The miniaturization of implantable sensors and actuators, combined with advances in interactive modelling and high-resolution imaging, is propelling the use of medical devices for counteracting impaired neural control of the cardiovascular system. In a review article just published in, DPAG’s David Paterson, Neil Herring and international co-authors, discuss the current effectiveness of this technology for modulating autonomic activity in numerous cardiovascular conditions, including high blood pressure, heart failure and cardiac arrhythmias.
The authors advocate for smarter closed-loop bionic devices fitted with feedback from multiple sensors to allow adaptive, state-dependent control, and discuss how the adoption of artificial intelligence technology would facilitate auto-personalization to meet the needs of patients. They also describe how transcriptomics of autonomic circuits can guide device-based approaches. Finally, the use of stem cell therapies to target sympathetic circuits more precisely will help to optimize the therapeutic effects of autonomic modulation for the treatment of arrhythmia. For bioelectronic medicine to achieve clinical utility in neurocardiology, these innovations must demonstrate improved efficacy beyond that offered by contemporary interventions.
Key Points are:
Emerging evidence suggests that bioelectronic strategies that
involve the site-specific targeting of the autonomic circuit could be
used to treat cardiovascular diseases, including arrhythmia, heart
failure and neurogenic hypertension.
Advances in implantable sensor technology and device
miniaturization, together with the design of closed-loop bioelectronics
linked to multi-feedback sensors, should contribute to the development
of therapies to modulate autonomic nervous system activity.
Combining artificial intelligence and machine learning technologies
with novel neuroceutical devices could result in optimized and
personalized parameter set points that respond to physiological
feedback within a closed-loop system, thereby enabling dynamic
state-dependent adjustment.
Advances in Bluetooth technology might facilitate real-time device
readout, effectiveness and feedback dosing of neuroceutical devices.
The use of transcriptomics to understand whether visceral reflex
pathways are associated with distinct phenotypes might enable highly
selective functional neuromodulation in device-based medicine.
The autografting of novel biomaterials into the autonomic nervous
system or to the end organ, such as the heart, to alter excitability with
closed-loop bioelectronics is promising for the treatment of arrhythmias.