Extracellular pH monitoring for use in closed-loop vagus nerve stimulation

OBJECTIVE Vagal nerve stimulation (VNS) has shown potential benefits for obesity treatment; however, current devices lack physiological feedback, which limit their efficacy. Changes in extracellular pH (pHe) have shown to be correlated with neural activity, but have traditionally been measured with glass microelectrodes, which limit their in vivo applicability. APPROACH Iridium oxide has previously been shown to be sensitive to fluctuations in pH and is biocompatible. Iridium oxide microelectrodes were inserted into the subdiaphragmatic vagus nerve of anaesthetised rats. Introduction of the gut hormone cholecystokinin (CCK) or distension of the stomach was used to elicit vagal nerve activity. MAIN RESULTS Iridium oxide microelectrodes have sufficient pH sensitivity to readily detect changes in pHe associated with both CCK and gastric distension. Furthermore, a custom-made Matlab script was able to use these changes in pHe to automatically trigger an implanted VNS device. SIGNIFICANCE This is the first study to show pHe changes in peripheral nerves in vivo. In addition, the demonstration that iridium oxide microelectrodes are sufficiently pH sensitive as to measure changes in pHe associated with physiological stimuli means they have the potential to be integrated into closed-loop neurostimulating devices.

[1]  C. Nicholson,et al.  Alkaline and acid transients in cerebellar microenvironment. , 1983, Journal of neurophysiology.

[2]  W. Endres,et al.  Changes in extracellular pH during electrical stimulation of isolated rat vagus nerve , 1986, Neuroscience Letters.

[3]  M. Chesler,et al.  Stimulus-induced extracellular pH transients in the in vitro turtle cerebellum , 1988, Neuroscience.

[4]  Wouter Olthuis,et al.  pH sensor properties of electrochemically grown iridium oxide , 1990 .

[5]  P. McHugh,et al.  Integration of vagal afferent responses to gastric loads and cholecystokinin in rats. , 1991, The American journal of physiology.

[6]  S. Ward,et al.  Inhibition of electrical slow waves and Ca2+ currents of gastric and colonic smooth muscle by phosphatase inhibitors. , 1991, The American journal of physiology.

[7]  K. Kaila,et al.  Modulation of pH by neuronal activity , 1992, Trends in Neurosciences.

[8]  Z. Lewandowski,et al.  Iridium oxide pH microelectrode , 1992, Biotechnology and bioengineering.

[9]  R. Stein,et al.  Instrumentation for ENG and EMG recordings in FES systems , 1994, IEEE Transactions on Biomedical Engineering.

[10]  M. Chesler,et al.  Activity-evoked extracellular pH shifts in slices of rat dorsal lateral geniculate nucleus , 1999, Brain Research.

[11]  J. L. Stringer,et al.  Extracellular pH responses in CA1 and the dentate gyrus during electrical stimulation, seizure discharges, and spreading depression. , 2000, Journal of neurophysiology.

[12]  T. Lundeberg,et al.  Cholecystokinin-8 (CCK-8) has no effect on heart rate in rats lacking CCK-A receptors , 2001, Peptides.

[13]  R. Kuzniecky,et al.  Weight loss associated with vagus nerve stimulation , 2002, Neurology.

[14]  M. Yacoub,et al.  Effect of dopamine receptor agonists on sensory nerve activity: possible therapeutic targets for the treatment of asthma and COPD , 2002, British journal of pharmacology.

[15]  In-Seop Lee,et al.  Characterization of iridium film as a stimulating neural electrode. , 2002, Biomaterials.

[16]  M. Chesler Regulation and modulation of pH in the brain. , 2003, Physiological reviews.

[17]  D. Lübbers,et al.  Time course of changes of extracellular H+ and K+ activities during and after direct electrical stimulation of the brain cortex , 1978, Pflügers Archiv.

[18]  E. A. Lima,et al.  Thin-film IrOx pH microelectrode for microfluidic-based microsystems. , 2005, Biosensors & bioelectronics.

[19]  B. Ludvik,et al.  One-Year Experience with Tantalus™: a New Surgical Approach to Treat Morbid Obesity , 2006, Obesity surgery.

[20]  Jon A. Mukand,et al.  Neuronal ensemble control of prosthetic devices by a human with tetraplegia , 2006, Nature.

[21]  A. Frazer,et al.  Induction of c-Fos and ΔFosB Immunoreactivity in Rat Brain by Vagal Nerve Stimulation , 2008, Neuropsychopharmacology.

[22]  R. Rogers,et al.  Mechanisms of action of CCK to activate central vagal afferent terminals , 2008, Peptides.

[23]  S. Micera,et al.  On the identification of sensory information from mixed nerves by using single-channel cuff electrodes , 2010, Journal of NeuroEngineering and Rehabilitation.

[24]  M. Chesler,et al.  Rapid rise of extracellular pH evoked by neural activity is generated by the plasma membrane calcium ATPase. , 2010, Journal of neurophysiology.

[25]  Sung Jin Park,et al.  Impaired intestinal afferent nerve satiety signalling and vagal afferent excitability in diet induced obesity in the mouse , 2011, The Journal of physiology.

[26]  Max Ortiz-Catalan,et al.  Effect on signal-to-noise ratio of splitting the continuous contacts of cuff electrodes into smaller recording areas , 2013, Journal of NeuroEngineering and Rehabilitation.

[27]  F. Marrosu,et al.  Vagus Nerve Stimulation Reduces Body Weight and Fat Mass in Rats , 2012, PloS one.

[28]  Ninh T. Nguyen,et al.  The EMPOWER Study: Randomized, Prospective, Double-Blind, Multicenter Trial of Vagal Blockade to Induce Weight Loss in Morbid Obesity , 2012, Obesity Surgery.

[29]  P. Tresco,et al.  A new high-density (25 electrodes/mm2) penetrating microelectrode array for recording and stimulating sub-millimeter neuroanatomical structures , 2013, Journal of neural engineering.

[30]  M. Ismail,et al.  An overview of pH Sensors Based on Iridium Oxide: Fabrication and Application , 2013 .

[31]  G. Dockray Enteroendocrine cell signalling via the vagus nerve. , 2013, Current opinion in pharmacology.

[32]  James Toouli,et al.  Effect of reversible intermittent intra-abdominal vagal nerve blockade on morbid obesity: the ReCharge randomized clinical trial. , 2014, JAMA.

[33]  T. Horbach,et al.  abiliti® Closed-Loop Gastric Electrical Stimulation System for Treatment of Obesity: Clinical Results with a 27-Month Follow-Up , 2015, Obesity Surgery.

[34]  Lohitash Karumbaiah,et al.  Intracortical recording interfaces: current challenges to chronic recording function. , 2015, ACS chemical neuroscience.

[35]  S. Silberstein,et al.  Vagus Nerve and Vagus Nerve Stimulation, a Comprehensive Review: Part II , 2016, Headache.

[36]  S. Silberstein,et al.  Vagus Nerve and Vagus Nerve Stimulation, a Comprehensive Review: Part III , 2016, Headache.

[37]  Rui B Chang,et al.  Sensory Neurons that Detect Stretch and Nutrients in the Digestive System , 2016, Cell.

[38]  C. Apovian,et al.  Two-Year Outcomes of Vagal Nerve Blocking (vBloc) for the Treatment of Obesity in the ReCharge Trial , 2016, Obesity Surgery.

[39]  Christofer Toumazou,et al.  An array of individually addressable micro-needles for mapping pH distributions. , 2016, The Analyst.

[40]  Vaughan G. Macefield,et al.  A Review of Control Strategies in Closed-Loop Neuroprosthetic Systems , 2016, Front. Neurosci..

[41]  Pedram Mohseni,et al.  Neurochemostat: A Neural Interface SoC With Integrated Chemometrics for Closed-Loop Regulation of Brain Dopamine , 2016, IEEE Transactions on Biomedical Circuits and Systems.

[42]  Stéphane Bonnet,et al.  Vagus nerve stimulation: state of the art of stimulation and recording strategies to address autonomic function neuromodulation , 2016, Journal of neural engineering.

[43]  Eduardo Fernandez,et al.  Clinical applications of penetrating neural interfaces and Utah Electrode Array technologies , 2016, Journal of neural engineering.

[44]  Christofer Toumazou,et al.  Injection moulded microneedle sensor for real-time wireless pH monitoring , 2017, 2017 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[45]  G. Boeckxstaens,et al.  The Vagus Nerve in Appetite Regulation, Mood, and Intestinal Inflammation. , 2017, Gastroenterology.