From Basic Research to Bioelectronic Medicine

Kevin Tracey
Kevin J. Tracey of the Feinstein Institute for Medical Research, the research branch of the North Shore-LIJ Health System, helped launch a new discipline called bioelectronic medicine. Credit: North Shore-LIJ Studios.

By showing that our immune and nervous systems are connected, Kevin J. Tracey Exit icon of the North Shore-LIJ Health System’s Feinstein Institute for Medical Research helped launch a new discipline called bioelectronic medicine. In this field, scientists explore how to use electricity to stimulate the body to produce its own disease-fighting molecules.

I spoke with Tracey about his research, the scientific process and where bioelectronic medicine is headed next.

How did you uncover the connection between our immune and nervous systems?

My lab was testing whether a chemical we developed called CNI-1493 could stop immune cells from producing inflammation-inducing molecules called TNFs in the brain of rats during a stroke. It does. But we were surprised to find that this chemical also affects neurons, or brain cells. The neurons sense the chemical and respond by sending an electrical signal along the vagus nerve, which runs from the brain to the internal organs. The vagus nerve then releases molecules that tell immune cells throughout the body to make less TNF. I’ve named this neural circuit the inflammatory reflex. Today, scientists in bioelectronic medicine are exploring ways to use tiny electrical devices to stimulate this reflex to treat diseases ranging from rheumatoid arthritis to cancer.

Why were you surprised by what you were finding?

Prior to this work, there was no direct evidence that the immune system could be controlled by neural reflexes. When we first noticed that delivering CNI-1493 to the brain somehow turned off TNF production, I realized that this connection must be really important. But even as a neurosurgeon who had thought about physiology and inflammation for 20 years, I couldn’t understand how it actually worked. Then, the idea that the immune and nervous systems might be connected through an inflammatory reflex struck me as such a simple concept that I began to wonder whether someone else had thought of it already.

Do scientific advances often seem obvious in hindsight?

The most important ones usually do. Many new findings seem so logical that you may ask: Why weren’t they revealed before? That’s because scientists must delineate molecular mechanisms, explain how these processes work at the cellular and atomic levels, and put the results into a meaningful context. If a researcher is fortunate, all this effort can produce insights that change how everyone thinks about a biological process from that time on.

What are you working on now?

We’re mapping the molecular mechanisms that allow signals to pass through the inflammatory reflex. The more we learn about how the reflex works, the more opportunities we’ll have to develop therapies directed at its individual components. We’re also identifying new reflexes that may one day be targets for bioelectronic medicine.

Has anyone already benefitted from bioelectronic medicine?

Yes. So far there’ve been two small clinical trials where people received vagus nerve stimulation to treat rheumatoid arthritis. I met the first patient who received this treatment. Before participating in the trial, his arthritis wasn’t responsive to any therapy that was available to him. After receiving a bioelectronic device treatment in the trial, he was dramatically better within weeks. Today, 3 years later, he’s still in remission. This patient isn’t the only one in remission as a result of participating in the trials. The challenge now is to understand how to identify other patients who will respond to this type of therapy.

Where do you foresee bioelectronic medicine going next?

Today, we understand that neural circuits can be targeted for therapy. This created an opportunity to determine how many other circuits we can target. There are probably hundreds of specific molecular mechanisms under the control of nerve fibers. By targeting these nerves, we may be able to develop therapies for many chronic conditions such as diabetes, inflammatory bowel disease and cancer.

Read more about Tracey’s journey in a Findings profile article about him.

Elements That Keep Us Alive Also Give Color to Fireworks

Looking up at the night sky this Fourth of July, you might wonder what gives fireworks their vivid colors. The bright hues result from chemical elements that are also essential for life. Chemists and other researchers have been uncovering their roles in a range of important biological processes.

By mass, about 96 percent of our bodies are made of four key elements: oxygen (65 percent), carbon (18.5 percent), hydrogen (9.5 percent) and nitrogen (3.3 percent). These elements do not give color to fireworks, but they are found in our body’s most abundant and important molecules, including water, proteins and DNA.

A dozen or so other elements—mostly metals—make up the remaining 4 percent. Present in minuscule amounts, these elements are involved in everything from transporting oxygen and releasing hormones to regulating blood pressure and maintaining bone strength. They also add a burst of color when put in to a fireworks recipe. Here are several examples. Continue reading

Designing Drugs That Kill Invasive Fungi Without Harming Humans

Top to bottom: Cryptococcus, Candida, Aspergillus, Pneumocystis
Invasive fungal infections kill more than 1 million people worldwide every year. Almost all of these deaths are due to fungi in one of these four groups. Credit: Centers for Disease Control and Prevention.

Invasive fungal infections—the kind that infect the bloodstream, lung and brain—are inordinately deadly. A big part of the problem is the lack of drugs that are both effective against the fungi and nontoxic to humans.

The situation might change in the future though, thanks to the work of a multidisciplinary research team led by chemist Martin Burke at the University of Illinois. For years, the team has focused on an antifungal agent called amphotericin B (AmB for short). Although impressively lethal to fungi, AmB is also notoriously toxic to human cells.

Most recently, the research team chemically modified the drug to create compounds that kill fungi, but don’t disrupt human cells. The scientists explain it all in the latest issue of Nature Chemical Biology.

Invasive fungal infections are so intractable because most antifungal drugs aren’t completely effective. Plus, fungi have a tendency to develop resistance to them. AmB is a notable exception. Isolated 50 years ago from Venezuelan dirt, AmB has evaded resistance and remains highly effective. Unfortunately, it causes side effects so debilitating that some doctors call it “ampho-terrible.” At high doses, it is fatal.

For decades, scientists believed that AmB molecules kill fungal cells by forming membrane-piercing pores, or ion channels, through which the cells’ innards leak out. Last year, Burke’s group overturned this well-established concept using evidence from nuclear magnetic resonance, chemistry and cell-based experiments. The researchers showed that AmB molecules assemble outside cells into lattice-like structures. These structures act as powerful sponges, sucking vital lipid molecules, called ergosterol, right out of the fungal cell membrane, destroying the cell. Continue reading

Unusual DNA Form May Help Virus Withstand Extreme Conditions

A, B and Z DNA.
DNA comes in three forms: A, B and Z. Credit: A-DNA, B-DNA and Z-DNA by Zephyris (Richard Wheeler) under CC BY-SA 3.0.

DNA researcher Rosalind Franklin Exit icon first described an unusual form of DNA called the A-form in the early 1950s (Franklin, who died in 1958, would have turned 95 next month). New research on a heat- and acid-loving virus has revealed surprising information about this DNA form, which is one of three known forms of DNA: A, B and Z.

“Many people have felt that this A-form of DNA is only found in the laboratory under very non-biological conditions, when DNA is dehydrated or dry,” says Edward Egelman Exit icon in a University of Virginia news release Exit icon about the recent study. But considered with earlier studies on bacteria by other researchers, the new findings suggest that the A-form “appears to be a general mechanism in biology for protecting DNA.” Continue reading

Preventing Sepsis in Half the Time

Human digestive system
A new study suggests that an antibiotic regimen half as long as the standard course could be just as effective in treating intra-abdominal infections and preventing sepsis. Credit: Stock image.

When treating infections, the most critical actions are to quash the infection at its site of origin and prevent it from spreading. If allowed to spread to the bloodstream, an infection could result in body-wide inflammation known as sepsis that can cause organ failure and death.

Intra-abdominal infections, most often caused by gut bacteria, can lead to painful inflammation and present a high risk for sepsis. These infections, which include appendicitis, are some of the most common illnesses around the world.

A standard treatment regimen includes surgically removing the original infection and then prescribing antibiotics to keep the infection from coming back and to prevent sepsis. Currently, doctors administer antibiotics until 2 days after the symptoms disappear, for a total of up to 2 weeks.

Like many other researchers, University of Virginia’s Robert Sawyer Exit icon wondered if treating intra-abdominal infections with shorter antibiotic courses could be just as effective as the standard treatment. To find out, he and a team of researchers from around the country designed the Study to Optimize Peritoneal Infection Therapy (STOP-IT). Continue reading

How a Cell Knows Friend From Foe

We asked the heads of our scientific divisions to tell us about some of the big questions in fundamental biomedical science that researchers are investigating with NIGMS support. This article is the first in an occasional series that will explore these questions and explain how pursuing the answers could advance understanding of important biological processes.

Video screen shot showing different strains of amoeba cells in red and green.
This video shows different strains of amoeba cells in red and green. As cells move toward one another, they use two sets of proteins to recognize others from the same strain. When close relatives meet, their proteins match and the cells join together to form a multicellular structure. When cells from different strains meet, their proteins don’t match, so they can’t aggregate. Credit: Shigenori Hirose, Baylor College of Medicine.

Cells are faced with many decisions: When’s the best time to produce a new protein? To grow and split into two? To treat another cell as an invader? Scientists are working to understand how cells make these and many other decisions, and how these decisions contribute to health and disease.

An active area of research on cell decisions focuses on allorecognition, the ability of an organism to distinguish its own cells from those of another. Immune cells use a system called the major histocompatibility complex (MHC) to identify which cells belong to the body and which are foreign. The particular set of MHC proteins on the outer surface of a cell helps immune cells decide whether it does not belong and should be attacked.

But the system isn’t perfect. Invading pathogens can go undetected, and the body can mistake its own cells for intruders. Continue reading

Mapping Our Skin’s Microbes and Molecules

Last month, we shared some facts about the microbes that inhabit us. Here’s another: From head to toe, our skin bacteria coexist with chemicals in hygiene products, fibers from clothes and proteins shed by dead or dying skin cells.

These images highlight the complex composition of our body’s largest organ. They show the association between microbial diversity (top images) and skin chemistry (middle images). The different colors note the abundance of a certain bacterium or molecule—red is high, and blue is low. The skin maps remind NIH Director Francis Collins of a 60’s rock album cover. Continue reading

Meet Nels Elde and His Team’s Amazing, Expandable Viruses

Nels Elde, Ph.D.
Credit: Kristan Jacobsen
Nels Elde, Ph.D.
Fields: Evolutionary genetics, virology, microbiology, cell biology
Works at: University of Utah, Salt Lake City
When not in the lab, he’s: Gardening, supervising pets, procuring firewood
Hobbies: Canoeing, skiing, participating in facial hair competitions

“I really look at my job as an adventure,” says Nels Elde. “The ability to follow your nose through different fields is what motivates me.”

Elde has used that approach to weave evolutionary genetics, bacteriology, virology, genomics and cell biology into his work. While a graduate student at the University of Chicago and postdoctoral researcher at the Fred Hutchinson Cancer Research Center in Seattle, he became interested in how interactions between pathogens (like viruses and bacteria) and their hosts (like humans) drive the evolution of both parties. He now works in Salt Lake City, where, as an avid outdoorsman, he draws inspiration from the wild landscape.

Outside the lab, Elde keeps diverse interests and colorful company. His best friend wrote a song about his choice of career as a cell biologist. (You can hear this song at the end of the 5-minute video Exit icon in which Elde explains his work.) Continue reading

Structural Studies Demystify Membrane Protein

Animated structural model of TSPO.
Animated structural model of TSPO. Credit: Michigan State University.

Mitochondria have proteins that span their membranes to control the flow of messages and materials moving into and out of the organelle. One way scientists can learn more about how membrane proteins function—and how medicines might interact with them—is to determine their structures. But for a variety of reasons, obtaining the structures has been notoriously difficult.

Two structural studies have now shed light on the mysterious mitochondrial membrane protein TSPO. This protein plays a key role in transporting cholesterol and drugs into the cell’s mitochondria. While here, the cholesterol is converted to steroid hormones that are essential for numerous bodily functions. Although many researchers have been studying TSPO since the 1990s, they’ve remained uncertain about its mechanisms and how it truly functions. Continue reading

Our Microbial Menagerie

Trillions of microorganisms inhabit us—inside and out. Scientists are surveying these microbial metropolises to learn more about their role in health. Microbiologists Darren Sledjeski of NIGMS and Andrew Goodman Exit icon of Yale University share a few details of what researchers have learned so far.

Vitruvian man filled with bacteria.
Researchers are surveying the microbes that inhabit us to learn more about their role in health. Credit: Andrew Goodman, Yale University.
  1. The majority of the microbes that inhabit us are bacteria. The rest of the microbial menagerie is fungi and viruses, including ones that infect the bacteria! Collectively, our resident microorganisms are referred to as the human microbiota, and their genomes are called the human microbiome.
  2. Our bodies harbor more bacterial cells than human ones. Even so, the microbiota accounts for less than 3 percent of a person’s body mass. That’s because our cells are up to 10,000 times bigger in volume than bacterial cells.
  3. Your collection of bacteria has more genes than you do. Scientists estimate that the genomes of gut bacteria contain 100-fold or more genes than our own genomes. For this reason, the human microbiome is sometimes called our second genome.
  4. Most of our microbes are harmless, and some are helpful. For example, harmless microbes on the skin keep infectious microbes from occupying that space. Microbes in the colon break down lactose and other complex carbohydrates that our bodies can’t naturally digest.
  5. Different microbes occupy different parts of the body. Some skin bacteria prefer the oily nooks near the nose, while others like the dry terrain of the forearm. Bacteria don’t all fare well in the same environment and have adapted to live in certain niches. The NIGMS Findings Magazine article Body Bacteria: Exploring the Skin’s Microbial Metropolis shows what types of bacteria colonize where.
  6. Screenshot from the iBiology video.
    Are we more microbial than human? Richard Losick, a microbiologist at Harvard University, explores that question in this video lecture produced by iBiology Exit icon.
  7. Each person’s microbiota is unique. The demographics of microbiota differ among individuals. Diet is one reason. Also, while a type of microbe might be part of one person’s normal microbial flora, it might not be part of another’s, and could potentially make that person sick.
  8. Host-microbial interactions are universal. Microbial communities may vary from person to person, but everyone’s got them, including other creatures. For this reason, researchers can use model organisms to tease apart the complexities of host-microbial interactions and develop broad principles for understanding them. The mouse is the most widely used animal model for microbiome studies.
  9. The role of microbiota in our health isn’t entirely clear. While it’s now well accepted that the microbial communities that inhabit us are actively involved in a range of conditions—from asthma to obesity—research studies have not yet pinpointed why or how. In other words, the results may suggest that the presence of a bacterial community is associated with a disease, but they don’t show cause and effect.
  10. Most of our microbes have not been grown in the lab. Microbes require a certain mix of nutrients and other microbes to survive, making it challenging to replicate their natural environments in a petri dish. New culturing techniques are enabling scientists to study previously uncultivated microbes.
  11. The impact of probiotic and prebiotic products isn’t clear. Fundamental knowledge gaps remain regarding how these products may work and what effects they might have on host-microbial interactions. A new NIH effort to stimulate research in this area is under way.
  12. There’s even more we don’t know! Additional areas of research include studying the functions of microbial genes and the effects of gut microbes on medicines. The more we learn from these and other studies, the more we’ll understand how our normal microbiota interacts with us and how to apply that knowledge to promote our health.