Research on electrical nerve-block implant aims at treating asthma and heart failure

Biomedical engineering researchers at Case Western Reserve University are refining more than 15 years of work on an electrical nerve-block implant, focusing their next step on new applications related to treating asthma and heart failure.

The research by Niloy Bhadra, MD, PhD, an assistant research professor of Biomedical Engineering, Kevin Kilgore, PhD, a professor of Orthopaedic Surgery and three other Case Western Reserve investigators was bolstered this summer by a four-year, $2 million National Institutes of Health grant.

The new research, aimed at blocking unwanted generation of nerve impulses in many clinical applications, will be conducted at The MetroHealth System, where Bhadra is on the bioscientific staff. The study will be done in collaboration with teams at UCLA and Johns Hopkins University.

Bhadra and Kilgore, also both researchers at the Cleveland FES (Functional Electrical Stimulation) Center, have been developing the nerve block since 2000. Their technology is in commercial use for pain management by Neuros Medical Inc., a Willoughby Hills company which this summer received a $20 million boost from five venture-capital partners.

FES refers to the use of small, artificially generated electrical currents selectively applied to the central or peripheral nervous system to replace the actions of neurons damaged by injury or disease.

The Case Western Reserve team will focus on "inducing a reliable, rapid, gradable and reversible nerve block" to the autonomic nervous system, which regulates the functions of internal organs. The electrical block is proposed as an alternative to surgery or drugs to "calm down" nerves or reduce pain.

The collaboration with researchers at UCLA will focus on an application that aims for nerve control after cardiac failure, which is now primarily addressed with drugs. Similarly, the Johns Hopkins researchers will team up with Case Western Reserve to use the nerve block to keep bronchial tissue from constricting in asthma patients.

To do all of that, researchers are developing a "combined waveform," referring to the application of both alternating current (AC) and direct current (DC) at different times and for different periods in the treatment. Until now, the technology has been hampered by a dual problem: AC electricity can cause initial pain and DC can cause nerve damage.

"DC is the headache, because if you do it wrong, there's not only pain, but you can damage the nerve," said Jesse Wainwright, PhD, a research professor of Chemical and Biomolecular Engineering at Case Western Reserve involved in the work.

"Historically, that's why people said DC is not safe," he said, "but we've developed a way to do it safely and accurately."

The advances made in this new research could also boost pain-management potential for the nerve-block technology--and that could play an important role in reducing an increasing societal reliance on medication, Wainright said.

"After knee or hip-replacement surgery, for example, patients now are sent home with some powerful drug packs," Wainwright said. "But our electrical nerve block could be implanted for a week or two to provide the same pain relief. That might eliminate the need for those drugs and possibly reduce the chance to become addicted to heavy narcotics."

Opioids are a broad category of drugs which include many legal painkillers as well as illegal drugs like heroin. Experts have said today's nationwide health crisis has roots in the increased availability and use of opioid painkillers in the 1990s.

Other investigators on the project are Narenda Bhadra (Niloy Bhadra's brother) and Tina Vrabec from Case Western Reserve; Jeffrey Ardell from the UCLA David Geffen School of Medicine; and Brendan Canning of Johns Hopkins University.

Case Western Reserve University is one of the country's leading private research institutions. Located in Cleveland, we offer a unique combination of forward-thinking educational opportunities in an inspiring cultural setting. Our leading-edge faculty engage in teaching and research in a collaborative, hands-on environment. Our nationally recognized programs include arts and sciences, dental medicine, engineering, law, management, medicine, nursing and social work. About 5,100 undergraduate and 6,200 graduate students comprise our student body. Visit case.edu to see how Case Western Reserve thinks beyond the possible.

The MetroHealth System is an essential health system committed to providing health care to everyone in Cuyahoga County, Ohio, and improving the health of the community overall. Its 7,400 employees deliver care to everyone at its main campus, just west of downtown Cleveland, and at more than 20 other MetroHealth locations. It also provides health care at more than 40 additional sites in Cuyahoga County through community partnerships such as the School Health Program.

MetroHealth is home to Cuyahoga County's most experienced Level I Adult Trauma Center, verified since 1992 by the Committee on Trauma of the American College of Surgeons, and one of two adult and pediatric burn centers in the state of Ohio verified by the American Burn Association. MetroHealth also is home to a verified Level II Pediatric Trauma Center.

In the past year, MetroHealth provided more than 1.3 million patient visits in its hospital and health centers. MetroHealth also is an academic medical center committed to teaching and research; each of its active physicians holds a faculty appointment at Case Western Reserve University School of Medicine. MetroHealth has earned Magnet status, which places it in the top six percent of all hospitals nationwide for nursing excellence.

MetroHealth's mission is, "Leading the way to a healthier you and a healthier community through service, teaching, discovery, and teamwork."