The implantable system that restores hemodynamic stability after spinal cord injury (2024)

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Aaron A. Phillips, Aasta P. Gandhi, Nicolas Hankov, Sergio D. Hernandez-Charpak, Julien Rimok, Anthony Incognito, Anouk E. J. Nijland, Marina D’Ercole, Anne Watrin, Maxime Berney, Aikaterini Damianaki, Grégory Dumont, Nicolò Macellari, Laura De Herde, Edeny Baaklini, Donovan Smith, Ryan Miller, Jordan Lee, Nadine Intering, Jean-Baptiste Ledoux, Javier G. Ordonnez, Taylor Newton, Ettore F. Meliadò, Léa Duguet, Charlotte Jacquet, Léa Bole-Feysot, Markus Rieger, Kristen Gelenitis, Yoann Dumeny, Miroslav Caban, Damien Ganty, Edoardo Paoles, Thomas Baumgartner, Clinical Study Team, Onward Team, Cathal Harte, Charles David Sasportes, Paul Romo, Tristan Vouga, Jemina Fasola, Jimmy Ravier, Matthieu Gautier, Frédéric Merlos, Rik Buschman, Tomislav Milekovic, Andreas Rowald, Stefano Mandija, Cornelis A.T. van den Berg, Niels Kuster, Esra Neufeld, Etienne Pralong, View ORCID ProfileLorenz Hirt, Stefano Carda, Fabio Becce, Etienne Aleton, Kyle Rogan, Patrick Schoettker, Grégoire Wuerzner, Nelleke Langerak, Noël L.W. Keijsers, Brian K. Kwon, James D. Guest, Erika Ross, John Murphy, Erkan Kurt, Steve Casha, Fady Girgis, Ilse van Nes, Kelly A. Larkin-Kaiser, Robin Demesmaeker, Léonie Asboth, Jordan W. Squair, Jocelyne Bloch, Grégoire Courtine

doi: https://doi.org/10.1101/2024.05.10.24306826

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Abstract

A spinal cord injury (SCI) causes immediate and sustained hemodynamic instability that threatens neurological recovery and impacts quality of life. Here, we establish the clinical burden of chronic hypotensive complications due to SCI and expose the ineffective treatment of these complications with conservative measures. To address this clinical burden, we developed a purpose-built implantable system based on biomimetic epidural electrical stimulation (EES) of the spinal cord that immediately triggered robust pressor responses. The system durably reduced the severity of hypotensive complications in people with SCI, removed the necessity for conservative treatments, improved quality of life, and enabled superior engagement in activities of daily living. Central to the development of this therapy was the head-to-head demonstration in the same participants that EES must target the last three thoracic segments, and not the lumbosacral segments, to achieve the safe and effective regulation of blood pressure in people with SCI. These findings establish a path forward to treat the underappreciated, treatment-resistant hypotensive complications due to SCI.

Competing Interest Statement

The authors declare competing financial interests: G.C., A.Phillips., J.W.S, J.Bloch., R.D., L.Asboth, T.M. and A.R. hold various patents in relation with the present work. G.C., A.Philips., J.Bloch, V.D., J.Murphy and H.L. are minority shareholders of ONWARD medical, a company with direct relationships with the presented work. G.C., J.Bloch., A.Phillips. and R.D. are consultants of ONWARD medical. P.B., M.D., L.D., K.G., C.J., H.L., C.Picq, M.Rieger, E.R., R.V., A.W., F.A., S.Morand, J.Pradarelli, E.Paoles, J.Murphy, Y.D., M.C. D.G., A.K, J.D., F.S. and V.D. are employees of ONWARD medical. N.Kuster and E.N. are shareholders of ZMT Zurich MedTech AG, which produces the Sim4Life software. The other authors declare no competing interests.

Clinical Trial

NCT04994886 NCT05044923 NCT05111093 NCT05941819

Funding Statement

This work was financially supported by: Eurostars project E!113969 PREP2GO, DARPA subaward A21-0795-S001 (P.O. 1083297), Eurostars E!1748 IMPULSE, Medtronic (ERP-2020-12543), Onward Medical, PHRT-279, the Defitech foundation, CIHR, Cumming Medical Research Fund, Edith Rodie Estate, Hotchkiss Brain Institute, Libin Cardiovascular Institute.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Swissethics gave ethical approval for this work (Ethics reference number: CER-VD 2021-00588). Swissmedic gave regulatory approval before the start of the study for the STIMO-HEMO trial conducted in Switzerland (Competent authorities number: Swissmedic 10000882). The STIMO-HEMO study followed the Declaration of Helsinki (clinicaltrials.gov ID: NCT 04994886).The Canadian ethical authorities gave ethical approval for this work (Ethics reference number: REB21-0027). The HEMO trial was conducted following the Declaration of Helsinki in Canada (clinicaltrials.gov ID: NCT 05044923).Swissethics gave ethical approval for this work (Ethics reference number: CER-VD 2021-D0025). Swissmedic gave regulatory approval before the start of the study for the HemON trial conducted in Switzerland (Competent authorities number: Swissmedic 10000932). The HemON study followed the Declaration of Helsinki (clinicaltrials.gov ID: NCT 05111093).The Central Committee on Research Involving Human Subjects of Radboud University Medical Center gave ethical approval for this work (Ethics reference number: 2023-16316). The Central Committee on Research Involving Human Subjects gave regulatory approval before the start of the study for the HemON-NL trial conducted in The Netherlands (CCMO NL83694.000.23). The HemON-NL study followed the Declaration of Helsinki (clinicaltrials.gov ID: NCT 05941819).Veritas Independent Review Board, the Research Ethics Board of Universite Laval (principal investigators institution) and local research ethics IRBs across Canada gave ethical approval for the epidemiological survey in this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Footnotes

  • # These authors jointly supervised this work

  • & Clinical Study Team Lorraine Aviolat7, Nadia Bérard23, Julie Brancato23, Krystel Bruyère7, Rebecca Charbonneau1,2, Chris Drummond-Main2, Sean Dukelow1,2, Grégoire Eberle7, John Gaudet25, Natacha Herrmann7, Julie Hervé5,6,7, Jamie Johnston2, Valentin Lupi7, John-Paul Miroz5,6,7, Aurélie Paley5,6,7, Julie Pillonel7, Carole Poulin-Kella7, Mélanie Ramirez7, Katrien Van Den Keybus7, Camille Varescon5,6,7, Molywan Vat5,6,7, Xavier Vo Pham7, Laurence Wenger7 and Patrick Koomen9

  • && Onward Team Francesco Acquati6,11, Pierre Bessot11, Julien Dedelley11, Vincent Delattre11, Anahita Kyani11, Hendrik Lambert11, Sebastien Morand11, Chloé Picq11, Jared Pradarelli11, Francesca Stradolini11 and Rosanne van Dijsseldonk11

  • Missing Table 1 and 2 added.

Data availability

Software routines developed for the data analysis will be made available upon reasonable request to the corresponding authors.

Copyright

The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.

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The implantable system that restores hemodynamic stability after spinal cord injury (2024)

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