medical history of provoked pulmonary embolism completed 6 months of apixaban and negative thrombophilia workup presented to the hospital with complaints of progressive pain and swelling in her right arm. The patient reports donating blood using her right arm in January 2021. Phlebotomy duration for blood donation was approximately 10minutes. She reported pain and swelling several days after blood donation. Subsequently, a duplex ultrasound showed a thrombus in the right brachial vein. The patient was started on apixaban for 6 months. Although most whole blood donors do not experience complications, DVT is a rare complication from whole blood donation with severe consequences. It should be considered in a donor with worsening pain and swelling.
Collapse
Affiliation(s)
- Oluseyi Abidoye
- Internal Medicine Department, Northeast Georgia Medical Center, Gainesville, Georgia
| | | | - Young Min Cho
- Internal Medicine Department, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Henry Ogbuagu
- Internal Medicine Department, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Hasan Choudhury
- Internal Medicine Department, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Ryosuke Takegawa
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Kei Hayashida
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Koichiro Shinozaki
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Tomoaki Aoki
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Yu Okuma
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Neurological Surgery, Sonoda Daiichi Hospital, Tokyo, Japan
| | - Stavros Zanos
- Feinstein Institutes for Medical Research, Manhasset, New York
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
| | - Stefanos Zafeiropoulos
- Feinstein Institutes for Medical Research, Manhasset, New York
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
| | - Dimitrios Giannis
- Department of Surgery, North Shore University Hospital, Manhasset, New York
| | - Derek O. Pipolo
- Department of Surgery, North Shore University Hospital, Manhasset, New York
| | - Lance B. Becker
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Santiago J. Miyara
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sara Guevara
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Department of Family Medicine, Glen Cove Hospital, Glen Cove, New York
| | - Ernesto P. Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, New York
- Department of Family Medicine, Glen Cove Hospital, Glen Cove, New York
| |
Collapse
|
19
|
Farmakis IT, Vrana E, Mouratoglou SA, Zafeiropoulos S, Zanos S, Giannakoulas G. Haemodynamic effects of initial combination therapy in pulmonary arterial hypertension: a systematic review and meta-analysis. ERJ Open Res 2022; 8:00313-2022. [PMID: 36299361 PMCID: PMC9589336 DOI: 10.1183/23120541.00313-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background Although the initial use of combination treatment has been proven to be beneficial for patients’ clinical outcomes, there are scarce data on its haemodynamic effects. The objective of the present study was to evaluate the effect of an initial combination of pulmonary arterial hypertension (PAH)-targeted therapies on haemodynamic parameters in treatment-naïve PAH patients. Methods A systematic search of PubMed, Cochrane Central Register of Controlled Trials and Web of Science was performed. We considered eligible studies with an intervention of initial PAH-targeted combination therapy in treatment-naïve PAH patients with or without monotherapy control. A random-effects meta-analysis was performed for the difference between baseline and follow-up in pulmonary vascular resistance (PVR) and other haemodynamic parameters. Results In 880 patients receiving initial combination therapy PVR was reduced by −6.5 Wood Units (95% CI −7.4–−5.7 Wood Units) or by −52% (95% CI −56%–−48%, I2=0%) compared to baseline. Initial triple therapy including a parenteral prostanoid resulted in significantly greater PVR reduction (−67% versus −50% with all other combination therapies, p=0.01). The effect was more pronounced in younger patients (p=0.02). Compared to baseline, there was −12.2 mmHg (95% CI −14.0–−10.4 mmHg) decrease in mean pulmonary artery pressure, 0.9 L·min−1·m−2 (95% CI 0.8–1.1 L·min−1·m−2) increase in cardiac index, −3.2 mmHg (95% CI −4.1–−2.3 mmHg) decrease in right atrial pressure and 8.6% (95% CI 6.9–10.3%) increase in mixed venous oxygen saturation. In the controlled studies, initial combination therapy reduced PVR by −4.2 Wood Units (95% CI −6.1–−2.4 Wood Units) compared to monotherapy. Conclusion Initial combination therapy leads to remarkable haemodynamic amelioration. Parenteral prostanoids should be considered early, especially in more severely affected patients, to enable right ventricular reverse remodelling. Initial combination therapy in PAH results in >50% reduction in pulmonary vascular resistance compared to baseline. Parenteral prostanoids accentuate this response and should be considered early to enable timely right ventricular reverse remodelling.https://bit.ly/3uG3k8H
Collapse
|
20
|
Choudhary RC, Ahmed U, Shoaib M, Alper E, Rehman A, Kim J, Shinozaki K, Volpe BT, Chavan S, Zanos S, Tracey KJ, Becker LB. Threshold adjusted vagus nerve stimulation after asphyxial cardiac arrest results in neuroprotection and improved survival. Bioelectron Med 2022; 8:10. [PMID: 35854394 PMCID: PMC9297561 DOI: 10.1186/s42234-022-00092-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Vagus nerve stimulation (VNS) has shown therapeutic potential in a variety of different diseases with many ongoing clinical trials. The role of VNS in reducing ischemic injury in the brain requires further evaluation. Cardiac arrest (CA) causes global ischemia and leads to the injury of vital organs, especially the brain. In this study, we investigated the protective effects of customized threshold-adjusted VNS (tVNS) in a rat model of CA and resuscitation. Methods Sprague-Dawley rats underwent 12 min asphyxia-CA followed by resuscitation. Rats were assigned to either post-resuscitation tVNS for 2 h or no-tVNS (control). tVNS was applied by electrode placement in the left cervical vagus nerve. To optimize a threshold, we used animal’s heart rate and determined a 15–20% drop from baseline levels as the effective and physiological threshold for each animal. The primary endpoint was 72 h survival; secondary endpoints included neurological functional recovery, reduction in brain cellular injury (histopathology), cardiac and renal injury parameters (troponin I and creatinine levels, respectively). Results In comparison to the control group, tVNS significantly improved 72 h survival and brain functional recovery after 12 minutes of CA. The tVNS group demonstrated significantly reduced numbers of damaged neurons in the CA1 hippocampal region of the brain as compared to the control group. Similarly, the tVNS group showed decreased trend in plasma troponin I and creatinine levels as compared to the control group. Conclusions Our findings suggest that using tVNS for 2 h after 12 minutes of CA attenuates ischemia neuronal cell death, heart and kidney damage, and improves 72 h survival with improved neurological recovery.
Collapse
Affiliation(s)
- Rishabh C Choudhary
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, 11030, USA.,Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA.,Department of Emergency Medicine, Northwell Health, Manhasset, NY, USA
| | - Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Muhammad Shoaib
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, 11030, USA.,Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Eric Alper
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Abdul Rehman
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Junhwan Kim
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, 11030, USA.,Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA.,Department of Emergency Medicine, Northwell Health, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Koichiro Shinozaki
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, 11030, USA.,Department of Emergency Medicine, Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Bruce T Volpe
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Center for Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Sangeeta Chavan
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Lance B Becker
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Manhasset, NY, 11030, USA. .,Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA. .,Department of Emergency Medicine, Northwell Health, Manhasset, NY, USA.
| |
Collapse
|
21
|
Ahmed U, Graf JF, Daytz A, Yaipen O, Mughrabi I, Jayaprakash N, Cotero V, Morton C, Deutschman CS, Zanos S, Puleo C. Ultrasound Neuromodulation of the Spleen Has Time-Dependent Anti-Inflammatory Effect in a Pneumonia Model. Front Immunol 2022; 13:892086. [PMID: 35784337 PMCID: PMC9244783 DOI: 10.3389/fimmu.2022.892086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/17/2022] [Indexed: 12/27/2022] Open
Abstract
Interfaces between the nervous and immune systems have been shown essential for the coordination and regulation of immune responses. Non-invasive ultrasound stimulation targeted to the spleen has recently been shown capable of activating one such interface, the splenic cholinergic anti-inflammatory pathway (CAP). Over the past decade, CAP and other neuroimmune pathways have been activated using implanted nerve stimulators and tested to prevent cytokine release and inflammation. However, CAP studies have typically been performed in models of severe, systemic (e.g., endotoxemia) or chronic inflammation (e.g., collagen-induced arthritis or DSS-induced colitis). Herein, we examined the effects of activation of the splenic CAP with ultrasound in a model of local bacterial infection by lung instillation of 105 CFU of Streptococcus pneumoniae. We demonstrate a time-dependent effect of CAP activation on the cytokine response assay during infection progression. CAP activation-induced cytokine suppression is absent at intermediate times post-infection (16 hours following inoculation), but present during the early (4 hours) and later phases (48 hours). These results indicate that cytokine inhibition associated with splenic CAP activation is not observed at all timepoints following bacterial infection and highlights the importance of further studying neuroimmune interfaces within the context of different immune system and inflammatory states.
Collapse
Affiliation(s)
- Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - John F. Graf
- General Electric Research, Niskayuna, NY, United States
| | - Anna Daytz
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Omar Yaipen
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Ibrahim Mughrabi
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Naveen Jayaprakash
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | | | | | - Clifford Scott Deutschman
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Chris Puleo
- General Electric Research, Niskayuna, NY, United States
- *Correspondence: Chris Puleo,
| |
Collapse
|
22
|
Cotero V, Graf J, Miwa H, Hirschstein Z, Qanud K, Huerta TS, Tai N, Ding Y, Jimenez-Cowell K, Tomaio JN, Song W, Devarajan A, Tsaava T, Madhavan R, Wallace K, Loghin E, Morton C, Fan Y, Kao TJ, Akhtar K, Damaraju M, Barenboim L, Maietta T, Ashe J, Tracey KJ, Coleman TR, Di Carlo D, Shin D, Zanos S, Chavan SS, Herzog RI, Puleo C. Stimulation of the hepatoportal nerve plexus with focused ultrasound restores glucose homoeostasis in diabetic mice, rats and swine. Nat Biomed Eng 2022; 6:683-705. [PMID: 35361935 PMCID: PMC10127248 DOI: 10.1038/s41551-022-00870-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/18/2022] [Indexed: 12/17/2022]
Abstract
Peripheral neurons that sense glucose relay signals of glucose availability to integrative clusters of neurons in the brain. However, the roles of such signalling pathways in the maintenance of glucose homoeostasis and their contribution to disease are unknown. Here we show that the selective activation of the nerve plexus of the hepatic portal system via peripheral focused ultrasound stimulation (pFUS) improves glucose homoeostasis in mice and rats with insulin-resistant diabetes and in swine subject to hyperinsulinemic-euglycaemic clamps. pFUS modulated the activity of sensory projections to the hypothalamus, altered the concentrations of metabolism-regulating neurotransmitters, and enhanced glucose tolerance and utilization in the three species, whereas physical transection or chemical blocking of the liver-brain nerve pathway abolished the effect of pFUS on glucose tolerance. Longitudinal multi-omic profiling of metabolic tissues from the treated animals confirmed pFUS-induced modifications of key metabolic functions in liver, pancreas, muscle, adipose, kidney and intestinal tissues. Non-invasive ultrasound activation of afferent autonomic nerves may represent a non-pharmacologic therapy for the restoration of glucose homoeostasis in type-2 diabetes and other metabolic diseases.
Collapse
Affiliation(s)
- Victoria Cotero
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - John Graf
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Hiromi Miwa
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Khaled Qanud
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Tomás S Huerta
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Yuyan Ding
- Yale School of Medicine, New Haven, CT, USA
| | - Kevin Jimenez-Cowell
- Yale School of Medicine, New Haven, CT, USA
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Weiguo Song
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Alex Devarajan
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Tea Tsaava
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Radhika Madhavan
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Kirk Wallace
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Evelina Loghin
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Christine Morton
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Ying Fan
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Tzu-Jen Kao
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | | | | | | | | | - Jeffrey Ashe
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA
| | - Kevin J Tracey
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Dino Di Carlo
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Stavros Zanos
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | | | - Chris Puleo
- General Electric (GE) Research, 1 Research Circle, Niskayuna, NY, USA.
| |
Collapse
|
23
|
Ahmed U, Chang YC, Zafeiropoulos S, Nassrallah Z, Miller L, Zanos S. Strategies for precision vagus neuromodulation. Bioelectron Med 2022; 8:9. [PMID: 35637543 PMCID: PMC9150383 DOI: 10.1186/s42234-022-00091-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/05/2022] [Indexed: 12/21/2022] Open
Abstract
The vagus nerve is involved in the autonomic regulation of physiological homeostasis, through vast innervation of cervical, thoracic and abdominal visceral organs. Stimulation of the vagus with bioelectronic devices represents a therapeutic opportunity for several disorders implicating the autonomic nervous system and affecting different organs. During clinical translation, vagus stimulation therapies may benefit from a precision medicine approach, in which stimulation accommodates individual variability due to nerve anatomy, nerve-electrode interface or disease state and aims at eliciting therapeutic effects in targeted organs, while minimally affecting non-targeted organs. In this review, we discuss the anatomical and physiological basis for precision neuromodulation of the vagus at the level of nerve fibers, fascicles, branches and innervated organs. We then discuss different strategies for precision vagus neuromodulation, including fascicle- or fiber-selective cervical vagus nerve stimulation, stimulation of vagal branches near the end-organs, and ultrasound stimulation of vagus terminals at the end-organs themselves. Finally, we summarize targets for vagus neuromodulation in neurological, cardiovascular and gastrointestinal disorders and suggest potential precision neuromodulation strategies that could form the basis for effective and safe therapies.
Collapse
|
24
|
Shoaib M, Choudhary RC, Chillale RK, Kim N, Miyara SJ, Haque S, Yin T, Frankfurt M, Molmenti EP, Zanos S, Kim J, Becker LB. Metformin-mediated mitochondrial protection post-cardiac arrest improves EEG activity and confers neuroprotection and survival benefit. FASEB J 2022; 36:e22307. [PMID: 35394702 DOI: 10.1096/fj.202200121r] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/09/2022] [Accepted: 03/28/2022] [Indexed: 12/25/2022]
Abstract
Cardiac arrest (CA) produces global ischemia/reperfusion injury resulting in substantial multiorgan damage. There are limited efficacious therapies to save lives despite CA being such a lethal disease process. The small population of surviving patients suffer extensive brain damage that results in substantial morbidity. Mitochondrial dysfunction in most organs after CA has been implicated as a major source of injury. Metformin, a first-line treatment for diabetes, has shown promising results in the treatment for other diseases and is known to interact with the mitochondria. For the treatment of CA, prior studies have utilized metformin in a preconditioning manner such that animals are given metformin well before undergoing CA. As the timing of CA is quite difficult to predict, the present study, in a clinically relevant manner, sought to evaluate the therapeutic benefits of metformin administration immediately after resuscitation using a 10 min asphxyial-CA rat model. This is the first study to show that metformin treatment post-CA (a) improves 72 h survival and neurologic function, (b) protects mitochondrial function with a reduction in apoptotic brain injury without activating AMPK, and (c) potentiates earlier normalization of brain electrophysiologic activity. Overall, as an effective and safe drug, metformin has the potential to be an easily translatable intervention for improving survival and preventing brain damage after CA.
Collapse
Affiliation(s)
- Muhammad Shoaib
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Rishabh C Choudhary
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA.,Department of Emergency Medicine, Northwell Health, Manhasset, New York, USA
| | - Rupesh K Chillale
- Neural System Laboratory, University of Maryland, College Park, Maryland, USA
| | - Nancy Kim
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Santiago J Miyara
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA.,Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, USA
| | - Shabirul Haque
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Tai Yin
- Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Maya Frankfurt
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Molecular Medicine and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | | | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Junhwan Kim
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA.,Department of Emergency Medicine, Northwell Health, Manhasset, New York, USA.,Molecular Medicine and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Lance B Becker
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Laboratory for Critical Care Physiology, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, New York, USA.,Department of Emergency Medicine, Northwell Health, Manhasset, New York, USA.,Molecular Medicine and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| |
Collapse
|
25
|
Wright JP, Mughrabi IT, Wong J, Mathew J, Jayaprakash N, Crosfield C, Chang EH, Chavan SS, Tracey KJ, Pavlov VA, Al-Abed Y, Zanos TP, Zanos S, Datta-Chaudhuri T. A fully implantable wireless bidirectional neuromodulation system for mice. Biosens Bioelectron 2022; 200:113886. [PMID: 34995836 PMCID: PMC9258776 DOI: 10.1016/j.bios.2021.113886] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 01/09/2023]
Abstract
Novel research in the field of bioelectronic medicine requires neuromodulation systems that pair high-performance neurostimulation and bio-signal acquisition hardware with advanced signal processing and control algorithms. Although mice are the most commonly used animal in medical research, the size, weight, and power requirements of such bioelectronic systems either preclude use in mice or impose significant constraints on experimental design. Here, a fully-implantable recording and stimulation neuromodulation system suitable for use in mice is presented, measuring 2.2 cm3 and weighing 2.8 g. The bidirectional wireless interface allows simultaneous readout of multiple physiological signals and complete control over stimulation parameters, and a wirelessly rechargeable battery provides a lifetime of up to 5 days on a single charge. The device was implanted to deliver vagus nerve stimulation (n = 12 animals) and a functional neural interface (capable of inducing acute bradycardia) was demonstrated with lifetimes exceeding three weeks. The design utilizes only commercially-available electrical components and 3D-printed packaging, with the goal of facilitating widespread adoption and accelerating discovery and translation of future bioelectronic therapeutics.
Collapse
|
26
|
Zafeiropoulos S, Doundoulakis I, Farmakis IT, Miyara S, Giannis D, Giannakoulas G, Tsiachris D, Mitra R, Skipitaris NT, Mountantonakis SE, Stavrakis S, Zanos S. Autonomic Neuromodulation for Atrial Fibrillation Following Cardiac Surgery: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:682-694. [PMID: 35177198 DOI: 10.1016/j.jacc.2021.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/12/2021] [Accepted: 12/07/2021] [Indexed: 12/17/2022]
Abstract
Autonomic neuromodulation therapies (ANMTs) (ie, ganglionated plexus ablation, epicardial injections for temporary neurotoxicity, low-level vagus nerve stimulation [LL-VNS], stellate ganglion block, baroreceptor stimulation, spinal cord stimulation, and renal nerve denervation) constitute an emerging therapeutic approach for arrhythmias. Very little is known about ANMTs' preventive potential for postoperative atrial fibrillation (POAF) after cardiac surgery. The purpose of this review is to summarize and critically appraise the currently available evidence. Herein, the authors conducted a systematic review of 922 articles that yielded 7 randomized controlled trials. In the meta-analysis, ANMTs reduced POAF incidence (OR: 0.37; 95% CI: 0.25 to 0.55) and burden (mean difference [MD]: -3.51 hours; 95% CI: -6.64 to -0.38 hours), length of stay (MD: -0.82 days; 95% CI: -1.59 to -0.04 days), and interleukin-6 (MD: -79.92 pg/mL; 95% CI: -151.12 to -8.33 pg/mL), mainly attributed to LL-VNS and epicardial injections. Moving forward, these findings establish a base for future larger and comparative trials with ANMTs, to optimize and expand their use.
Collapse
Affiliation(s)
- Stefanos Zafeiropoulos
- Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, New York, USA; Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA.
| | - Ioannis Doundoulakis
- Department of Cardiology, 424 General Military Training Hospital, Thessaloniki, Greece; Athens Heart Center, Athens Medical Center, Athens, Greece
| | - Ioannis T Farmakis
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Santiago Miyara
- Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, New York, USA; Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA
| | - Dimitrios Giannis
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Raman Mitra
- Division of Electrophysiology, Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Nicholas T Skipitaris
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York City, New York, USA
| | | | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Stavros Zanos
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA.
| |
Collapse
|
27
|
Merchant K, Zanos S, Datta-Chaudhuri T, Deutschman CS, Sethna CB. Transcutaneous auricular vagus nerve stimulation (taVNS) for the treatment of pediatric nephrotic syndrome: a pilot study. Bioelectron Med 2022; 8:1. [PMID: 35078538 PMCID: PMC8790887 DOI: 10.1186/s42234-021-00084-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Children with frequently relapsing nephrotic syndrome (FRNS) and steroid resistant nephrotic syndrome (SRNS) are exposed to immunosuppressant medications with adverse side effects and variable efficacy. Transcutaneous auricular vagus nerve stimulation (taVNS) modulates the immune system via the inflammatory reflex and has become a therapy of interest for treating immune-mediated illnesses. METHODS An open-label, pilot study of tavNS for five minutes daily for 26 weeks via a TENS 7000 unit was conducted. RESULTS Three FRNS participants and 4 SRNS participants had a mean age of 9.5±4.2 years (range 4 to 17). Those with FRNS remained relapse-free during the study period; two participants continued treatment and remained in remission for 15 and 21 months, respectively. Three SRNS participants experienced a reduction in first morning UPC (mean of 42%, range 25-76%). Although UPC decreased (13.7%) in one SRNS participant with congenital nephrotic syndrome, UPC remained in nephrotic range. All but one participant (non-compliant with treatment) experienced a reduction in TNF (7.33pg/mL vs. 5.46pg/mL, p=0.03). No adverse events or side effects were reported. CONCLUSIONS taVNS was associated with clinical remission in FRNS and moderately reduced proteinuria in non-congenital SRNS. Further study of taVNS as a treatment for nephrotic syndrome in children is warranted. ClinicalTrials.gov Identifier: NCT04169776, Registered November 20, 2019, https://clinicaltrials.gov/ct2/show/NCT04169776 .
Collapse
Affiliation(s)
- Kumail Merchant
- Cohen Children's Medical Center of New York, New Hyde Park, United States, NY
| | - Stavros Zanos
- The Feinstein Institutes for Medical Research, Manhasset, United States, NY
| | | | - Clifford S Deutschman
- Cohen Children's Medical Center of New York, New Hyde Park, United States, NY
- The Feinstein Institutes for Medical Research, Manhasset, United States, NY
| | - Christine B Sethna
- Cohen Children's Medical Center of New York, New Hyde Park, United States, NY.
- The Feinstein Institutes for Medical Research, Manhasset, United States, NY.
| |
Collapse
|
28
|
Sethna CB, Merchant K, Zanos S, Deutschman CS, Datta-Chaudhuri T, Chavan S, Tracey KJ. Vagus Nerve Stimulation: A Potential Therapeutic Role in Childhood Nephrotic Syndrome? Am J Nephrol 2022; 53:290-296. [PMID: 35340000 PMCID: PMC9090973 DOI: 10.1159/000523837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/18/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Christine B. Sethna
- Cohen Children’s Medical Center of NY, New Hyde Park, NY, USA
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kumail Merchant
- Cohen Children’s Medical Center of NY, New Hyde Park, NY, USA
| | - Stavros Zanos
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Clifford S. Deutschman
- Cohen Children’s Medical Center of NY, New Hyde Park, NY, USA
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Timir Datta-Chaudhuri
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Sangeeta Chavan
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kevin J. Tracey
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| |
Collapse
|
29
|
Yun R, Bogaard AR, Richardson AG, Zanos S, Perlmutter SI, Fetz EE. Cortical Stimulation Paired With Volitional Unimanual Movement Affects Interhemispheric Communication. Front Neurosci 2021; 15:782188. [PMID: 35002605 PMCID: PMC8739774 DOI: 10.3389/fnins.2021.782188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022] Open
Abstract
Cortical stimulation (CS) of the motor cortex can cause excitability changes in both hemispheres, showing potential to be a technique for clinical rehabilitation of motor function. However, previous studies that have investigated the effects of delivering CS during movement typically focus on a single hemisphere. On the other hand, studies exploring interhemispheric interactions typically deliver CS at rest. We sought to bridge these two approaches by documenting the consequences of delivering CS to a single motor cortex during different phases of contralateral and ipsilateral limb movement, and simultaneously assessing changes in interactions within and between the hemispheres via local field potential (LFP) recordings. Three macaques were trained in a unimanual reaction time (RT) task and implanted with epidural or intracortical electrodes over bilateral motor cortices. During a given session CS was delivered to one hemisphere with respect to movements of either the contralateral or ipsilateral limb. Stimulation delivered before contralateral limb movement onset shortened the contralateral limb RT. In contrast, stimulation delivered after the end of contralateral movement increased contralateral RT but decreased ipsilateral RT. Stimulation delivered before ipsilateral limb movement decreased ipsilateral RT. All other stimulus conditions as well as random stimulation and periodic stimulation did not have consistently significant effects on either limb. Simultaneous LFP recordings from one animal revealed correlations between changes in interhemispheric alpha band coherence and changes in RT, suggesting that alpha activity may be indicative of interhemispheric communication. These results show that changes caused by CS to the functional coupling within and between precentral cortices is contingent on the timing of CS relative to movement.
Collapse
Affiliation(s)
- Richy Yun
- Department of Bioengineering, University of Washington, Seattle, WA, United States
- Washington National Primate Research Center, University of Washington, Seattle, WA, United States
| | - Andrew R. Bogaard
- Washington National Primate Research Center, University of Washington, Seattle, WA, United States
- Department of Physiology and Biophysics, University of Washington, Seattle, WA, United States
| | - Andrew G. Richardson
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, New York, NY, United States
| | - Steve I. Perlmutter
- Washington National Primate Research Center, University of Washington, Seattle, WA, United States
- Department of Physiology and Biophysics, University of Washington, Seattle, WA, United States
| | - Eberhard E. Fetz
- Department of Bioengineering, University of Washington, Seattle, WA, United States
- Washington National Primate Research Center, University of Washington, Seattle, WA, United States
- Department of Physiology and Biophysics, University of Washington, Seattle, WA, United States
| |
Collapse
|
30
|
Chang JL, Coggins AN, Saul M, Paget-Blanc A, Straka M, Wright J, Datta-Chaudhuri T, Zanos S, Volpe BT. Transcutaneous Auricular Vagus Nerve Stimulation (tAVNS) Delivered During Upper Limb Interactive Robotic Training Demonstrates Novel Antagonist Control for Reaching Movements Following Stroke. Front Neurosci 2021; 15:767302. [PMID: 34899170 PMCID: PMC8655845 DOI: 10.3389/fnins.2021.767302] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Implanted vagus nerve stimulation (VNS) delivered concurrently with upper limb rehabilitation has been shown to improve arm function after stroke. Transcutaneous auricular VNS (taVNS) offers a non-invasive alternative to implanted VNS and may provide similar therapeutic benefit. There is much discussion about the optimal approach for combining VNS and physical therapy, as such we sought to determine whether taVNS administered during robotic training, specifically delivered during the premotor planning stage for arm extension movements, would confer additional motor improvement in patients with chronic stroke. Thirty-six patients with chronic, moderate-severe upper limb hemiparesis (>6 months; mean Upper Extremity Fugl-Meyer score = 25 ± 2, range 13-48), were randomized to receive 9 sessions (1 h in length, 3x/week for 3 weeks) of active (N = 18) or sham (N = 18) taVNS (500 ms bursts, frequency 30 Hz, pulse width 0.3 ms, max intensity 5 mA, ∼250 stimulated movements per session) delivered during robotic training. taVNS was triggered by the onset of a visual cue prior to center-out arm extension movements. Clinical assessments and surface electromyography (sEMG) measures of the biceps and triceps brachii were collected during separate test sessions. Significant motor improvements were measured for both the active and sham taVNS groups, and these improvements were robust at 3 month follow-up. Compared to the sham group, the active taVNS group showed a significant reduction in spasticity of the wrist and hand at discharge (Modified Tardieu Scale; taVNS = -8.94% vs. sham = + 2.97%, p < 0.05). The EMG results also demonstrated significantly increased variance for the bicep peak sEMG amplitude during extension for the active taVNS group compared to the sham group at discharge (active = 26.29% MVC ± 3.89, sham = 10.63% MVC ± 3.10, mean absolute change admission to discharge, p < 0.01), and at 3-month follow-up, the bicep peak sEMG amplitude was significantly reduced in the active taVNS group (P < 0.05). Thus, robot training improved the motor capacity of both groups, and taVNS, decreased spasticity. taVNS administered during premotor planning of movement may play a role in improving coordinated activation of the agonist-antagonist upper arm muscle groups by mitigating spasticity and increasing motor control following stroke. Clinical Trial Registration: www.ClinicalTrials.gov, identifier (NCT03592745).
Collapse
Affiliation(s)
- Johanna L Chang
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Ashley N Coggins
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Maira Saul
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Alexandra Paget-Blanc
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Malgorzata Straka
- Institute for Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Jason Wright
- Institute for Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Timir Datta-Chaudhuri
- Institute for Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Stavros Zanos
- Institute for Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Bruce T Volpe
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| |
Collapse
|
31
|
Rembado I, Song W, Su DK, Levari A, Shupe LE, Perlmutter S, Fetz E, Zanos S. Cortical Responses to Vagus Nerve Stimulation Are Modulated by Brain State in Nonhuman Primates. Cereb Cortex 2021; 31:5289-5307. [PMID: 34151377 PMCID: PMC8567998 DOI: 10.1093/cercor/bhab158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/30/2023] Open
Abstract
Vagus nerve stimulation (VNS) has been tested as therapy for several brain disorders and as a means to modulate cortical excitability and brain plasticity. Cortical effects of VNS, manifesting as vagal-evoked potentials (VEPs), are thought to arise from activation of ascending cholinergic and noradrenergic systems. However, it is unknown whether those effects are modulated by brain state at the time of stimulation. In 2 freely behaving macaque monkeys, we delivered short trains of 5 pulses to the left cervical vagus nerve at different frequencies (5-300 Hz) while recording local field potentials (LFPs) from sites in contralateral prefrontal, sensorimotor and parietal cortical areas. Brain states were inferred from spectral components of LFPs and the presence of overt movement: active awake, resting awake, REM sleep and NREM sleep. VNS elicited VEPs in all sampled cortical areas. VEPs comprised early (<70 ms), intermediate (70-250 ms) and late (>250 ms) components. The magnitude of the intermediate and late components was largest during NREM sleep and smallest during wakefulness, whereas that of the early component was not modulated by brain state. VEPs during NREM were larger for stimuli delivered at the depolarized phase of ongoing delta oscillations. Higher pulsing frequencies generated larger VEPs. These short VNS trains did not affect brain state transitions during wakefulness or sleep. Our findings suggest that ongoing brain state modulates the evoked effects of VNS on cortical activity. This has implications for the role of ongoing cortical activity and brain state in shaping cortical responses to peripheral stimuli, for the modulation of vagal interoceptive signaling by cortical activity, and for the dose calibration of VNS therapies.
Collapse
Affiliation(s)
- Irene Rembado
- MindScope Program, Allen Institute, 615 Westlake Ave N., Seattle, WA 98103, USA
| | - Weiguo Song
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset NY 11030, USA
| | - David K Su
- Providence Regional Medical Center Cranial Joint and Spine Clinic, Everett, WA 98201, USA
| | - Ariel Levari
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Larry E Shupe
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Steve Perlmutter
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Eberhard Fetz
- Department of Physiology & Biophysics, University of Washington, Seattle, WA 98195, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset NY 11030, USA
| |
Collapse
|
32
|
Morales LF, Miyara SJ, Guevara S, Metz CN, Shoaib M, Watt S, Zafeiropoulos S, McCann-Molmenti A, Hayashida K, Takegawa R, Shinozaki K, Choudhary RC, Brindley EC, Nishikimi M, Kressel AM, Alsalmay YM, Mazzotta EA, Cho YM, Aranalde GI, Grande DA, Zanos S, Becker LB, Molmenti EP. Sequential Use of Romiplostim after Eltrombopag for Refractory Thrombocytopenia in Hydrocarbon-Induced Myelodysplasia. Int J Angiol 2021. [DOI: 10.1055/s-0041-1726366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractWe describe the clinical course of a 65-year-old male patient who suffered from hydrocarbon-induced myelodysplasia and was successfully treated with the thrombopoietin receptor agonist (TPO-RA), romiplostim. Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis, cytopenias, and increased risk of leukemic transformation. Here, we present a clinical vignette of MDS-associated thrombocytopenia refractory to first-line drugs as well as the TPO-RA, eltrombopag. To date, romiplostim is an U.S. Food and Drug Administration (FDA)-approved drug for idiopathic thrombocytopenic purpura and thrombocytopenia secondary to liver disease. Of note, currently the FDA advises against its use in MDS based on previous long-term safety concerns. Since the therapeutic options for thrombocytopenia in MDS patients are sparse, repurposing and reassessing romiplostim in this setting have been the focus of recent studies. At the time of writing, no published double-blind randomized clinical trials have conducted a head-to-head comparison between romiplostim and eltrombopag in thrombocytopenic MDS patients. To the best of our knowledge, for a thrombocytopenic patient in the setting of MDS, this is the first documented report of refractory clinical response after a 2-year use of eltrombopag in which replacement of treatment with romiplostim resulted in sustained physiological counts of thrombocytes within four weeks.
Collapse
Affiliation(s)
- Luis F. Morales
- Department of Surgery, North Shore University Hospital, Manhasset, New York
| | - Santiago J. Miyara
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
- Feinstein Institutes for Medical Research, Manhasset, New York
| | - Sara Guevara
- Department of Surgery, North Shore University Hospital, Manhasset, New York
| | - Christine N. Metz
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
- Feinstein Institutes for Medical Research, Manhasset, New York
| | - Muhammad Shoaib
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Stacey Watt
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, University at Buffalo, Buffalo, New York
| | - Stefanos Zafeiropoulos
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
- Feinstein Institutes for Medical Research, Manhasset, New York
| | | | - Kei Hayashida
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Ryosuke Takegawa
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Koichiro Shinozaki
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Rishabh C. Choudhary
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Elena C. Brindley
- Feinstein Institutes for Medical Research, Manhasset, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Mitsuaki Nishikimi
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
| | - Adam M. Kressel
- Department of Surgery, North Shore University Hospital, Manhasset, New York
- Feinstein Institutes for Medical Research, Manhasset, New York
| | - Yaser M. Alsalmay
- Department of Surgery, North Shore University Hospital, Manhasset, New York
| | - Elvio A. Mazzotta
- Department of Anesthesiology, The Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Young Min Cho
- Department of Surgery, North Shore University Hospital, Manhasset, New York
- Feinstein Institutes for Medical Research, Manhasset, New York
| | | | - Daniel A. Grande
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
- Feinstein Institutes for Medical Research, Manhasset, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Stavros Zanos
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
- Feinstein Institutes for Medical Research, Manhasset, New York
| | - Lance B. Becker
- Department of Surgery, North Shore University Hospital, Manhasset, New York
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
- Feinstein Institutes for Medical Research, Manhasset, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Ernesto P. Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, New York
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| |
Collapse
|
33
|
Debnath S, Levy TJ, Bellehsen M, Schwartz RM, Barnaby DP, Zanos S, Volpe BT, Zanos TP. A method to quantify autonomic nervous system function in healthy, able-bodied individuals. Bioelectron Med 2021; 7:13. [PMID: 34446089 PMCID: PMC8394599 DOI: 10.1186/s42234-021-00075-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/20/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The autonomic nervous system (ANS) maintains physiological homeostasis in various organ systems via parasympathetic and sympathetic branches. ANS function is altered in common diffuse and focal conditions and heralds the beginning of environmental and disease stresses. Reliable, sensitive, and quantitative biomarkers, first defined in healthy participants, could discriminate among clinically useful changes in ANS function. This framework combines controlled autonomic testing with feature extraction during physiological responses. METHODS Twenty-one individuals were assessed in two morning and two afternoon sessions over two weeks. Each session included five standard clinical tests probing autonomic function: squat test, cold pressor test, diving reflex test, deep breathing, and Valsalva maneuver. Noninvasive sensors captured continuous electrocardiography, blood pressure, breathing, electrodermal activity, and pupil diameter. Heart rate, heart rate variability, mean arterial pressure, electrodermal activity, and pupil diameter responses to the perturbations were extracted, and averages across participants were computed. A template matching algorithm calculated scaling and stretching features that optimally fit the average to an individual response. These features were grouped based on test and modality to derive sympathetic and parasympathetic indices for this healthy population. RESULTS A significant positive correlation (p = 0.000377) was found between sympathetic amplitude response and body mass index. Additionally, longer duration and larger amplitude sympathetic and longer duration parasympathetic responses occurred in afternoon testing sessions; larger amplitude parasympathetic responses occurred in morning sessions. CONCLUSIONS These results demonstrate the robustness and sensitivity of an algorithmic approach to extract multimodal responses from standard tests. This novel method of quantifying ANS function can be used for early diagnosis, measurement of disease progression, or treatment evaluation. TRIAL REGISTRATION This study registered with Clinicaltrials.gov , identifier NCT04100486 . Registered September 24, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04100486 .
Collapse
Affiliation(s)
- Shubham Debnath
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Todd J Levy
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Mayer Bellehsen
- Department of Psychiatry, Unified Behavioral Health Center and World Trade Center Health Program, Northwell Health, Bay Shore, NY, USA
| | - Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology and Prevention, Northwell Health, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Center for Disaster Health, Trauma, and Resilience, New York, NY, USA
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Douglas P Barnaby
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Northwell Health, Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Bruce T Volpe
- Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Northwell Health, Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.
| |
Collapse
|
34
|
Miyara SJ, Guevara S, Shore-Lesserson L, Shoaib M, Kirsch C, Metz CN, Nair V, Lau L, Choudhary RC, McCann-Molmenti A, Baez AM, Hayashida K, Takegawa R, Shinozaki K, Aoki T, Nishikimi M, Cho YM, Morell A, Zafeiropoulos S, Zanos S, Watt S, Montorfano L, Bartoc CD, Lumermann CM, Aronsohn J, Becker LB, Molmenti EP. Right Ventricle Embolization of IVC Filter Fragments: An Incidental Finding. Int J Angiol 2021. [DOI: 10.1055/s-0041-1730451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractThis case report describes a 52-year-old male patient, with the incidental finding of inferior vena cava filter (IVCF) fragments impacted into the right ventricle, secondary to IVCF fragmentation and subsequent embolization. While IVCFs are prescribed to prevent pulmonary embolizations when anticoagulation is either contraindicated, or has failed, IVCF embolizations to the heart represent an extremely rare, but potentially life-threatening complication. Of note, at the time of writing, the utility and effectiveness of IVCF are not fully established. Intracardiac embolizations of IVCF typically present with complications such as hypotension, cardiac tamponade, arrhythmias, ventricle perforation, bleeding, cardiac arrest, and death. To our knowledge, this is the first case report of an asymptomatic kidney transplant recipient found to have right ventricle embolizations of IVCF fragments through routine assessment. Additionally, this is also the first report of an asymptomatic patient who presented IVCF fragments embolized to the right ventricle and left gonadal vein in the same clinical setting.
Collapse
Affiliation(s)
- Santiago J. Miyara
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
| | - Sara Guevara
- Department of Surgery, North Shore University Hospital, Manhasset, New York, New York
| | - Linda Shore-Lesserson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
- Department of Anesthesiology, North Shore University Hospital, Manhasset, New York, New York
| | - Muhammad Shoaib
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
| | - Claudia Kirsch
- Department of Radiology, North Shore University Hospital, Manhasset, New York, New York
| | - Christine N. Metz
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
| | - Vinay Nair
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
- Department of Medicine, North Shore University Hospital, Manhasset, New York, New York
| | - Lawrence Lau
- Department of Surgery, North Shore University Hospital, Manhasset, New York, New York
| | - Rishabh C. Choudhary
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
| | - Alexia McCann-Molmenti
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
| | - Anthony M. Baez
- Department of Surgery, North Shore University Hospital, Manhasset, New York, New York
| | - Kei Hayashida
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
| | - Ryosuke Takegawa
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
| | - Koichiro Shinozaki
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
| | - Tomoaki Aoki
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
| | - Mitsuaki Nishikimi
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
| | - Young Min Cho
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
| | - Alexis Morell
- Department of Surgery, North Shore University Hospital, Manhasset, New York, New York
| | - Stefanos Zafeiropoulos
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
| | - Stavros Zanos
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
| | - Stacey Watt
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, New York
| | | | - Cristian D. Bartoc
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
- Department of Anesthesiology, North Shore University Hospital, Manhasset, New York, New York
| | - Claudio M. Lumermann
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
- Department of Anesthesiology, North Shore University Hospital, Manhasset, New York, New York
| | - Judith Aronsohn
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
- Department of Anesthesiology, North Shore University Hospital, Manhasset, New York, New York
| | - Lance B. Becker
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, New York
- Feinstein Institutes for Medical Research, Manhasset, New York, New York
- Department of Surgery, North Shore University Hospital, Manhasset, New York, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
| | - Ernesto P. Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, New York, New York
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York, New York
| |
Collapse
|
35
|
Ahmed U, Chang YC, Lopez MF, Wong J, Datta-Chaudhuri T, Rieth L, Al-Abed Y, Zanos S. Implant- and anesthesia-related factors affecting cardiopulmonary threshold intensities for vagus nerve stimulation. J Neural Eng 2021; 18. [PMID: 34036940 DOI: 10.1088/1741-2552/ac048a] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/24/2021] [Indexed: 11/11/2022]
Abstract
Objective.Vagus nerve stimulation (VNS) is typically delivered at increasing stimulus intensity until a neurological or physiological response is observed ('threshold') for dose calibration, preclinically and therapeutically. Factors affecting VNS thresholds have not been studied systematically. In a rodent model of VNS we measured neural and physiological responses to increasing VNS intensity, determined neurological and physiological thresholds and examined the effect of implant- and anesthesia-related factors on thresholds.Approach.In acute and chronic vagus implants (45 and 20 rats, respectively) VNS was delivered under isoflurane, ketamine-xylazine, or awake conditions. Evoked compound action potentials (CAPs) were recorded and activation of different fiber types was extracted. Elicited physiological responses were registered, including changes in heart rate (HR), breathing rate (BR), and blood pressure (BP). CAP and physiological thresholds were determined.Main results. The threshold for evoking discernable CAPs (>10µV) (CAP threshold) is significantly lower than what elicits 5%-10% drop in heart rate (heart rate threshold, HRT) (25µA ± 1.8 vs. 80µA ± 5.1, respectively; mean ± SEM). Changes in BP and small changes in BR (bradypnea) occur at lowest intensities (70µA ± 8.3), followed by HR changes (80µA ± 5.1) and finally significant changes in BR (apnea) (310μA ± 32.5). HRT and electrode impedance are correlated in chronic (Pearson correlationr= 0.47;p< 0.001) but not in acute implants (r= -0.34;pNS); HRT and impedance both increase with implant age (r= 0.44;p< 0.001 andr= 0.64;p< 0.001, respectively). HRT is lowest when animals are awake (200µA ± 35.5), followed by ketamine-xylazine (640µA ± 151.5), and isoflurane (1000µA ± 139.5). The sequence of physiological responses with increasing VNS intensity is the same in anesthetized and awake animals. Pulsing frequency affects physiological responses but not CAPs.Significance. Implant age, electrode impedance, and type of anesthesia affect VNS thresholds and should be accounted for when calibrating stimulation dose.
Collapse
Affiliation(s)
- Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Maria F Lopez
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Jason Wong
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Loren Rieth
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY 11030, United States of America
| |
Collapse
|
36
|
Miyara SJ, Becker LB, Guevara S, Kirsch C, Metz CN, Shoaib M, Grodstein E, Nair VV, Jandovitz N, McCann-Molmenti A, Hayashida K, Takegawa R, Shinozaki K, Yagi T, Aoki T, Nishikimi M, Choudhary RC, Cho YM, Zanos S, Zafeiropoulos S, Hoffman HB, Watt S, Lumermann CM, Aronsohn J, Shore-Lesserson L, Molmenti EP. Pneumatosis Intestinalis in the Setting of COVID-19: A Single Center Case Series From New York. Front Med (Lausanne) 2021; 8:638075. [PMID: 34150792 PMCID: PMC8212022 DOI: 10.3389/fmed.2021.638075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
This case series reviews four critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] suffering from pneumatosis intestinalis (PI) during their hospital admission. All patients received the biological agent tocilizumab (TCZ), an interleukin (IL)-6 antagonist, as an experimental treatment for COVID-19 before developing PI. COVID-19 and TCZ have been independently linked to PI risk, yet the cause of this relationship is unknown and under speculation. PI is a rare condition, defined as the presence of gas in the intestinal wall, and although its pathogenesis is poorly understood, intestinal ischemia is one of its causative agents. Based on COVID-19's association with vasculopathic and ischemic insults, and IL-6's protective role in intestinal epithelial ischemia-reperfusion injury, an adverse synergistic association of COVID-19 and TCZ can be proposed in the setting of PI. To our knowledge, this is the first published, single center, case series of pneumatosis intestinalis in COVID-19 patients who received tocilizumab therapy.
Collapse
Affiliation(s)
- Santiago J. Miyara
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Lance B. Becker
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Sara Guevara
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Claudia Kirsch
- Department of Radiology, North Shore University Hospital, Manhasset, NY, United States
| | - Christine N. Metz
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Muhammad Shoaib
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Elliot Grodstein
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
| | - Vinay V. Nair
- Department of Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Nicholas Jandovitz
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
- Department of Pharmacy, North Shore University Hospital, Manhasset, NY, United States
| | | | - Kei Hayashida
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Ryosuke Takegawa
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Koichiro Shinozaki
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Tsukasa Yagi
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Tomoaki Aoki
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Mitsuaki Nishikimi
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Rishabh C. Choudhary
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
| | - Young Min Cho
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
| | - Stavros Zanos
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Stefanos Zafeiropoulos
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, United States
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Hannah B. Hoffman
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
| | - Stacey Watt
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Claudio M. Lumermann
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Anesthesiology, North Shore University Hospital, Manhasset, NY, United States
| | - Judith Aronsohn
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Anesthesiology, North Shore University Hospital, Manhasset, NY, United States
| | - Linda Shore-Lesserson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Anesthesiology, North Shore University Hospital, Manhasset, NY, United States
| | - Ernesto P. Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, NY, United States
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| |
Collapse
|
37
|
Datta-Chaudhuri T, Zanos T, Chang EH, Olofsson PS, Bickel S, Bouton C, Grande D, Rieth L, Aranow C, Bloom O, Mehta AD, Civillico G, Stevens MM, Głowacki E, Bettinger C, Schüettler M, Puleo C, Rennaker R, Mohanta S, Carnevale D, Conde SV, Bonaz B, Chernoff D, Kapa S, Berggren M, Ludwig K, Zanos S, Miller L, Weber D, Yoshor D, Steinman L, Chavan SS, Pavlov VA, Al-Abed Y, Tracey KJ. The Fourth Bioelectronic Medicine Summit "Technology Targeting Molecular Mechanisms": current progress, challenges, and charting the future. Bioelectron Med 2021; 7:7. [PMID: 34024277 PMCID: PMC8142479 DOI: 10.1186/s42234-021-00068-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 02/06/2023] Open
Abstract
There is a broad and growing interest in Bioelectronic Medicine, a dynamic field that continues to generate new approaches in disease treatment. The fourth bioelectronic medicine summit "Technology targeting molecular mechanisms" took place on September 23 and 24, 2020. This virtual meeting was hosted by the Feinstein Institutes for Medical Research, Northwell Health. The summit called international attention to Bioelectronic Medicine as a platform for new developments in science, technology, and healthcare. The meeting was an arena for exchanging new ideas and seeding potential collaborations involving teams in academia and industry. The summit provided a forum for leaders in the field to discuss current progress, challenges, and future developments in Bioelectronic Medicine. The main topics discussed at the summit are outlined here.
Collapse
Affiliation(s)
| | - Theodoros Zanos
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Eric H. Chang
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | | | - Stephan Bickel
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Chad Bouton
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Daniel Grande
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Loren Rieth
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
- University of Utah, Salt Lake City, UT USA
| | - Cynthia Aranow
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Ona Bloom
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Ashesh D. Mehta
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | | | | | | | | | | | | | | | - Saroj Mohanta
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
| | - Daniela Carnevale
- Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Silvia V. Conde
- CEDOC, Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Bruno Bonaz
- University of Grenoble Alpes, INSERM, Grenoble, France
| | | | | | | | - Kip Ludwig
- University of Wisconsin, Madison, WI USA
| | - Stavros Zanos
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Larry Miller
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Doug Weber
- Carnegie Mellon University, Pittsburgh, PA USA
| | | | | | - Sangeeta S. Chavan
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Valentin A. Pavlov
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Yousef Al-Abed
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| | - Kevin J. Tracey
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY USA
| |
Collapse
|
38
|
Ahmed U, Zafeiropoulos S, Giannakoulas G, Puleo C, Zanos S. FOCUSED ULTRASOUND STIMULATION OF THE INFLAMMATORY REFLEX AT THE SPLEEN AMELIORATES PULMONARY ARTERIAL HYPERTENSION IN RODENTS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03033-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
39
|
Mughrabi IT, Hickman J, Jayaprakash N, Thompson D, Ahmed U, Papadoyannis ES, Chang YC, Abbas A, Datta-Chaudhuri T, Chang EH, Zanos TP, Lee SC, Froemke RC, Tracey KJ, Welle C, Al-Abed Y, Zanos S. Development and characterization of a chronic implant mouse model for vagus nerve stimulation. eLife 2021; 10:e61270. [PMID: 33821789 PMCID: PMC8051950 DOI: 10.7554/elife.61270] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 04/02/2021] [Indexed: 12/17/2022] Open
Abstract
Vagus nerve stimulation (VNS) suppresses inflammation and autoimmune diseases in preclinical and clinical studies. The underlying molecular, neurological, and anatomical mechanisms have been well characterized using acute electrophysiological stimulation of the vagus. However, there are several unanswered mechanistic questions about the effects of chronic VNS, which require solving numerous technical challenges for a long-term interface with the vagus in mice. Here, we describe a scalable model for long-term VNS in mice developed and validated in four research laboratories. We observed significant heart rate responses for at least 4 weeks in 60-90% of animals. Device implantation did not impair vagus-mediated reflexes. VNS using this implant significantly suppressed TNF levels in endotoxemia. Histological examination of implanted nerves revealed fibrotic encapsulation without axonal pathology. This model may be useful to study the physiology of the vagus and provides a tool to systematically investigate long-term VNS as therapy for chronic diseases modeled in mice.
Collapse
Affiliation(s)
- Ibrahim T Mughrabi
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Jordan Hickman
- Departments of Neurosurgery, University of Colorado Anschutz Medical CampusAuroraUnited States
- Department of Physiology and Biophysics, University of Colorado Anschutz Medical CampusAuroraUnited States
| | - Naveen Jayaprakash
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Dane Thompson
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
- The Elmezzi Graduate School of Molecular MedicineManhassetUnited States
| | - Umair Ahmed
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Eleni S Papadoyannis
- Skirball Institute for Biomolecular Medicine, New York University School of Medicine, New York UniversityNew YorkUnited States
- Department of Neuroscience and Physiology, Neuroscience Institute, Center for Neural Science, New York University School of Medicine, New York UniversityNew YorkUnited States
- Department of Otolaryngology, New York University School of Medicine, New York UniversityNew YorkUnited States
- Howard Hughes Medical Institute Faculty Scholar, New York University School of Medicine, New York UniversityNew YorkUnited States
| | - Yao-Chuan Chang
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Adam Abbas
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Eric H Chang
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Sunhee C Lee
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Robert C Froemke
- Skirball Institute for Biomolecular Medicine, New York University School of Medicine, New York UniversityNew YorkUnited States
- Department of Neuroscience and Physiology, Neuroscience Institute, Center for Neural Science, New York University School of Medicine, New York UniversityNew YorkUnited States
- Department of Otolaryngology, New York University School of Medicine, New York UniversityNew YorkUnited States
- Howard Hughes Medical Institute Faculty Scholar, New York University School of Medicine, New York UniversityNew YorkUnited States
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Cristin Welle
- Departments of Neurosurgery, University of Colorado Anschutz Medical CampusAuroraUnited States
- Department of Physiology and Biophysics, University of Colorado Anschutz Medical CampusAuroraUnited States
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research, Northwell HealthManhassetUnited States
| |
Collapse
|
40
|
Zafeiropoulos S, Farmakis I, Kartas A, Arvanitaki A, Pagiantza A, Boulmpou A, Tampaki A, Kosmidis D, Nevras V, Markidis E, Papadimitriou I, Vlachou A, Arvanitakis K, Miyara SJ, Ziakas A, Molmenti EP, Kassimis G, Zanos S, Karvounis H, Giannakoulas G. Reinforcing adherence to lipid-lowering therapy after an acute coronary syndrome: A pragmatic randomized controlled trial. Atherosclerosis 2021; 323:37-43. [PMID: 33780749 DOI: 10.1016/j.atherosclerosis.2021.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/13/2021] [Accepted: 03/10/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Achieving the low-density lipoprotein cholesterol (LDL-C) goal following an acute coronary syndrome (ACS) is a milestone often missed due to suboptimal adherence to secondary prevention treatments. Whether improved adherence could result in reduced LDL-C levels is unclear. We aimed to evaluate whether an educational-motivational intervention increases long-term lipid-lowering therapy (LLT) adherence and LDL-C goal attainment rate among post-ACS patients. METHODS IDEAL-LDL was a parallel, two-arm, single-center, pragmatic, investigator-initiated randomized controlled trial. Hospitalized patients for ACS were randomized to a physician-led integrated intervention consisting of an educational session at baseline, followed by regular motivational interviewing phone sessions or usual care. Co-primary outcomes were the LLT adherence (measured by Proportion of Days Covered (PDC); good adherence defined as PDC>80%), and LDL-C goal (<70 mg/dl or 50% reduction from baseline) achievement rate at one year. RESULTS In total, 360 patients (mean age 62 years, 81% male) were randomized. Overall, good adherence was positively associated with LDL-C goal achievement rate at one year. Median PDC was higher in the intervention group than the control group [0.92 (IQR, 0.82-1.00) vs. 0.86 (0.62-0.98); p = 0.03] while the intervention group had increased odds of good adherence (odds ratio: 1.76 (95% confidence interval 1.02 to 2.62; p = 0.04). However, neither the LDL-C goal achievement rate (49.6% in the intervention vs. 44.9% in the control group; p = 0.49) nor clinical outcomes differed significantly between the two groups. CONCLUSIONS Α multifaceted intervention improved LLT adherence in post-ACS patients without a significant difference in LDL-C goal attainment.
Collapse
Affiliation(s)
- Stefanos Zafeiropoulos
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Elmezzi Graduate School of Molecular Medicine and Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, USA
| | - Ioannis Farmakis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Kartas
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandra Arvanitaki
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
| | - Areti Pagiantza
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Internal Medicine, Serres General Hospital, Serres, Greece
| | - Aristi Boulmpou
- 3rd Department of Cardiology, Ippokrateion University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Tampaki
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Diamantis Kosmidis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassileios Nevras
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Markidis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Papadimitriou
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Vlachou
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Arvanitakis
- Laboratory of Biomathematics, University of Thessaly, School of Medicine, Papakyriazi 22, Building "Katsigra", Larissa, Greece
| | - Santiago J Miyara
- Elmezzi Graduate School of Molecular Medicine and Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, USA
| | - Antonios Ziakas
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ernesto P Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - George Kassimis
- 2nd Department of Cardiology, Ippokrateion University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Haralambos Karvounis
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- 1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| |
Collapse
|
41
|
Toth V, Jayaprakash N, Abbas A, Khan A, Zanos S, Zanos TP. Single-axon level automatic segmentation and feature extraction from immuhistochemical images of peripheral nerves. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:1859-1862. [PMID: 33018362 DOI: 10.1109/embc44109.2020.9175974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Quantitative descriptions of the morphology and structure of peripheral nerves is central in the development of bioelectronic devices interfacing the nerves. While histological procedures and microscopy techniques yield high-resolution detailed images of individual axons, automated methods to extract relevant information at the single-axon level are not widely available. We implemented a segmentation algorithm that allows for subsequent feature extraction in immunohistochemistry (IHC) images of peripheral nerves at the single fiber scale. These features include short and long cross-sectional diameters, area, perimeter, thickness of surrounding myelin and polar coordinates of single axons within a nerve or nerve fascicle. We evaluated the performance of our algorithm using manually annotated IHC images of 27 fascicles of the swine cervical vagus; the accuracy of single-axon detection was 82%, and of the classification of fiber myelination was 89%.
Collapse
|
42
|
Lin Q, Shivdasani MN, Tsai D, Chang YC, Jayaprakash N, Zanos S, Lovell NH, Dokos S, Guo T. A Computational Model of Functionally-distinct Cervical Vagus Nerve Fibers. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:2475-2478. [PMID: 33018508 DOI: 10.1109/embc44109.2020.9175855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cervical vagus nerve stimulation (VNS) is a neuromodulation therapy used in the treatment of several chronic disorders. In order to maximize the therapeutic effectiveness of VNS, it has become increasingly important to deliver fiber-specific neurostimulation, so that undesired effects can be minimized. Assessing the activation of different vagal fiber types through electrical stimulation is therefore essential for developing fiber-selective VNS therapies. Towards this goal, we conducted in silico investigations using a generic model of functionally distinct nerve fibers and clinically relevant cuff electrodes using COMSOL. Our model is constrained by histological observations from rat cervical vagus nerves and its outputs are validated against averaged compound nerve action potentials (CNAPs) obtained from rat vagus nerve recordings. We propose this model as an effective tool to design fiber-specific stimulation protocols before testing them in experimental animals.
Collapse
|
43
|
Chang YC, Cracchiolo M, Ahmed U, Mughrabi I, Gabalski A, Daytz A, Rieth L, Becker L, Datta-Chaudhuri T, Al-Abed Y, Zanos TP, Zanos S. Quantitative estimation of nerve fiber engagement by vagus nerve stimulation using physiological markers. Brain Stimul 2020; 13:1617-1630. [PMID: 32956868 DOI: 10.1016/j.brs.2020.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/31/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cervical vagus nerve stimulation (VNS) is an emerging bioelectronic treatment for brain, metabolic, cardiovascular and immune disorders. Its desired and off-target effects are mediated by different nerve fiber populations and knowledge of their engagement could guide calibration and monitoring of VNS therapies. OBJECTIVE Stimulus-evoked compound action potentials (eCAPs) directly provide fiber engagement information but are currently not feasible in humans. A method to estimate fiber engagement through common, noninvasive physiological readouts could be used in place of eCAP measurements. METHODS In anesthetized rats, we recorded eCAPs while registering acute physiological response markers to VNS: cervical electromyography (EMG), changes in heart rate (ΔHR) and breathing interval (ΔBI). Quantitative models were established to capture the relationship between A-, B- and C-fiber type activation and those markers, and to quantitatively estimate fiber activation from physiological markers and stimulation parameters. RESULTS In bivariate analyses, we found that EMG correlates with A-fiber, ΔHR with B-fiber and ΔBI with C-fiber activation, in agreement with known physiological functions of the vagus. We compiled multivariate models for quantitative estimation of fiber engagement from these markers and stimulation parameters. Finally, we compiled frequency gain models that allow estimation of fiber engagement at a wide range of VNS frequencies. Our models, after calibration in humans, could provide noninvasive estimation of fiber engagement in current and future therapeutic applications of VNS.
Collapse
Affiliation(s)
- Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Marina Cracchiolo
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA; The BioRobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, 56127, Italy
| | - Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Ibrahim Mughrabi
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Arielle Gabalski
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Anna Daytz
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Loren Rieth
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Lance Becker
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA.
| |
Collapse
|
44
|
Ahmed U, Chang YC, Cracchiolo M, Lopez MF, Tomaio JN, Datta-Chaudhuri T, Zanos TP, Rieth L, Al-Abed Y, Zanos S. Anodal block permits directional vagus nerve stimulation. Sci Rep 2020; 10:9221. [PMID: 32513973 PMCID: PMC7280203 DOI: 10.1038/s41598-020-66332-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open
Abstract
Vagus nerve stimulation (VNS) is a bioelectronic therapy for disorders of the brain and peripheral organs, and a tool to study the physiology of autonomic circuits. Selective activation of afferent or efferent vagal fibers can maximize efficacy and minimize off-target effects of VNS. Anodal block (ABL) has been used to achieve directional fiber activation in nerve stimulation. However, evidence for directional VNS with ABL has been scarce and inconsistent, and it is unknown whether ABL permits directional fiber activation with respect to functional effects of VNS. Through a series of vagotomies, we established physiological markers for afferent and efferent fiber activation by VNS: stimulus-elicited change in breathing rate (ΔBR) and heart rate (ΔHR), respectively. Bipolar VNS trains of both polarities elicited mixed ΔHR and ΔBR responses. Cathode cephalad polarity caused an afferent pattern of responses (relatively stronger ΔBR) whereas cathode caudad caused an efferent pattern (stronger ΔHR). Additionally, left VNS elicited a greater afferent and right VNS a greater efferent response. By analyzing stimulus-evoked compound nerve potentials, we confirmed that such polarity differences in functional responses to VNS can be explained by ABL of A- and B-fiber activation. We conclude that ABL is a mechanism that can be leveraged for directional VNS.
Collapse
Affiliation(s)
- Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Marina Cracchiolo
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
- Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Maria F Lopez
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Jacquelyn N Tomaio
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Timir Datta-Chaudhuri
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Loren Rieth
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA.
| |
Collapse
|
45
|
Mitsopoulos E, Lysitska A, Zanos S, Mplatsa A, Alexandrou ME, Kevrekidou S, Stroppou P, Zazopoulou O, Kalliara TA, Voudouri A, Pateinakis P, Manou E, Kyriklidou P, Papadopoulou D. Normal white blood cell counts predict long-term mortality of hemodialysis patients. Int Urol Nephrol 2020; 52:783-790. [PMID: 32157617 DOI: 10.1007/s11255-020-02431-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/23/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE It is unclear whether normal white blood cell (WBC) counts are predictive of subsequent mortality in hemodialysis patients. METHODS All patients aged 17 years or more, who initiated hemodialysis at a tertiary Hospital from January 2000 to August 2017 with a dialysis vintage of greater than 90 days and normal median WBC count of their first dialysis year were included in the study. They were followed until they died, transferred to other dialysis facilities, switched to peritoneal dialysis, received a renal transplant or reached the end of the study (August 31, 2018). Cox regression was used to estimate hazard ratios for mortality of tertiles of WBC counts, adjusting for baseline demographic, clinical and laboratory variables. RESULTS 611 patients [median (interquartile range) age 65.2 (53.3-72.6) years, 62.4% male] were studied. During a median follow-up of 3.9 (1.6-7.2) years, 270 participants died. Patients in the mid- (6.25-7.73 × 103/μL, n = 203) and top-tertile (7.73-10.50 × 103/μL, n = 203) of normal WBC counts had significantly higher mortality than patients in the bottom-tertile (3.50-6.25 × 103/μL, n = 205). The adjusted hazard ratio for mortality relative to the bottom-tertile was 1.54, 95% confidence interval (CI) 1.05-2.25 and 2.20, 95% CI 1.46-3.32, for the mid- and top-tertiles, respectively. CONCLUSIONS In hemodialysis patients, higher WBC count within the normal range is associated with increased long-term mortality. This finding is described for the first time and provides further insight into the clinical significance of a "normal" WBC count result in dialysis patients.
Collapse
Affiliation(s)
- Efstathios Mitsopoulos
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece.
| | - Aikaterini Lysitska
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Stavros Zanos
- Center for Bioelectronic Medicine & Biomedical Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Aikaterini Mplatsa
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Maria-Eleni Alexandrou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Sofia Kevrekidou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Persia Stroppou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Ourania Zazopoulou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Theodora-Anastasia Kalliara
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Anastasia Voudouri
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Panagiotis Pateinakis
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Eleni Manou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Parthena Kyriklidou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Dorothea Papadopoulou
- Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece
| |
Collapse
|
46
|
Unterweger J, Seeber M, Zanos S, Ojemann JG, Scherer R. ECoG Beta Suppression and Modulation During Finger Extension and Flexion. Front Neurosci 2020; 14:35. [PMID: 32116497 PMCID: PMC7031656 DOI: 10.3389/fnins.2020.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
Neural oscillations originate predominantly from interacting cortical neurons and consequently reflect aspects of cortical information processing. However, their functional role is not yet fully understood and their interpretation is debatable. Amplitude modulations (AMs) in alpha (8–12 Hz), beta (13–30 Hz), and high gamma (70–150 Hz) band in invasive electrocorticogram (ECoG) and non-invasive electroencephalogram (EEG) signals change with behavior. Alpha and beta band AMs are typically suppressed (desynchronized) during motor behavior, while high gamma AMs highly correlate with the behavior. These two phenomena are successfully used for functional brain mapping and brain-computer interface (BCI) applications. Recent research found movement-phase related AMs (MPA) also in high beta/low gamma (24–40 Hz) EEG rhythms. These MPAs were found by separating the suppressed AMs into sustained and dynamic components. Sustained AM components are those with frequencies that are lower than the motor behavior. Dynamic components those with frequencies higher than the behavior. In this paper, we study ECoG beta/low gamma band (12–30 Hz/30–42 Hz) AM during repetitive finger movements addressing the question whether or not MPAs can be found in ECoG beta band. Indeed, MPA in the 12–18 Hz and 18–24 Hz band were found. This additional information may lead to further improvements in ECoG-based prediction and reconstruction of motor behavior by combining high gamma AM and beta band MPA.
Collapse
Affiliation(s)
- Julian Unterweger
- Institute of Neural Engineering, Graz University of Technology, Graz, Austria
| | - Martin Seeber
- Functional Brain Mapping Laboratory, Department of Fundamental Neurosciences, University of Geneva, Geneva, Switzerland
| | - Stavros Zanos
- Translational Neurophysiology Laboratory, Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Reinhold Scherer
- Brain-Computer Interfaces and Neural Engineering Laboratory, School of Computer Science and Electronic Engineering, University of Essex, Colchester, United Kingdom
| |
Collapse
|
47
|
Ntiloudi D, Qanud K, Tomaio JN, Giannakoulas G, Al-Abed Y, Zanos S. Pulmonary arterial hypertension: the case for a bioelectronic treatment. Bioelectron Med 2019; 5:20. [PMID: 32232109 PMCID: PMC7098229 DOI: 10.1186/s42234-019-0036-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/08/2019] [Indexed: 12/16/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare disease of unknown etiology that progresses to right ventricular failure. It has a complex pathophysiology, which involves an imbalance between vasoconstrictive and vasodilative processes in the pulmonary circulation, pulmonary vasoconstriction, vascular and right ventricular remodeling, systemic inflammation, and autonomic imbalance, with a reduced parasympathetic and increased sympathetic tone. Current pharmacological treatments for PAH include several classes of drugs that target signaling pathways in vascular biology and cardiovascular physiology, but they can have severe unwanted effects and they do not typically stop the progression of the disease. Pulmonary artery denervation has been tested clinically as a method to suppress sympathetic overactivation, however it is a nonspecific and irreversible intervention. Bioelectronic medicine, in particular vagus nerve stimulation (VNS), has been used in cardiovascular disorders like arrhythmias, heart failure and arterial hypertension and could, in principle, be tested as a treatment in PAH. VNS can produce pulmonary vasodilation and renormalize right ventricular function, via activation of pulmonary and cardiac vagal fibers. It can suppress systemic inflammation, via activation of fibers that innervate the spleen. Finally, VNS can gradually restore the balance between parasympathetic and sympathetic tone by regulating autonomic reflexes. Preclinical studies support the feasibility of using VNS in PAH. However, there are challenges with such an approach, arising from the need to affect a relatively small number of relevant vagal fibers, and the potential for unwanted cardiac and noncardiac effects of VNS in this sensitive patient population.
Collapse
Affiliation(s)
- Despοina Ntiloudi
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030 USA.,2Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Khaled Qanud
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030 USA
| | - Jacquelyn-Nicole Tomaio
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030 USA
| | | | - Yousef Al-Abed
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030 USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY 11030 USA
| |
Collapse
|
48
|
Abstract
Neuromodulation, the focused delivery of energy to neural tissue to affect neural or physiological processes, is a common method to study the physiology of the nervous system. It is also successfully used as treatment for disorders in which the nervous system is affected or implicated. Typically, neurostimulation is delivered in open-loop mode (i.e., according to a predetermined schedule and independently of the state of the organ or physiological system whose function is sought to be modulated). However, the physiology of the nervous system or the modulated organ can be dynamic, and the same stimulus may have different effects depending on the underlying state. As a result, open-loop stimulation may fail to restore the desired function or cause side effects. In such cases, a neuromodulation intervention may be preferable to be administered in closed-loop mode. In a closed-loop neuromodulation (CLN) system, stimulation is delivered when certain physiological states or conditions are met (responsive neurostimulation); the stimulation parameters can also be adjusted dynamically to optimize the effect of stimulation in real time (adaptive neurostimulation). In this review, the reasons and the conditions for using CLN are discussed, the basic components of a CLN system are described, and examples of CLN systems used in physiological and translational research are presented.
Collapse
Affiliation(s)
- Stavros Zanos
- Translational Neurophysiology Laboratory, Center for Bioelectronic Medicine, Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York 11030
| |
Collapse
|
49
|
Levy TJ, Ahmed U, Tsaava T, Chang YC, Lorraine PJ, Tomaio JN, Cracchiolo M, Lopez M, Rieth L, Tracey KJ, Zanos S, Zanos TP. An impedance matching algorithm for common-mode interference removal in vagus nerve recordings. J Neurosci Methods 2019; 330:108467. [PMID: 31654663 DOI: 10.1016/j.jneumeth.2019.108467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/06/2019] [Accepted: 10/17/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The peripheral nervous system is involved in a multitude of physiological functions. Recording neural signals provides information that can be used by diagnostic bioelectronic medicine devices, closed-loop neuromodulation therapies and other neuroprosthetic applications. The ability to accurately record these signals is challenging, due to the presence of various biological and instrument-related interference sources. NEW METHOD We developed a common-mode interference rejection algorithm based on an impedance matching approach for bipolar cuff electrodes. Two unipolar channels were recorded from the two electrode contacts of a bipolar cuff. The impedance mismatch was estimated and used to correct one of the two channels. RESULTS When applied to electrocardiographic (ECG) artifacts collected from three mice using CorTec electrodes, the algorithm reduced the interference to noise ratio (INR) over simple subtraction by 12 dB on average. The algorithm also reduced the INR of stimulation artifacts in recordings from three rats collected using flexible electrodes by an additional 2.4 dB. In the same experiments evoked electromyographic (EMG) interference was suppressed by 1.3 dB. COMPARISON WITH EXISTING METHODS Simple subtraction is the common approach for reducing common-mode interference in bipolar recordings, however impedance mismatches that exist or emerge compromise its efficiency. CONCLUSIONS The algorithm significantly reduced the common-mode interference from ECG artifacts, stimulation artifacts, and evoked EMG interference, while retaining neural signals, in two animal models and two recording setups. This approach can be used in a variety of different neurophysiological setups to remove common-mode interference from a variety of sources.
Collapse
Affiliation(s)
- Todd J Levy
- Institute of Bioelectronic Medicine, Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA.
| | - Umair Ahmed
- Institute of Bioelectronic Medicine, Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA
| | - Tea Tsaava
- Institute of Bioelectronic Medicine, Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA
| | - Yao-Chuan Chang
- Institute of Bioelectronic Medicine, Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA
| | | | - Jacquelyn N Tomaio
- Institute of Bioelectronic Medicine, Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA
| | - Marina Cracchiolo
- Institute of Bioelectronic Medicine, Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA; The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, PI, 56127, Italy
| | - Maria Lopez
- Institute of Bioelectronic Medicine, Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA
| | - Loren Rieth
- Institute of Bioelectronic Medicine, Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA
| | - Stavros Zanos
- Institute of Bioelectronic Medicine, Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA
| | - Theodoros P Zanos
- Institute of Bioelectronic Medicine, Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA; Zucker School of Medicine at Hofstra/Northwell, Heampstead, NY, 11549, USA.
| |
Collapse
|
50
|
Tavildar S, Mogen B, Zanos S, Seeman S, Perlmutter S, Fetz E, Ashrafi A. Inferring Cortical Connectivity from ECoG Signals Using Graph Signal Processing. IEEE Access 2019; 7:109349-109362. [PMID: 36883134 PMCID: PMC9988241 DOI: 10.1109/access.2019.2934490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
A novel method to characterize connectivity between sites in the cerebral cortex of primates is proposed in this paper. Connectivity graphs for two macaque monkeys are inferred from Electrocorticographic (ECoG) activity recorded while the animals were alert. The locations of ECoG electrodes are considered as nodes of the graph, the coefficients of the auto-regressive (AR) representation of the signals measured at each node are considered as the signal on the graph and the connectivity strengths between the nodes are considered as the edges of the graph. Maximization of the graph smoothness defined from the Laplacian quadratic form is used to infer the connectivity map (adjacency matrix of the graph). The cortical evoked potential (CEP) map was obtained by stimulating different electrodes and recording the evoked potentials at the other electrodes. The maps obtained by the graph inference and the traditional method of spectral coherence are compared with the CEP map. The results show that the proposed method provides a description of cortical connectivity that is more similar to the stimulation-based measures than spectral coherence. The results are also tested by the surrogate map analysis in which the CEP map is randomly permuted and the distribution of the errors is obtained. It is shown that error between the two maps is comfortably outside the surrogate map error distribution. This indicates that the similarity between the map calculated by the graph inference and the CEP map is statistically significant.
Collapse
Affiliation(s)
- Siddhi Tavildar
- Computational Science Research Center, San Diego State University, San Diego CA, USA
- Center for Neurotechnology, Seattle WA, USA
| | - Brian Mogen
- Center for Neurotechnology, Seattle WA, USA
- Department of Bioengineering, Univ of Washington, Seattle WA, USA
| | - Stavros Zanos
- Center for Neurotechnology, Seattle WA, USA
- WA National Primate Research Center, Univ of Washington, Seattle WA, USA
- Center for Bioelectronic Medicine, Feinstein Institute for Medical Research, Manhasset NY, USA
| | - Stephanie Seeman
- Center for Neurotechnology, Seattle WA, USA
- Dept. Physiology & Biophysics, University of Washington, Seattle WA, USA
| | - Steve Perlmutter
- Center for Neurotechnology, Seattle WA, USA
- WA National Primate Research Center, Univ of Washington, Seattle WA, USA
- Dept. Physiology & Biophysics, University of Washington, Seattle WA, USA
| | - Eberhard Fetz
- Center for Neurotechnology, Seattle WA, USA
- WA National Primate Research Center, Univ of Washington, Seattle WA, USA
- Dept. Physiology & Biophysics, University of Washington, Seattle WA, USA
| | - Ashkan Ashrafi
- Computational Science Research Center, San Diego State University, San Diego CA, USA
- Center for Neurotechnology, Seattle WA, USA
- Department of Electrical and Computer Engineering, San Diego State University, San Diego CA, USA
| |
Collapse
|