Device and method for attenuating an immune response

• US 7,418,292 B2
• Filed: 04/08/2004
• Issued: 08/26/2008
• Est. Priority Date: 10/01/2003
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Shafer, Lisa Lynn
• Primary Examiner(s): Layno; Carl H.
• Assistant Examiner(s): Gedeon; Brian T
• Application Number:
  US10/820,677
• Publication Number:
  US 20050075701A1
• Time in Patent Office: 1,601 Days
• Field of Search: 607/2, 607 4- 5, 607/115, 607/118
• US Class Current: 607/2
• CPC Class Codes: A61B 5/4041 Evaluating nerves condition
• CPC Class Codes: A61B 5/41 Detecting, measuring or recording for evaluating the immune or lymphatic systems
• CPC Class Codes: A61B 5/412 Detecting or monitoring sepsis
• CPC Class Codes: A61B 5/416 the spleen
• CPC Class Codes: A61N 1/0553 Paddle shaped electrodes, e.g. for laminotomy
• CPC Class Codes: A61N 1/0558 Anchoring or fixation means therefor
• CPC Class Codes: A61N 1/326 for promoting growth of cells, e.g. bone cells
• CPC Class Codes: A61N 1/36017 with leads or electrodes penetrating the skin
• CPC Class Codes: A61N 1/36021 for treatment of pain
• CPC Class Codes: A61N 1/3605 Implantable neurostimulators for stimulating central or peripheral nerve system
• CPC Class Codes: A61N 1/36071 Pain
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362

Abstract

Stimulation of one or more neurons of the sympathetic nervous system, including the splenic nerve, to attenuate an immune response, including an inflammatory immune response, is discussed. Devices and systems to stimulate the sympathetic nervous system to attenuate an immune response are also discussed. Devices discussed include pulse generators and drug pumps. Systems are described as optionally having one or more sensors and operator instructions. In specific examples, stimulation of the splenic nerve of pigs with a pulse generator is shown to be safe and effective in attenuating a lipopolysaccharide-induced immune response.

Claims

1. A method for attenuating an immune response, comprising:

identifying a subject suffering from or at risk of a disease or disorder mediated by the immune response;

placing at least a portion of a lead comprising an electrode within a tissue of the subject at a location in which stimulation of the tissue by the electrode is capable of stimulating a sympathetic neuron;

applying a plurality of electrical stimulation pulses to the tissue via the electrode to stimulate the sympathetic neuron in an amount effective to attenuate the immune response;

sensing a condition of the subject; and

modifying a parameter of at least one of the plurality of electrical pulses based on the sensed condition,

wherein the sympathetic neuron is a neuron of a splenic nerve, splenic neurovascular bundle, a periarterial splenic nerve, splenic peritoneum, splenic tissue, celiac plexus surrounding the celiac artery, a celiac ganglion, an aorticorenal ganglion, a greater thoracic splanchnic nerve, a lesser thoracic splanchnic nerve, or a least thoracic splanchinc nerve,

wherein the disease or disorder is selected from the group consisting of allergy, anaphylactic shock, immune complex disease, hay fever, sepsis, septicemia, endotoxic shock, cachexia, hyperpyrexia, eosinophilic granuloma, granulomatosis, sarcoidosis, septic abortion, epididymitis, vaginitis, prostatitis, urethritis, bronchitis, emphysema, rhinitis, cystic fibrosis, pneumonitis, pelvic inflammatory disease, alvealitis, bronchiolitis, pharyngitis, pleurisy, sinusitis, influenza, respiratory syncytial virus infection, herpes infection, HIV infection, disseminated bacteremia, Dengue fever, candidiasis, malaria, filariasis, amebiasis, hydatid cysts, burns, dermatitis, dermatomyositis, urticaria, warts, wheals, vasulitis, rheumatoid arthritis, Alzheimer'"'"'s disease, meningitis, encephalitis, multiple sclerosis, Guillane-Barre syndrome, neuritis, neuralgia, spinal cord injury, paralysis, uveitis, arthritides, arthralgias, osteomyelitis, fasciitis, Paget'"'"'s disease, gout, periodontal disease, synovitis, Sjogren'"'"'s syndrome, myasthenia gravis, thryoiditis, systemic lupus erythematosus, lupus erythematosus, Addison'"'"'s disease, pernicious anemia, Goodpasture'"'"'s syndrome, Behcets'"'"'s syndrome, allograft rejection, graft-versus-host disease, Berger'"'"'s disease, Type I diabetes, ankylosing spondylitis, Retier'"'"'s syndrome, Graves disease, and Hodgkins disease,

wherein sensing the condition comprises detecting a characteristic or symptom associated with a disorder or disease associated with the immune response or stimulation of the one or more neurons,

wherein the characteristic or symptom is selected from the group consisting of (i) presence of an immune mediator, (ii) an amount of an immune mediator, (iii) an objective symptom of the subject, and (iv) presence or amount of transforming growth factor (TGF), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epithelial growth factor (EGF), fibroblast growth factor (FGF), intracellular adhesion molecule (I-CAM), subtypes thereof, nitric oxide, nuclear factor kappa B (NFκ

-B), early growth response protein (ERG-1), a mitogen-activated protein (MAP) kinase, toll-like receptors (TLRs), or a SMAD transcription factor, and

wherein the immune mediator is selected from the group consisting of a cytokine receptor, a chemokine, a chemokine receptor, a cell type involved in an immune respone, a cell surface molecule involved in an immune response, an exogenous antigen, a cytokine.

2. The method of claim 1, further comprising implanting a pulse generator within the subject, wherein the pulse generator produces the electrical stimulation pulse and is electrically coupled to the electrode.

3. The method of claim 1, wherein the electrode is placed in contact with the sympathetic neuron.

4. The method of claim 3, wherein the sympathetic neuron is a neuron of the splenic nerve.

5. The method of claim 1, wherein the sympathetic neuron is a neuron of the splenic nerve.

6. The method of claim 1, wherein the electrode is placed in contact with splenic tissue.

7. The method of claim 1, wherein the immune response is an inflammatory immune response.

8. The method of claim 1, wherein the immune mediator is a cytokine receptor.

9. The method of claim 8, wherein the cytokine receptor is selected from the group consisting of TNF receptor, IL-1b receptor, and Toll-like receptors.

10. The method of claim 9, wherein the immune mediator is a chemokine.

11. The method of claim 10, wherein the chemokine is selected from the group consisting of 6Ckine and MIP3beta.

12. The method of claim 1, wherein the immune mediator is a chemokine receptor.

13. The method of claim 12, wherein the chemokine receptor is CCR7 receptor.

14. The method of claim 1, wherein the immune mediator is a cell type involved in an immune response.

15. The method of claim 14, wherein the cell type is selected from the group consisting of Langerhans cell, dendritic cell, T lymphocyte, and B lymphocyte.

16. The method of claim 1, wherein the immune mediator is a cell surface molecule involved in an immune response.

17. The method of claim 16, wherein the cell surface molecule is selected from the group consisting of major histocompatibility complex (MHC), CD80, CD86, CD28, CD40.

18. The method of claim 1, wherein the immune mediator is an exogenous antigen.

19. The method of claim 18, wherein the exogenous antigen is selected from the group consisting of a bacterial antigen, a viral antigen, and a fungal antigen.

20. The method of claim 1, wherein the immune mediator is a cytokine.

21. The method of claim 20, wherein the cytokine is a pro-inflammatory or anti-inflammatory cytokine.

22. The method of claim 21, wherein the cytokine is selected from the group consisting of tumor necrosis factor alpha (TNFα

), interleukin (IL)-1α

, IL-1β

, IL-5, IL-6, IL-8, IL-18, interferony, platelet-activating factor (PAF), macrophage migration inhibitory factor (MIF), high mobility group box protein 1 (HMGB-1), IL-4, IL-10, IL-13, and IL-17.

23. The method of claim 1, wherein the condition is the presence or amount of transforming growth factor (TGF), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epithelial growth factor (EGF), fibroblast growth factor (FGF), intracellular adhesion molecule (I-CAM), subtypes thereof, or nitric oxide.

24. The method of claim 1, wherein at least one of the one or more conditions is the presence or amount of nuclear factor kappa B (NFκ

-B), early growth response protein (ERG-1), a mitogen-activated protein (MAP) kinase, toll-like receptors (TLRs), or a SMAD transcription factor.

38. The method of claim 1, wherein applying the electrical stimulation pulse comprises applying the pulse to a celiac plexus surrounding the celiac artery.

39. The method of claim 1, wherein applying the electrical stimulation pulse comprises applying the pulse to a splenic neurovascular bundle.

40. The method of claim 1, wherein applying the electrical stimulation pulse comprises applying the pulse to a periarterial splenic nerve.

41. The method of claim 1, wherein applying the electrical stimulation pulse comprises applying the pulse to a splenic peritoneum.

42. The method of claim 1, wherein applying the electrical stimulation pulse comprises applying the pulse to a celiac ganglia.

43. The method of claim 1, wherein applying the electrical stimulation pulse comprises applying the pulse to an aorticorenal ganglia.

44. The method of claim 1, wherein applying the electrical stimulation pulse comprises applying the pulse to a greater thoracic splanchnic nerve.

45. The method of claim 1, wherein applying the electrical stimulation pulse comprises applying the pulse to a lesser thoracic splanchnic nerve.

46. The method of claim 1, wherein applying the electrical stimulation pulse comprises applying the pulse to a least thoracic splanchinc nerve.

25. A method for attenuating an immune response, comprising:

identifying a mammalian subject suffering from or at risk of a disease or disorder mediated by the immune response;

placing at least a portion of a lead comprising an electrode within a tissue of the mammalian subject at a location in which stimulation of the tissue by the electrode is capable of stimulating a sympathetic neuron; and

applying a plurality of electrical stimulation pulses to the tissue via the electrode to stimulate the sympathetic neuron in an amount effective to attenuate the immune response;

sensing a condition of the subject; and

modifying a parameter of at least one of the plurality of electrical pulses based on the sensed condition,

wherein the disease or disorder mediated by the immune response is selected from the group consisting of allergy, anaphylactic shock, immune complex disease, hay fever, sepsis, septicemia, endotoxic shock, cachexia, hyperpyrexia, eosinophilic granuloma, granulomatosis, sarcoidosis, septic abortion, epididymitis, vaginitis, prostatitis, urethritis, bronchitis, emphysema, rhinitis, cystic fibrosis, pneumonitis, pelvic inflammatory disease, alvealitis, bronchiolitis, pharyngitis, pleurisy, sinusitis, influenza, respiratory syncytial virus infection, herpes infection, HIV infection, disseminated bacteremia, Dengue fever, candidiasis, malaria, filariasis, amebiasis, hydatid cysts, burns, dermatitis, dermatomyositis, urticaria, warts, wheals, vasulitis, rheumatoid arthritis, Alzheimer'"'"'s disease, meningitis, encephalitis, multiple sclerosis, Guillane-Barre syndrome, neuritis, neuralgia, spinal cord injury, paralysis, uveitis, arthritides, arthralgias, osteomyelitis, fasciitis, Paget'"'"'s disease, gout, periodontal disease, synovitis, Sjogren'"'"'s syndrome, myasthenia gravis, thryoiditis, systemic lupus erythematosus, lupus erythematosus, Addison'"'"'s disease, pernicious anemia, Goodpasture'"'"'s syndrome, Behcets'"'"'s syndrome, allograft rejection, graft-versus-host disease, Berger'"'"'s disease, Type I diabetes, ankylosing spondylitis, Retier'"'"'s syndrome, Graves disease, and Hodgkins disease,

wherein sensing the condition comprises detecting a characteristic or symptom associated with a disorder or disease associated with the immune response or stimulation of the one or more neurons,

wherein the characteristic or symptom is selected from the group consisting of (i) presence of an immune mediator, (ii) an amount of an immune mediator, (iii) an objective symptom of the subject, and (iv) presence or amount of transforming growth factor (TGF), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epithelial growth factor (EGF), fibroblast growth factor (FGF), intracellular adhesion molecule (I-CAM), subtypes thereof, nitric oxide, nuclear factor kappa B (NFκ

-B), early growth response protein (ERG-1), a mitogen-activated protein (MAP) kinase, toll-like receptors (TLRs), or a SMAD transcription factor, and

wherein the immune mediator is selected from the group consisting of a cytokine receptor, a chemokine, a chemokine receptor, a cell type involved in an immune respone, a cell surface molecule involved in an immune response, an exogenous antigen, a cytokine.

26. The method of claim 25, further comprising implanting a pulse generator within the subject, wherein the pulse generator produces the electrical stimulation pulse and is electrically coupled to the electrode.

27. The method of claim 25, wherein placing the lead comprises placing the electrode in contact with the sympathetic neuron.

28. The method of claim 25, wherein the sympathetic neuron is a neuron selected from the group consisting of a projection from the brain to the spinal cord;

an interneuron;

a pre-ganglionic neuron;

a ganglion; and

a post-ganglionic neuron.

29. The method of claim 28, wherein the sympathetic neuron is a post-ganglionic neuron.

30. The method of claim 29, wherein the sympathetic neuron is a neuron of the splenic nerve.

31. The method of claim 30, wherein the sympathetic neuron is a neuron of the splenic nerve.

32. The method of claim 25, wherein the sympathetic neuron is a neuron of the splenic nerve.

33. The method of claim 25, wherein placing the lead comprises placing the electrode in contact with an end organ.

34. The method of claim 33, wherein the end organ is a lymph organ.

35. The method of claim 34, wherein the lymph organ is a spleen.

36. The method of claim 25, wherein placing the lead comprises placing the electrode in contact with tissue of an organ in a peritoneal sac.

37. The method of claim 36, wherein the organ in the peritoneal sac is selected from the group consisting of pancreas;

stomach; and

intestine.

47. The method of claim 25, wherein the disease or disorder is selected from the group consisting of allergy, anaphylactic shock, immune complex disease, hay fever, sepsis, septicemia, and endotoxic shock.

48. The method of claim 25, wherein the disease or disorder is cachexia.

49. The method of claim 25, wherein the disease or disorder is hyperpyrexia.

50. The method of claim 25, wherein the disease or disorder is eosinophilic granuloma.

51. The method of claim 25, wherein the disease or disorder is granulomatosis.

52. The method of claim 25, wherein the disease or disorder is sarcoidosis.

53. The method of claim 25, wherein the disease or disorder is septic abortion.

54. The method of claim 25, wherein the disease or disorder is epididymitis.

55. The method of claim 25, wherein the disease or disorder is vaginitis.

56. The method of claim 25, wherein the disease or disorder is prostatitis.

57. The method of claim 25, wherein the disease or disorder is urethritis.

58. The method of claim 25, wherein the disease or disorder is bronchitis.

59. The method of claim 25, wherein the disease or disorder is emphysema.

60. The method of claim 25, wherein the disease or disorder is rhinitis.

61. The method of claim 25, wherein the disease or disorder is cystic fibrosis.

62. The method of claim 25, wherein the disease or disorder is pneumonitis.

63. The method of claim 25, wherein the disease or disorder is pelvic inflammatory disease.

64. The method of claim 25, wherein the disease or disorder is alvealitis.

65. The method of claim 25, wherein the disease or disorder is bronchiolitis.

66. The method of claim 25, wherein the disease or disorder is pharyngitis.

67. The method of claim 25, wherein the disease or disorder is pleurisy.

68. The method of claim 25, wherein the disease or disorder is sinusitis.

69. The method of claim 25, wherein the disease or disorder is selected from the group consisting of influenza, respiratory syncytial virus infection, herpes infection, HIV infection, disseminated bacteremia, Dengue fever, candidiasis, malaria, and filariasis, amebiasis.

70. The method of claim 25, wherein the disease or disorder is hydatid cysts, bums, dermatitis, dermatomyositis, urticaria, warts, and wheals.

71. The method of claim 25, wherein the disease or disorder is vasulitis.

72. The method of claim 25, wherein the disease or disorder is arthritides or rheumatoid arthritis.

73. The method of claim 25, wherein the disease or disorder is Alzheimer'"'"'s disease.

74. The method of claim 25, wherein the disease or disorder is meningitis.

75. The method of claim 25, wherein the disease or disorder is encephalitis.

76. The method of claim 25, wherein the disease or disorder is multiple sclerosis.

77. The method of claim 25, wherein the disease or disorder is Guillane-Barre syndrome.

78. The method of claim 25, wherein the disease or disorder is neuritis.

79. The method of claim 25, wherein the disease or disorder is neuralgia.

80. The method of claim 25, wherein the disease or disorder is spinal cord injury.

81. The method of claim 25, wherein the disease or disorder is paralysis.

82. The method of claim 25, wherein the disease or disorder is uveitis.

83. The method of claim 25, wherein the disease or disorder is arthralgias.

84. The method of claim 25, wherein the disease or disorder is osteomyelitis.

85. The method of claim 25, wherein the disease or disorder is fasciitis.

86. The method of claim 25, wherein the disease or disorder is Paget'"'"'s disease.

87. The method of claim 25, wherein the disease or disorder is gout.

88. The method of claim 25, wherein the disease or disorder is periodontal disease.

89. The method of claim 25, wherein the disease or disorder is synovitis.

90. The method of claim 25, wherein the disease or disorder is Sjogren'"'"'s syndrome.

91. The method of claim 25, wherein the disease or disorder is myasthenia gravis.

92. The method of claim 25, wherein the disease or disorder is thryoiditis.

93. The method of claim 25, wherein the disease or disorder is lupus erythematosus or systemic lupus erythematosus.

94. The method of claim 25, wherein the disease or disorder is Addison'"'"'s disease.

95. The method of claim 25, wherein the disease or disorder is pernicious anemia.

96. The method of claim 25, wherein the disease or disorder is Goodpasture'"'"'s syndrome.

97. The method of claim 25, wherein the disease or disorder is Behcets'"'"'s syndrome.

98. The method of claim 25, wherein the disease or disorder is allograft rejection or graft-versus-host disease.

99. The method of claim 25, wherein the disease or disorder is Berger'"'"'s disease.

100. The method of claim 25, wherein the disease or disorder is Type I diabetes.

101. The method of claim 25, wherein the disease or disorder is ankylosing spondylitis.

102. The method of claim 25, wherein the disease or disorder is Retier'"'"'s syndrome.

103. The method of claim 25, wherein the disease or disorder is Graves disease.

104. The method of claim 25, wherein the disease or disorder is Hodgkins disease.

105. A method for inhibiting release of a proinflammatory mediator from a mammalian cell, comprising:

identifying a mammalian subject suffering from, or at risk for, a disease or disorder mediated by a proinflammatory mediator; and

applying a plurality of electrical stimulation pulses to a sympathetic neuron of the subject in an amount effective to inhibit the release of the proinflammatory mediator;

sensing a condition of the subject; and

modifying a parameter of at least one of the plurality of electrical pulses based on the sensed condition,

wherein the disease or disorder mediated by a proinflammatory mediator is selected from the group consisting of allergy, anaphylactic shock, immune complex disease, hay fever, sepsis, septicemia, endotoxic shock, cachexia, hyperpyrexia, eosinophilic granuloma, granulomatosis, sarcoidosis, septic abortion, epididymitis, vaginitis, prostatitis, urethritis, bronchitis, emphysema, rhinitis, cystic fibrosis, pneumonitis, pelvic inflammatory disease, alvealitis, bronchiolitis, pharyngitis, pleurisy, sinusitis, influenza, respiratory syncytial virus infection, herpes infection, HIV infection, disseminated bacteremia, Dengue fever, candidiasis, malaria, filariasis, amebiasis, hydatid cysts, burns, dermatitis, dermatomyositis, urticaria, warts, wheals, vasulitis, rheumatoid arthritis, Alzheimer'"'"'s disease, meningitis, encephalitis, multiple sclerosis, Guillane-Barre syndrome, neuritis, neuralgia, spinal cord injury, paralysis, uveitis, arthritides, arthralgias, osteomyelitis, fasciitis, Paget'"'"'s disease, gout, periodontal disease, synovitis, Sjogren'"'"'s syndrome, myasthenia gravis, thryoiditis, systemic lupus erythematosus, lupus erythematosus, Addison'"'"'s disease, pernicious anemia, Goodpasture'"'"'s syndrome, Behcets'"'"'s syndrome, allograft rejection, graft-versus-host disease, Berger'"'"'s disease, Type I diabetes, ankylosing spondylitis, Retier'"'"'s syndrome, Graves disease, and Hodgkins disease,

wherein sensing the condition comprises detecting a characteristic or symptom associated with a disorder or disease associated with the immune response or stimulation of the one or more neurons,

wherein the characteristic or symptom is selected from the group consisting of (i) presence of an immune mediator, (ii) an amount of an immune mediator, (iii) an objective symptom of the subject, and presence or amount of transforming growth factor (TGF), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epithelial growth factor (EGF), fibroblast growth factor (FGF), intracellular adhesion molecule (I-CAM), subtypes thereof, nitric oxide, nuclear factor kappa B (NFκ

-B), early growth response protein (ERG-1), a mitogen-activated protein (MAP) kinase, toll-like receptors (TLRs), or a SMAD transcription factor, and

wherein the immune mediator is selected from the group consisting of a cytokine receptor, a chemokine, a chemokine receptor, a cell type involved in an immune respone, a cell surface molecule involved in an immune response, an exogenous antigen, a cytokine.

106. A method of inhibiting an inflammatory cytokine cascade in a patient, comprising:

applying a plurality of electrical stimulation pulses to a sympathetic neuron in the patient in an amount sufficient to inhibit the inflammatory cytokine cascade,

wherein the patient is diagnosed as suffering from, or at risk for, a disease or disorder mediated by the inflammatory cytokine cascade;

sensing a condition of the subject; and

modifying a parameter of at least one of the plurality of electrical pulses based on the sensed condition,

wherein the disease or disorder mediated by a proinflammatory mediator is selected from the group consisting of allergy, anaphylactic shock, immune complex disease, hay fever, sepsis, septicemia, endotoxic shock, cachexia, hyperpyrexia, eosinophilic granuloma, granulomatosis, sarcoidosis, septic abortion, epididymitis, vaginitis, prostatitis, urethritis, bronchitis, emphysema, rhinitis, cystic fibrosis, pneumonitis, pelvic inflammatory disease, alvealitis, bronchiolitis, pharyngitis, pleurisy, sinusitis, influenza, respiratory syncytial virus infection, herpes infection, HIV infection, disseminated bacteremia, Dengue fever, candidiasis, malaria, filariasis, amebiasis, hydatid cysts, burns, dermatitis, dermatomyositis, urticaria, warts, wheals, vasulitis, rheumatoid arthritis, Alzheimer'"'"'s disease, meningitis, encephalitis, multiple sclerosis, Guillane-Barre syndrome, neuritis, neuralgia, spinal cord injury, paralysis, uveitis, arthritides, arthralgias, osteomyelitis, fasciitis, Paget'"'"'s disease, gout, periodontal disease, synovitis, Sjogren'"'"'s syndrome, myasthenia gravis, thryoiditis, systemic lupus erythematosus, lupus erythematosus, Addison'"'"'s disease, pernicious anemia, Goodpasture'"'"'s syndrome, Behcets'"'"'s syndrome, allograft rejection, graft-versus-host disease, Berger'"'"'s disease, Type I diabetes, ankylosing spondylitis, Retier'"'"'s syndrome, Graves disease, and Hodgkins,

wherein sensing the condition comprises detecting a characteristic or symptom associated with a disorder or disease associated with the immune response or stimulation of the one or more neurons,

wherein the characteristic or symptom is selected from the group consisting of (i) presence of an immune mediator, (ii) an amount of an immune mediator,m (iii) an objective symptom of the subject, and (iv) presence or amount of transforming growth factor (TGF), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), epithelial growth factor (EGF), fibroblast growth factor (FGF), intracellular adhesion molecule (I-CAM), subtypes thereof, nitric oxide, nuclear factor kappa B (NFκ

-B), early growth response protein (ERG-1), a mitogen-activated protein (MAP) kinase, toll-like receptors (TLRs), or a SMAD transcription factor, and

wherein the immune mediator is selected from the group consisting of a cytokine receptor, a chemokine, a chemokine receptor, a cell type involved in an immune respone, a cell surface molecule involved in an immune response, an exogenous antigen, a cytokine.