Bioelectronic Medicine May Open New Therapeutic Avenues for PAH, Review Says

Bioelectronic medicine is a promising new therapeutic approach to treat pulmonary arterial hypertension (PAH), according to a recent review study.

The review, “Pulmonary arterial hypertension: the case for a bioelectronic treatment,” was published in the journal Bioelectronic Medicine.

Current treatments for PAH include medications that interfere with different signaling cascades in order to lower blood pressure by inducing the widening and relaxation of blood vessels.

Despite treatment advancements in recent years, some of these medications can cause undesirable side effects, including low blood pressure, heart complications, headache, muscle pain, indigestion, nausea, and other gastrointestinal problems. None of these therapies cures PAH or prevents the disease from progressing over time.

Bioelectronic medicine is an emerging field based on the idea of using special devices to control the electrical activity of the body’s nervous system, with the goal of diagnosing and treating certain disorders and injuries.

“Targeting nerves with electrical stimulation to treat diseases has two major advantages over pharmaceutical therapies. First is specificity with regards to the targeted organ system, … [and] second is specificity with regards to time: the timing of delivery of neurostimulation can be tightly controlled,” the researchers wrote.

According to the team, a particular type of bioelectronic-based therapy called vagus nerve stimulation (VNS) seems to hold promise for the treatment of PAH.

The vagus nerve is a major nerve that is part of the autonomic nervous system — the non-conscious part of the nervous system that controls several body functions — and is known to control the contraction and relaxation of the heart. For that reason, VNS has been used in the past to treat different types of heart disorders, including arrhythmias, heart failure, and high blood pressure.

VNS may be useful to treat people with PAH because it helps normalize heart function, promotes the widening of blood vessels in the lungs, suppresses inflammation, and restores the balance between the sympathetic and parasympathetic nervous system.

Of note, the sympathetic and parasympathetic nervous system are the two divisions of the autonomic nervous system; the sympathetic system prepares the body for physical and mental activity, while the parasympathetic system is responsible for bodily functions while at rest.

“VNS has proven, positive effects on suppressing inflammation and restoring homeostatic autonomic balance within the body,” Stavros Zanos, MD, PhD, assistant professor at the Feinstein Institutes for Medical Research and corresponding author of the study, said in a press release.

“There is a need to explore bioelectronic medicine as a way to normalize the function of the heart and the pulmonary vessels to provide treatment alternatives for PAH and help thousands of patients with this disease,” he added.

Preliminary studies in animal models of PAH support the potential therapeutic effects of VNS in PAH. However, further studies are needed to determine “the therapeutic potential of such an approach,” the researchers wrote.