Electroceuticals, hailed as the next frontier in medicine, is garnering considerable interest from medical researchers and entrepreneurs on the lookout for the next class of therapies
Since time immemorial, the idea of a miracle cure to rid all the ailments afflicting the human body have held tremendous fascination for scientists, medical researchers, alternative medicine practitioners and even faith healers. Could it be that the panacea the world’s looking for is nothing but electricity? The concept might not have had too many takers a few decades earlier, but today ‘electroceuticals’ a term used to describe miniature devices which can alter electrical signals diffused by nerves throughout the body to treat a wide range of illnesses, is being touted as the next great frontier in medicine.
Also known as bioelectric medicine, it is has generated considerable interest globally among medical researchers and entrepreneurs. Leading medical device manufacturers like Medtronics, Boston Scientific Corporation, Cochlear and even pharma majors like GlaxoSmithKline (GSK) are making significant investments for research in this arena. Even organisations like the Defense Advanced Research Projects Agency (DARPA) and National Institutes of Health (NIH) in the US have shown immense interest in the field of electroceuticals.
DARPA, an agency of the US Department of Defense in charge of the development of emerging technologies for military use, has initiated a $79 million project called Electrical Prescriptions (ElectRx), in this field. NIH’s Stimulating Peripheral Activity to Relieve Conditions (SPARC) programme is another initiative that seeks to expand our current knowledge of nerve-organ interactions and propel progress in the field of neuromodulation. In October 2016, NIH also announced $20 million in funding for the field. The endeavour’s goal is to understand more about the body’s electrical circuit – the peripheral nervous system.
Catalysts of change
A MarketsandMarkets report predicts that the global electroceuticals/ bioelectric medicine market will reach $25.20 billion by 2021 from $17.20 billion in 2016, growing at a CAGR of 7.9 per cent from 2016 to 2021.
The reports also reveal that North America would be the leader in bioelectric medicine market because of the presence of several bioelectric medicine organisations in the region. Yet, the highest percentage of growth would be registered in the Asia-Pacific region due to rising healthcare demands in the region.
A report on global bioelectric/ electroceuticals market by Transparency Market Research highlights the factors which would drive growth and states, “Growing global geriatric population, rising cost pressures of drug based medicines, growing interest from major pharma players in the electroceuticals segment, and increasing incidence and prevalence of neurological disorders and chronic diseases across the world are some of the factors likely to boost the growth of the global electroceuticals market during the forecast period.”
A McKinsey report, ‘Aging with tech support – the promise of new technologies for longer and healthier lives’ outlines a few advantages which would aid growth in this emerging sphere. It states, “First, and most important, it holds out the promise of treating conditions that today’s drugs and medical procedures are unable to address, such as severe spinal-cord injuries and blindness. Second, miniaturised electric stimulators have the potential to deliver true precision medicine. Almost all drugs have a degree of systemic effect, but the precise targeting permitted by bioelectronics could limit the number and extent of side effects. Additionally, electrical dosing is much easier to adjust as a treatment’s effects on a patient become clear. An electrical current can be increased or reduced far more easily than a drug concentration, and unlike surgical procedures, the effects are reversible: the current can be switched off.” Thus, electroceuticals hold the potential to treat diseases and conditions where conventional therapies fall short.
The McKinsey report also claims, “As this therapeutic approach is applied more widely, the lines between medical technology and pharmaceuticals will continue to blur.” The belief that electroceuticals would be the gold standard of treatment in the times to come is also spurring progress in this arena. Here are a few instances:
GSK: Gung ho on growth
A very important case in point would be GSK, one of the leading proponents of electroceuticals or bioelectric medicine. Since 2012, it has announced various initiatives to catalyse research in this field and to unite researchers from these different disciplines including:
In another crucial move, the company has also tied up with Verily Life Sciences, Google’s sister concern, to form a joint venture called Galvani Bioelectronics with an investment of up to £540 million over seven years, to develop and commercialise bioelectronic medicine.
Kris Famm, President, Galvani Bioelectronics (former Vice President of Bioelectronics R&D at GSK) informs, “Bioelectronic medicines represent a whole new frontier in the treatment of disease, potentially allowing us to treat a broad range of chronic disorders with greater precision and fewer side effects than with conventional medicines.”
Galvani Bioelectronics will be dedicated to the research, development and commercialisation of these medicines. By combining the worlds of health and tech – fusing GSK’s drug discovery and development expertise and deep understanding of disease biology with Verily’s technical expertise in the miniaturisation of low-power electronics, device development, data analytics and software development – we believe Galvani has the potential to rapidly accelerate the development of these treatments for patients,” Famm informs.
Medtronic: Paving the path
Medtronic, a leading medical device manufacturer, is also investing in electronic implantables that work with the nervous system. A company spokesperson gives a few examples:
E.g. 1: In 2009, Medtronic began working to produce a pacemaker one-tenth the size of its standard models. The result was a breakthrough innovation – Leadless pacemakers. Unlike a standard pacemaker, Med-tronic’s leadless pacemaker in its small, capsulised form allows it to be implanted using a catheter through a vein in the leg, similar to how a stent is inserted. This makes the procedure much simpler, faster and leaves no scars of the surgery besides eliminating all lead (wires in traditional pacemakers) related complications that can impact patient outcomes behind, adding to the cosmetic value of the procedure.
E.g. 2: Medtronic’s belief in meaningful innovations for positive patient outcomes led to the invention of Deep Brain Stimulation Therapy (DBS). DBS helps control movement symptoms when medications aren’t working as well as they used to. For many people with Parkinson’s, DBS makes a difference when even small tasks have become challenging and helps people stay as independent as possible and keep doing the activities they love.
E.g. 3: Having an overactive bladder prevents patients from controlling when and how much a patient urinates. He/ she may experience unexpected small or large leaks, or use the bathroom very frequently. Medtronic Bladder Control Therapy modulates the sacral nerves with mild electrical pulses. This helps the brain and the nerves to communicate so the bladder and related muscles can function properly. Medtronic Bladder Control Therapy may help the patient resume normal activities and help them avoid frustrating or embarrassing experiences associated with overactive bladder.
The spokesperson also speaks on Medtronic’s commitment in encouraging innovation and says, “Medtronic has been at the forefront of innovation and we have evolved our products through continuous technological innovation in all aspects of their design, materials and delivery mechanism in the areas of heart, brain, spine, urinary and gastrointestinal tract. Over the years we have through innovation in our technologies built products that meet the needs of patients and caregivers as well as the needs of physicians with simpler and quicker procedures. Medtronic globally invests more than $1.6 billion in R&D every year and owns more than 53,000 patents across the therapy areas.”
GE: Partnering for progress
In a very recent undertaking, GE Ventures and Northwell Health’s Feinstein Institute for Medical Research (FIMR) have entered into a partnership to develop bioelectronic devices to treat nervous system-mediated acute and chronic diseases. Under the collaboration, the partners would provide up to $200 million in joint funding over seven years to set up a new Center for Bioelectronic Medicine (CBEM). Reportedly, the new partnership will build on the work between Feinstein Institute and a team of GE scientists specialising in bioelectronics research at GE’s Global Research Center in Niskayuna, NY. The alliance will be headquartered at the Feinstein Institute in Manhasset, NY.
Thus, the world is witnessing a wave of such technologies.
Electroceuticals vs pharmaceuticals
However, the rise of electroceuticals has given birth to many crucial questions. Can they become the mainstay of treatment in the times to come? Can they replace drug-based therapies? What would the future hold for pharma companies?
These questions become more relevant in the backdrop that the US FDA has already granted approvals to some electroceuticals. Today, they are being used as alternatives to medicines to treat certain conditions. For instance, Inspire Medical Systems’ treatment of sleep apnea by the implantation of a device that stimulates the airway muscles. A second example is a device to treat morbid obesity from EnteroMedics Inc (ETRM). This device stimulates the vagus nerve to make a person feel full. (Check Table 2 for more examples)
GSK, a pharma company is definitely moving towards becoming a leader in this emerging field. As Famm puts it, “Huge advances in low-power electronics and the nanotechnology space have paved the way for the creation of gamechanging miniaturised devices, which we believe will enable the development of precision bioelectronic medicines. We believe the knowledge and IP we’ve built up over the past three years places GSK at the forefront of the bioelectronics field.”
Incidentally, other major pharma players like Pfizer, Novartis, haven’t been as enthused about this field or rather have not clarified their positions on electroceuticals. The investments in this arena have not been made public. On the contrary, a larger number of medical device players have been more vocal about their stance about electroceuticals.
Nevertheless, there is a growing number of those who believe that drug-based treatments are on their way out and it will be replaced by bioelectric medicine. However, it is more likely that a combination of both electroceuticals and pharmaceuticals will prove to be not only more effective but also reinvent healthcare delivery as we know it today.
Vanquishing the challenges
The potential of this field is immense but then so are the challenges. As the McKinsey report explains, “A much more detailed understanding of the anatomy and function of neural circuits is needed to target treatments precisely in what can be viewed as the neural equivalent of gene therapy.” It further highlights that we are still a long way from fully understanding extremely complex pathways, given that there are upto 100 billion neurons in the brain.
Another big challenge is making the devices really small and enabling them to work on as little power as possible. Likewise, there is also a need to encourage more innovation to help electroceuticals and bioelectronics reach their full potential. Scepticism about the field and its potential is also rampant. While there are many supporters, the number of naysayers are also huge. This too is a deterrent to progress.
Fortunately, some measure of success in establishing proof of concept and enhancing quality of life have helped galvanise progress in this promising new field. It is to be hoped that in times to come, further research will help us gain more understanding about this vast field to usher in a new era of medicine to provide sweeping therapeutic advantages to deliver significant clinical impact.