‘Electroceuticals’ could be the answer to treating diabetes

Earlier this month, a panel of experts recommended that the US Food and Drug Administration approve electroceuticals for use in treating obesity.

A radical new approach to treating a host of common diseases could soon benefit diabetics in the UAE.

In the search for potential miracle cures, electricity may seem an unlikely candidate. The mere mention of it conjures up images of psychiatric patients being “shocked” with electrodes on their skulls.

But now a raft of exciting results – and a hefty influx of money – look set to spark a revolution in the use of electricity to treat ailments.

It centres on the emergence of what are being called – somewhat misleadingly – “electroceuticals”.

You don’t swallow them, or take them intravenously, but instead have them implanted where they can monitor nerve impulses, detect problems – and then deliver jolts of electricity to affected organs to make them work properly.

Last week the US National Institutes of Health unveiled a quarter-billion dollar project to speed the development of electroceuticals.

Meanwhile, pharmaceutical giant GlaxoSmithKline (GSK) is offering a US$1 million prize for research into the technology, which could bring new hope in the fight against diseases ranging from diabetes and rheumatoid arthritis to cancer.

In retrospect, perhaps the biggest shock is that it has taken everyone so long to wake up to the idea behind electroceuticals.

It’s been known for centuries that living organisms are made from cells that respond to electrical impulses.

In 1780, the Italian physician Luigi Galvani famously discovered that a small electric voltage applied to the muscles of a frog’s legs make them twitch – even after the frog was dead.

We’re also familiar with the idea of our thoughts and memories being the product of electricity flowing between neurons in our brain.

Less well-known is the fact that the functioning of virtually every organ depends on electrical impulses known as “action potentials”. These spikes of voltage flow to and from organs across a network of nerves of astonishing complexity.

Our bodies are, in essence, collections of electrically-powered gadgets. But while the likes of smartphones rely on the flow of negatively-charged electrons, organisms exploit the flow of positively-charged fragments of atoms known as ions.

If this flow of ions goes wrong or stops altogether, the result can be anything from a flutter of the heart to chronic illness and even death.

Until now, attempts to exploit the link between electricity and organs have been pretty crude. For example, sizeable battery-powered pacemakers simply supply milliamps of electricity to a vast number of heart muscle cells.

But now researchers are taking a more subtle approach – and uncovering new ways of tackling more subtle disorders.

The excitement stems partly from the fact that – unlike drugs – implants can be very precisely targeted, with the impulses being applied just to miscreant cells, rather than the whole body. This should reduce the risk of side-effects.

It also comes from some early successes using this technique. EnteroMedics, based in Minnesota, recently published the results of a study in which over 100 obese patients were fitted with an electroceutical implant that stimulates the vagus nerve, which affects both hunger and satiety – the feeling of fullness that comes after a large meal.

The study found that over half lost at least 20 per cent of their excess weight – double the success rate achieved by patients in a comparison group. Blood pressure and heart rate also improved.

Earlier this month, a panel of experts recommended that the US Food and Drug Administration approve this electroceutical for use in treating obesity.

The vagus nerve and the so-called splenic nerve are also the focus of electroceutical therapy for rheumatoid arthritis, an autoimmune disease in which the body’s own defences turn against itself.

Exactly why and how these nerves affects the immune system isn’t clear, but early research has found that an implant can produce a dramatic reduction in symptoms.

At GSK, Dr Kristoffer Famm leads a team trying to identify electroceutical approaches to other diseases – including diabetes.

Caused by the failure of the pancreas to release the right level of insulin in response to blood sugar, so-called Type 2 diabetes affects almost one in five Emiratis. While it can be managed through a strict diet and exercise regime, a cure has never been found.

Now Dr Famm and his team believe a tiny implant could provide a permanent remedy. The idea is to develop a tiny implant that can detect the nerve signals calling for insulin to be released, and then generate their own signals ordering the pancreas to respond.

In a recent review paper for Nature, Dr Famm said the immediate challenge is to understand the circuitry of the body, to reveal the precise links between nerves and organs.

That’s unlikely to be easy. It’s already known that multiple nerves are involved in bladder function, while the vagus nerve has multiple functions.

According to Dr Famm, the other key challenge lies in bringing together teams with the right skill-sets to make the most of the emerging discoveries.

Clinicians will need to work with neuroscientists to map the circuitry and understand which impulses are linked to which disorders.

Then materials scientists and electronic engineers will have to create tiny devices capable of being left in the body for years without creating problems of their own.

To kick-start the process, GSK have set up a $50m subsidiary – Action Potential Venture Capital – to invest in start-ups in the field. It is also offering its prize of $1m to the first team to create a miniaturised, implantable wireless device that logs, stimulates and blocks electrical impulses to and from an organ over 60 days.

Researchers are already making serious progress. Work is currently underway on 20 electroceuticals for a range of disorders, and the first ones are starting to emerge.

Earlier this year the US Food and Drug Administration approved an electroceutical for treating sleep apnoea using an implant that delivers impulses to muscles to maintain steady breathing during sleep.

It could be the first step in a new direction for medicine whose impact on human health will prove – literally – electrifying.

Robert Matthews is visiting reader in science at Aston University, Birmingham