This neuroscientist has the secret to tackling inflammation

Telegraph

8 hours ago

Imagine a future where you no longer have to take a pill for your ill. No more monthly prescription charges or time-consuming trips to the doctor. No debilitating side-effects; all you'd need is an hour-long operation to insert a tiny electrical device in your chest and neck to calm the inflammation in your body.
Inflammation is a natural process, and a certain amount is healthy and necessary. When a person becomes ill or injured, their immune system sends out its 'first responders' – inflammatory cells which start to heal the injured tissue. For example, a fever is evidence that your immune system is working properly. However, if this process continues for too long, inflammation can harm healthy tissues, and lead to chronic illness.
Dr Kevin Tracey is a professor of neurosurgery at the Zucker School of Medicine in Long Island, New York, and the president and chief executive of the Feinstein Institute for Medical Research. 'Inflammation causes or contributes to the conditions that kill two thirds of people on the planet,' he says. 'Of the 60 million that die per year, 40 million die from inflammatory conditions such as heart disease, stroke, or cancer.'
The key to fighting inflammation, according to Dr Tracey, is stimulation of the vagus nerve.
The vagus nerve, which runs down your neck and into your chest and abdomen, is an anatomical 'superhighway' comprising a complex network of more than 200,000 fibres connecting the brain to vital organs. It is part of your parasympathetic nervous system, responsible for the body's 'rest and digest' functions.
Dr Tracey is something of a pioneer in this area, which he investigates in his new book, The Great Nerve: The New Science of the Vagus Nerve and How To Harness Its Healing Reflexes, and he claims to be one of the most highly cited living scientists in the world.
Scientists have known about the vagus nerve since the 16th century, but for Dr Tracey, a breakthrough came in 1998 when a laboratory experiment gone wrong led to an unexpected discovery. He and his colleagues accidentally injected a rat with an inflammatory toxin – and an anti-inflammatory drug simultaneously injected in its brain had a restorative effect. Until then, scientists thought that the brain and immune system did not communicate.
The groundbreaking discovery on that that day gave way to to Dr Tracey and his colleagues realising that the vagus nerve wasn't just something that impacted the brain; it also controlled inflammation and, as a result, all areas of our health – from gut health to joints – and stimulating it could reduce harmful inflammation. 'It's obvious, at least to me, that this mode of treatment will soon be able to help millions who are suffering with inflammatory illnesses,' says Dr Tracey.
A new era of medicine
Thanks to ongoing research into the vagus nerve, the next decade could see vastly improved treatment of inflammatory illnesses such as rheumatoid arthritis and Crohn's disease. In fact, Dr Tracey's new bioelectronic treatment for rheumatoid arthritis – which like all vagus nerve stimulation (VNS) treatment works on the premise of 'turning off' an inflammatory molecule called TNF – is awaiting regulatory approval.
Since Dr Tracey's initial breakthrough, research into the vagus nerve has accelerated, giving rise to a field known as 'bioelectronic medicine', where treatments use electrical signals rather than drugs. A pacemaker is an example of bioelectronic medicine, as is VNS, which some experts describe as 'a pacemaker for the brain'.
VNS involves the implantation of a device that sends regular, mild pulses of electrical energy to your brain stem through your vagus nerve in your neck. After reaching your brainstem, the electrical charge is discharged to different areas of your brain to change the way brain cells work.
'Vagus nerve stimulation has saved lives,' says Dr Tracey. 'Many patients who turn to VNS have tried everything – they have run out of options.
'The advantages over medication are that it's more targeted than a pill, it has a short half-life – you can turn the treatment on and off – and it has fewer side-effects than many drugs,' he adds.
Where VNS does work, it works miraculously. Dr Tracey tells the story of a lorry driver in one of his trials whose hands and feet were so affected by rheumatoid arthritis, he was unable to work. A week after being implanted with a vagal nerve stimulator the size of a pain-killing tablet, the driver was back to his normal life, even playing tennis.
'Meeting him was one of the happiest days of my professional life,' says Dr Tracey. 'Few scientists have the privilege of inventing something and then shaking hands with a patient it has helped. We're now getting emails from patients who are desperate for help. In one rheumatoid arthritis trial, we had room for 242 participants, but 20,000 people applied.'
Should this new treatment be patented by the FDA in the United States, the chances of it rolling out internationally are high. 'There will be a surge of patient demand,' says Dr Tracey, who believes it could help 1,500,000 to two million rheumatoid arthritis patients in the US, and 17 million worldwide. 'Just imagine: a one-hour surgery rather than a lifetime on toxic drugs.'
Farther into the future, says Dr Tracey, there may even be a VNS treatment for dementia. 'The link between Alzheimer's and inflammation is often talked about, but not well understood,' he says. 'But there is some evidence that VNS can enhance learning or memory.'
Will VNS become mainstream?
Even Dr Tracey accepts that VNS is not a fail-safe treatment, and that it only benefits about two thirds of patients. He knows that many traditional doctors still raise their eyebrows.
'Early advocates of VNS may be criticised by those defending the status quo, and who will say the 'effect' size of VNS is too small,' he says. 'Other, less benign forces may also hinder the adoption of vagal nerve stimulation, because this idea has the potential to disrupt the pharmaceutical industry.'
He is keenly aware that it's not in the interests of big pharma to invest in trials for a product that will make their products redundant – hence Dr Tracey's trials are funded by venture capital.
'I actually wrote my book for doctors to read, as well as for laypeople,' he says. 'My mission is to shorten the adoption curve of a new technology. I'm an introvert rather than an extrovert: I don't want the limelight personally. But I want the facts to be in the limelight.'
In Dr Tracey's eyes, the facts are clear: it's a low-risk treatment, with a high reward for those who do respond. 'I expect that vagus nerve therapy, like every other therapy, will not work in 100 per cent of patients,' he says. 'VNS has three possible outcomes. Those who respond are in remission, and others are much better and need less medication.'
On those who do not respond at all, he says: 'There is still more work to do. But I fully expect that millions of people with inflammatory conditions will soon be helped by this therapy.' He dreams that it will become a preventative treatment, for conditions such as atherosclerosis, diabetes or cancer.
'For those people who have exhausted the gamut of drug treatments, VNS represents hope – from the woman whose arthritic hands are so twisted she cannot do up her blouse, to the man unable to work or play with his small children because of the debilitating pain in his wrists and hands.
'VNS is not a cure-all, but for many patients, it's a possible. And as a neurosurgeon and scientist, I love to chase the possible.'
DIY stimulation of the vagus nerve for stress and anxiety
What about the miracle cures we see everywhere on the internet, from meditating to breathwork and plunging into ice-water?
Dr Tracey has a healthy scepticism. 'A clinical trial of one or two subjects is more like a fairy tale with a happy ending than scientific proof that the cold makes you healthier and stronger,' he says. 'In some cases, there is deep science, in others, not that much.'
Regulated breathing seems to have more evidence than meditation or coldwater plunges. 'These things are important, but it's important not to overhype, or oversell them. It devalues the science that we do know. I don't want to dilute my vagus nerve work for over 30 years,' he says.
On the other hand, says Dr Tracey, if these methods work for you, they work for you. He meditates, takes cold showers, and practices deep breathing every morning.