Device and method for inhibiting release of pro-inflammatory mediator

• US 7,769,442 B2
• Filed: 08/29/2006
• Issued: 08/03/2010
• 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): Schaetzle; Kennedy J
• Assistant Examiner(s): SARCIONE, JESSICA LYNN
• Application Number:
  US11/467,963
• Publication Number:
  US 20060287678A1
• Time in Patent Office: 1,435 Days
• Field of Search: 607 1- 3, 607 39- 46, 607/48, 607/72
• US Class Current: 607/2
• CPC Class Codes: A61N 1/0556 Cuff electrodes
• CPC Class Codes: A61N 1/0558 Anchoring or fixation means therefor
• 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 1/36053 adapted for vagal stimulation A61N1/36114 takes precedence
• CPC Class Codes: A61N 1/36071 Pain

Abstract

Stimulation of one or more neurons of the sympathetic nervous system, including the splenic nerve, is provided to attenuate an immune response, including an inflammatory immune response. Devices such as pulse generators and drug pumps may be used to stimulate the sympathetic nervous system to attenuate an immune response. Systems optionally having one or more sensors and operator instructions may also be used. 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 inhibiting release of a proinflammatory mediator from a mammalian cell, the method comprising:

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

applying a stimulation signal to the subject in an amount effective to inhibit the release of the proinflammatory mediator, wherein the stimulation signal is directly applied to a splenic nerve, a splenic neurovascular bundle, a periarterial splenic nerve, splenic peritoneum, splenic tissue, celiac plexus surrounding a celiac artery, a celiac ganglion, an aorticorenal ganglion, a greater thoracic splanchnic nerve, a lesser thoracic splanchnic nerve, a least thoracic splanchinc nerve or a combination thereof.

2. The method of claim 1, wherein the proinflammatory mediator is a pro-inflammatory cytokine.

3. The method of claim 2, wherein the pro-inflammatory cytokine is selected from the group consisting of tumor necrosis factor alpha (TNFα

);

interleukin (IL)-1α

;

IL-1β

;

IL-2;

IL-5;

IL-6;

IL-8;

IL-15;

IL-18;

interferon (IFN-γ

);

platelet-activating factor (PAF);

Thromboxane;

soluble adhesion molecules;

vasoactive neuropeptides;

phospholipase A2;

Plasminogen activator inhibitor (PAI-1);

Free radical generation;

Neopterin;

CD14;

prostacyclin;

Neutrophil elastase;

Protein kinase;

Monocyte chemotactic proteins 1 and 2 (MCP-1, MCP-2);

macrophage migration inhibitory factor (MIF); and

high mobility group box protein 1 (HMGB-1).

4. The method of claim 2, wherein the proinflammatory cytokine is selected from the group consisting of TNF-α

;

HMGB-1;

IL-1; and

IL-6.

5. The method of claim 2, wherein the proinflammatory cytokine is TNF-α

.

6. The method of claim 1, wherein the pro-inflammatory mediator is a chemokine.

7. The method of claim 1, wherein the disease or disorder is selected from the group consisting of appendicitis, peptic, gastric and duodenal ulcers, peritonitis, pancreatitis, pseudomembranous colitis, acute ulcerative colitis, chronic ulcerative colitis and ischemic colitis, diverticulitis, epiglottitis, achalasia, cholangitis, cholecystitis, hepatitis, nosicomial infection, Crohn'"'"'s disease, inflammatory bowl disease, enteritis, Whipple'"'"'s disease, diabetes, asthma, allergy, anaphylactic shock, immune complex disease, organ ischemia, reperfusion injury, organ necrosis, 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, hepatitis B virus infection, hepatitis C virus infection, disseminated bacteremia, Dengue fever, candidiasis, malaria, filariasis, amebiasis, hydatid cysts, burns, dermatitis, dermatomyositis, urticaria, warts, wheals, vasulitis, cardiovascular disease, angiitis, endocarditis, arteritis, atherosclerosis, thrombophlebitis, pericarditis, myocarditis, myocardial ischemia, periarteritis nodosa, rheumatic fever, rheumatoid arthritis, Alzheimer'"'"'s disease, coeliac disease, congestive heart failure, adult respiratory distress syndrome, meningitis, encephalitis, multiple sclerosis, cerebral infarction, cerebral embolism, Guillane-Barre syndrome, neuritis, neuralgia, spinal cord injury, paralysis, uveitis, arthritides, arthralgias, osteomyelitis, fasciitis, Paget'"'"'s disease, gout, periodontal disease, rheumatoid arthritis, 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, Type I diabetes, ankylosing spondylitis, Berger'"'"'s disease, Type I diabetes, ankylosing spondylitis, spinal cord injury, Retier'"'"'s syndrome, Graves disease, and Hodgkins disease.

8. The method of claim 1, wherein the disease or disorder is selected from the group consisting of endotoxic shock, appendicitis, peptic, gastric and duodenal ulcers, peritonitis, pancreatitis, inflammatory bowl disease, acute ulcerative colitis, chronic ulcerative colitis, ischemic colitis, hepatitis, nosicomial infection, Crohn'"'"'s disease, diabetes, asthma, allergy, anaphylactic shock, arteriosclerosis, organ ischemia, reperfusion injury, organ necrosis, sepsis, septicemia, cachexia, septic abortion, disseminated bacteremia, burns, rheumatoid arthritis, Alzheimer'"'"'s disease, coeliac disease, congestive heart failure, adult respiratory distress syndrome, cardiovascular disease, multiple sclerosis, diabetes, spinal cord injury, allograft rejection and graft-versus-host disease.

9. The method of claim 1, wherein applying the stimulation signal comprises applying the stimulation signal to a splenic nerve.

10. The method of claim 9, wherein applying the stimulation signal to the splenic nerve comprises applying the stimulation signal to a substantially fully dissected splenic nerve or nerve bundle.

11. The method of claim 1, wherein applying the stimulation signal further comprises applying the stimulation signal to a celiac plexus surrounding a celiac artery.

12. The method of claim 1, wherein applying the stimulation signal comprises applying the stimulation signal to a splenic neurovascular bundle.

13. The method of claim 1, wherein applying the stimulation signal comprises applying the stimulation signal to a periarterial splenic nerve.

14. The method of claim 1, wherein applying the stimulation signal comprises applying the stimulation signal to a splenic peritoneum.

15. The method of claim 1, wherein applying the stimulation signal further comprises applying the stimulation signal to a celiac ganglion.

16. The method of claim 1, wherein applying the stimulation signal further comprises applying the stimulation signal to an aorticorenal ganglion.

17. The method of claim 1, wherein applying the stimulation signal further comprises applying the stimulation signal to a greater thoracic splanchnic nerve.

18. The method of claim 1, wherein applying the stimulation signal further comprises applying the stimulation signal to a lesser thoracic splanchnic nerve.

19. The method of claim 1, wherein applying the stimulation signal further comprises applying the stimulation signal to a least thoracic splanchinc nerve.

20. The method of claim 1, further comprising stimulating a vagus nerve.