Northwell Health - Feinstein Institute for Medical Research

A NEURAL CIRCUIT MAPPED BY KEVIN J. TRACEY, MD, PRESIDENT AND CEO OF THE FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH, MAY BE THE KEY TO EFFECTIVE TREATMENT FOR RHEUMATOID ARTHRITIS (RA). Despite the fact that RA affects 1.3 million adults in the United States and costs billions of dollars in annual medical expenses, no existing therapeutic agent universally relieves the joint pain and inflammation that characterize the chronic, often disabling disease. Some treatments target tumor necrosis factor (TNF), a molecule that causes inflammation, and bring relief to many RA patients, but the treatment is ineffective for at least half of those who suffer from the disease. Based on initial studies that showed inhibited TNF production following electrical stimulation of the vagus nerve, Dr. Tracey and a team comprised of investigators from the Feinstein Institute, the Academic Medical Center at the University of Amsterdam, and SetPoint Medical assessed the mechanism as a potential approach to treatment for human subjects with RA. Dr. Tracey and his coauthors published their results in 2016 in the Proceedings of the National Academy of Sciences. Learning from Epilepsy Vagus nerve stimulators have been used to treat epilepsy that cannot be treated with medications for decades with no noted association with immunosuppression — when a pharmaceutical agent reduces the immune response — or long-term complications. Dr. Tracey and the team of researchers studied a group of seven patients with epilepsy who were already being treated with vagus nerve stimulation to identify whether the findings of the animal studies translated to human subjects. Their findings led to a potentially game-changing breakthrough in the treatment of RA. Alleviating Pain Researchers then surgically implanted vagus nerve stimulators in 17 patients and optimized the degree of stimulation to account for each person's tolerance for the therapy. A small amount of electrical current was delivered to the vagus nerve for 60 seconds, four times per day. After 42 days, TNF production decreased significantly, which led to improvement in RA symptoms, including the number of tender and swollen joints, patients' assessments of pain, physicians' evaluations of patients, and C-reactive protein levels. TNF production was further inhibited and symptom severity was further reduced after 84 days. Researchers reported that several patients whose disease had not responded to other therapies reported significant improvements. Expanding Views The researchers believe the study's results encourage further investigation into vagus nerve stimulation as a therapeutic device for RA, and they also demonstrate the efficacy of bioelectronic medicine as a viable approach to treating conditions such as Crohn's disease, diabetes, hemorrhage, hypertension and paralysis. BIOELECTRONIC THERAPY for Rheumatoid Arthritis For more information about bioelectronic medicine, visit FeinsteinInstitute.org/Programs-Researchers/ Bioelectronic-Medicine. 4 / Fall 2016 Innovation

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