Next generation bioelectronic medicine: making the case for non-invasive closed-loop autonomic neuromodulation
Abstract The field of bioelectronic medicine has advanced rapidly from rudimentary electrical therapies to cutting-edge closed-loop systems that integrate real-time physiological monitoring with adaptive neuromodulation. Early innovations, such as cardiac pacemakers and deep brain stimulation, paved...
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BMC
2025-01-01
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| Series: | Bioelectronic Medicine |
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| Online Access: | https://doi.org/10.1186/s42234-024-00163-4 |
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| author | Imanuel Lerman Yifeng Bu Rahul Singh Harold A. Silverman Anuj Bhardwaj Alex J. Mann Alik Widge Joseph Palin Christopher Puleo Hubert Lim |
| author_facet | Imanuel Lerman Yifeng Bu Rahul Singh Harold A. Silverman Anuj Bhardwaj Alex J. Mann Alik Widge Joseph Palin Christopher Puleo Hubert Lim |
| author_sort | Imanuel Lerman |
| collection | DOAJ |
| description | Abstract The field of bioelectronic medicine has advanced rapidly from rudimentary electrical therapies to cutting-edge closed-loop systems that integrate real-time physiological monitoring with adaptive neuromodulation. Early innovations, such as cardiac pacemakers and deep brain stimulation, paved the way for these sophisticated technologies. This review traces the historical and technological progression of bioelectronic medicine, culminating in the emerging potential of closed-loop devices for multiple disorders of the brain and body. We emphasize both invasive techniques, such as implantable devices for brain, spinal cord and autonomic regulation, while we introduce new prospects for non-invasive neuromodulation, including focused ultrasound and newly developed autonomic neurography enabling precise detection and titration of inflammatory immune responses. The case for closed-loop non-invasive autonomic neuromodulation (incorporating autonomic neurography and splenic focused ultrasound stimulation) is presented through its applications in conditions such as sepsis and chronic inflammation, illustrating its capacity to revolutionize personalized healthcare. Today, invasive or non-invasive closed-loop systems have yet to be developed that dynamically modulate autonomic nervous system function by responding to real-time physiological and molecular signals; it represents a transformative approach to therapeutic interventions and major opportunity by which the bioelectronic field may advance. Knowledge gaps remain and likely contribute to the lack of available closed loop autonomic neuromodulation systems, namely, (1) significant exogenous and endogenous noise that must be filtered out, (2) potential drift in the signal due to temporal change in disease severity and/or therapy induced neuroplasticity, and (3) confounding effects of exogenous therapies (e.g., concurrent medications that dysregulate autonomic nervous system functions). Leveraging continuous feedback and real-time adjustments may overcome many of these barriers, and these next generation systems have the potential to stand at the forefront of precision medicine, offering new avenues for individualized and adaptive treatment. |
| format | Article |
| id | doaj-art-38fdd04fb42f4cbfa988b0bc43386b51 |
| institution | Kabale University |
| issn | 2332-8886 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Bioelectronic Medicine |
| spelling | doaj-art-38fdd04fb42f4cbfa988b0bc43386b512025-01-26T12:45:03ZengBMCBioelectronic Medicine2332-88862025-01-0111111810.1186/s42234-024-00163-4Next generation bioelectronic medicine: making the case for non-invasive closed-loop autonomic neuromodulationImanuel Lerman0Yifeng Bu1Rahul Singh2Harold A. Silverman3Anuj Bhardwaj4Alex J. Mann5Alik Widge6Joseph Palin7Christopher Puleo8Hubert Lim9Department of Electrical and Computer Engineering, University of California San DiegoInflammaSense Incorporated Head QuartersInflammaSense Incorporated Head QuartersWolf Greenfield Biotechnology Practice GroupSecondWave Systems Incorporated, Head QuartershVIVO Limited, Head QuartersDepartment of Psychiatry & Behavioral Sciences, University of MinnesotaConvergent Research Inc, Head QuartersDepartment of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic InstituteSecondWave Systems Incorporated, Head QuartersAbstract The field of bioelectronic medicine has advanced rapidly from rudimentary electrical therapies to cutting-edge closed-loop systems that integrate real-time physiological monitoring with adaptive neuromodulation. Early innovations, such as cardiac pacemakers and deep brain stimulation, paved the way for these sophisticated technologies. This review traces the historical and technological progression of bioelectronic medicine, culminating in the emerging potential of closed-loop devices for multiple disorders of the brain and body. We emphasize both invasive techniques, such as implantable devices for brain, spinal cord and autonomic regulation, while we introduce new prospects for non-invasive neuromodulation, including focused ultrasound and newly developed autonomic neurography enabling precise detection and titration of inflammatory immune responses. The case for closed-loop non-invasive autonomic neuromodulation (incorporating autonomic neurography and splenic focused ultrasound stimulation) is presented through its applications in conditions such as sepsis and chronic inflammation, illustrating its capacity to revolutionize personalized healthcare. Today, invasive or non-invasive closed-loop systems have yet to be developed that dynamically modulate autonomic nervous system function by responding to real-time physiological and molecular signals; it represents a transformative approach to therapeutic interventions and major opportunity by which the bioelectronic field may advance. Knowledge gaps remain and likely contribute to the lack of available closed loop autonomic neuromodulation systems, namely, (1) significant exogenous and endogenous noise that must be filtered out, (2) potential drift in the signal due to temporal change in disease severity and/or therapy induced neuroplasticity, and (3) confounding effects of exogenous therapies (e.g., concurrent medications that dysregulate autonomic nervous system functions). Leveraging continuous feedback and real-time adjustments may overcome many of these barriers, and these next generation systems have the potential to stand at the forefront of precision medicine, offering new avenues for individualized and adaptive treatment.https://doi.org/10.1186/s42234-024-00163-4Closed loop bioelectronic medicineNeuromodulationBioelectronic medicineFocused ultrasound stimulationAutonomic neurographyNeurography |
| spellingShingle | Imanuel Lerman Yifeng Bu Rahul Singh Harold A. Silverman Anuj Bhardwaj Alex J. Mann Alik Widge Joseph Palin Christopher Puleo Hubert Lim Next generation bioelectronic medicine: making the case for non-invasive closed-loop autonomic neuromodulation Bioelectronic Medicine Closed loop bioelectronic medicine Neuromodulation Bioelectronic medicine Focused ultrasound stimulation Autonomic neurography Neurography |
| title | Next generation bioelectronic medicine: making the case for non-invasive closed-loop autonomic neuromodulation |
| title_full | Next generation bioelectronic medicine: making the case for non-invasive closed-loop autonomic neuromodulation |
| title_fullStr | Next generation bioelectronic medicine: making the case for non-invasive closed-loop autonomic neuromodulation |
| title_full_unstemmed | Next generation bioelectronic medicine: making the case for non-invasive closed-loop autonomic neuromodulation |
| title_short | Next generation bioelectronic medicine: making the case for non-invasive closed-loop autonomic neuromodulation |
| title_sort | next generation bioelectronic medicine making the case for non invasive closed loop autonomic neuromodulation |
| topic | Closed loop bioelectronic medicine Neuromodulation Bioelectronic medicine Focused ultrasound stimulation Autonomic neurography Neurography |
| url | https://doi.org/10.1186/s42234-024-00163-4 |
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