Electrical current to fight COVID-19: The intelligent electric pill

In 2020, Prof. Eugenijus Kaniusas and his research partners hypothesized that stimulating the auricular vagus nerve has anti-inflammatory effects in severe COVID-19 cases. In 2022, they were able to confirm this hypothesis thanks to a clinical trial.

As an electrical engineer, Prof. Eugenijus Kaniusas has shown repeatedly that electrical vagus nerve stimulation of the auricle (abbreviated aVNS) is an effective technique that delivers many therapeutic options. In this interview with MEDICA-tradefair.com, he reveals what prompted him to test this treatment method for the SARS-CoV-2 virus.

Prof. Kaniusas, what is vagus nerve stimulation and what are its uses?

Prof. Eugenijus Kaniusas: Our brain controls our body. But it does not just have direct lines to control organs, it also has sensory pathways. That is why the brain knows exactly whether an organ is functioning properly and can subsequently deliver optimal modulation based on the respective feedback. Here is one example of this: Baroreceptors send signals to the brain pertaining to blood pressure. The brain can subsequently regulate the blood pressure by expanding or contracting the blood vessels or by slowing or speeding up the heartbeat. Surprisingly, it's the vagus nerve that has the biggest sensory network. It keeps the brain in the know by sending sensory information.

We detected that this sensory pathway is lacking when it comes to chronic conditions such as excessive inflammation. The brain then no longer knows which direction it should go for regulation. This is where electrical stimulation of the sensory function of the vagus nerve comes into play. By actively stimulating the nerve in this setting, we replace the lost feedback pathway. This replacement is not just temporary – meaning it does not just occur during stimulation – because the sensory pathway gradually rebuilds. It regenerates, allowing the brain to regain optimal control over the essential processes via the command and sensory pathways. The stimulation thus restores the balance between the initially protective inflammatory response and the regenerative processes.

Why are you focusing on aVNS?

Kaniusas: The ear has sensory vagus nerve endings. They create a direct gateway to the brainstem, the nucleus tractus solitarius. Figuratively speaking, it is a kind of USB connection straight to the brain, directly to the human control center. The vagal afferent endings are as close to the surface in the ear as they are in the mouth. But wearing electrodes in your mouth would obviously be very uncomfortable.

Why is the aVNS technique ideal for treating severe COVID-19 cases?

Kaniusas: The stimulation supports the systemic healing process – meaning, it affects the entire body – especially in severe COVID-19 cases. In doing so, it protects against drastic damage caused by an excessive inflammatory response. To test our hypothesis, we worked closely with the Hospital Favoriten, the Medical University of Vienna, the Health Service Centre of the Vienna Private Clinic, the Sigmund Freud Private University Vienna, and the Immunological Day Clinic Vienna. We examined the application of aVNS in critically ill patients with COVID-19, who were about to receive artificial respiration. The electrostimulation of the auricular vagus nerve was not only able to stop the inflammatory reaction in these patients, but it was also able to counteract it.

How does the stimulation process work?

Kaniusas: In this minimally invasive therapy, miniature needles are inserted 1 to 1.5 millimeters deep into the ear near the vagus nerve and electrical stimulation is applied. The surge triggers an activation impulse along the vagus nerve, which is transmitted to the brain via the nerve tracts.

What are some other therapeutic uses of vagus nerve stimulation?

Kaniusas: Vagus nerve stimulation is already being used to treat pain, epilepsy, depression, and cardiovascular diseases. But apart from these uses, there are many other conceivable applications since the therapy – like the vagus nerve – prompts systemic whole-body effects. In long-term collaboration with Dr. Constantin Szeles from the Medical University of Vienna, we have provided scientific evidence that this system works and yields positive effects.

How long have you been dedicated to this topic?

Kaniusas: I have focused on vagus nerve stimulation for the past fifteen years. It is – quite literally – an "exciting" topic that touches both mind and heart and helps people. As researchers, it is very satisfying to see that these innovative therapies are helping. It motivates you to keep going. Our latest aVNS system listens to the measured biosignals through the newly integrated closed-loop control system and sends its stimulus at exactly the right time, like an intelligent electric pill. This is an important step towards personalization. It’s also why our team expects better therapeutic success, reduced power consumption and, above all, more user acceptance.