Treatment of Low Blood Pressure with Epidural Electrical Neuromodulation Wins Prize | American Association for the Advancement of Science (AAAS)

For developing an approach that treats debilitating hypotension after spinal cord injury, Aaron Phillips is the 2023 grand prize winner of the Science & PINS Prize for Neuromodulation. In an individual with chronic cervical spinal cord injury, long-term use of this therapy allowed the individual to cease other medical treatments and resulted in greatly improved quality of life.

“In his beautiful essay, Dr. Phillips describes how he and his colleagues designed and developed a spinal cord stimulation-based treatment for extremely low blood pressure that affects individuals with spinal cord injury,” writes Mattia Maroso, senior editor at Science. “The results presented by Dr. Phillips demonstrate that non-pharmacological intervention can restore normal blood pressure after spinal cord injury, ameliorating life quality, reducing the risk of life-threatening situations.”

Once a spinal cord injury (SCI) occurs, little is available to medically treat the issues that result. One particularly devastating consequence of SCI is cardiovascular paralysis, leading to low blood pressure (BP) or hypotension, which can threaten survival, impair neurological recovery and increase cardiovascular disease risk.

New therapies for hypotension after SCI are needed, as current clinical management options lack efficacy and commonly lead to harmful side effects.

Phillips was inspired to tackle issues for SCI patients because of direct experience. “I witnessed firsthand through a good friend of mine who had a cervical spinal cord injury the profound ways in which unstable blood pressure affects their life,” he said. “This triggered me to focus my autonomic health expertise on trying to make a difference in the field of spinal cord injury.”

One potential treatment after SCI is epidural electrical stimulation (EES) of the spinal cord, a medical procedure that involves implanting an electrode array into the epidural space of the spinal cord. The epidural space is the area between the outermost protective covering of the spinal cord and the surrounding vertebrae.

In his essay, Philip writes about research he and colleagues had done years prior: “Our group made a tantalizing and unexpected observation in one patient that epidural electrical stimulation of … lumbosacral spinal cord segments transiently increases BP.”

The team was intrigued to further explore whether EES could be optimized to treat hypotension after SCI. This led to them develop an innovative and implantable “neuroprosthetic baroreflex” device that targets EES to discrete spinal cord circuits.

They tested this approach in nonhuman primates, with success. It improved hypotension after SCI.

To bring this therapy to the community, however, they needed to test their approach in a person. They worked with a patient with chronic complete cervical SCI that had resulted in debilitating hypotension.

In this patient, EES led to stabilized BP, among other improvements. Long-term use of this therapy allowed the individual to stop other medical treatments for hypotension and permitted participation in upright physical rehabilitation.

“We touch base every couple of months for dinner and great conversation,” said Phillips of this patient. He said he believes the patient is still using the therapy on a regular basis.

Phillips is proud of his team for coming together to answer a formidable question. “It’s extremely rewarding that this approach is now being tested in clinical trials as a potentially game-changing therapeutic,” he said. “We are racing towards our next major goal, which is to have this therapy approved for everyone that could benefit from it.”

Phillips wants young people to know that medical discoveries such as this one that improve lives on a population scale require resilient efforts over long periods of time, from a diverse team. “The reward for your efforts is beautiful. Come join us on this journey.”