An implantable system to restore hemodynamic stability after spinal cord injury

Aaron A. Phillips; Aasta P. Gandhi; Nicolas Hankov; Sergio D. Hernandez-Charpak; Julien Rimok; Anthony V. Incognito; Anouk E. J. Nijland; Marina D’Ercole; Anne Watrin; Maxime Berney; Aikaterini Damianaki; Grégory Dumont; Nicolò Macellari; Laura De Herde; Nadine Intering; Donovan Smith; Ryan Miller; Meagan N. Smith; Jordan Lee; Edeny Baaklini; Jean-Baptiste Ledoux; Javier G. Ordonnez; Taylor Newton; Ettore Flavio Meliadò; Léa Duguet; Charlotte Jacquet; Léa Bole-Feysot; Markus Rieger; Kristen Gelenitis; Yoann Dumeny; Miroslav Caban; Damien Ganty; Edoardo Paoles; Thomas Baumgartner; Cathal Harte; Charles David Sasportes; Paul Romo; Tristan Vouga; Jemina Fasola; Jimmy Ravier; Matthieu Gautier; Frédéric Merlos; Rik Buschman; Tomislav Milekovic; Andreas Rowald; Stefano Mandija; Cornelis A. T. van den Berg; Niels Kuster; Esra Neufeld; Etienne Pralong; Lorenz Hirt; Stefano Carda; Fabio Becce; Etienne Aleton; Kyle Rogan; Patrick Schoettker; Grégoire Wuerzner; Nelleke Langerak; Noël L. W. Keijsers; Brian K. Kwon; James D. Guest; Erika Ross; John Murphy; Erkan Kurt; Steve Casha; Fady Girgis; Ilse van Nes; Kelly A. Larkin-Kaiser; Robin Demesmaeker; Léonie Asboth; Jordan W. Squair; Onward Team; Jocelyne Bloch; Grégoire Courtine

doi:10.1038/s41591-025-03614-w

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An implantable system to restore hemodynamic stability after spinal cord injury

Journal article

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Peer reviewed

An implantable system to restore hemodynamic stability after spinal cord injury

Aaron A. Phillips, Aasta P. Gandhi, Nicolas Hankov, Sergio D. Hernandez-Charpak, Julien Rimok, Anthony V. Incognito, Anouk E. J. Nijland, Marina D’Ercole, Anne Watrin, Maxime Berney, …

Nature medicine, Vol.31(9), pp.2946-2957

2025-09

DOI: https://doi.org/10.1038/s41591-025-03614-w

PMID: 40962906

Appears in Miller School of Medicine - Latest Publications

Abstract

631/378/1687/1825

692/308/2779/109

Article

Biomedical and Life Sciences

Biomedicine

Cancer Research

General

Infectious Diseases

Metabolic Diseases

Molecular Medicine

Neurosciences

A spinal cord injury (SCI) causes immediate and sustained hemodynamic instability that threatens neurological recovery and impacts quality of life. Here we establish the clinical burden of chronic hypotensive complications due to SCI in 1,479 participants and expose the ineffective treatment of these complications with conservative measures. To address this clinical burden, we developed a purpose-built implantable system based on biomimetic epidural electrical stimulation (EES) of the spinal cord that immediately triggered robust pressor responses. The system durably reduced the severity of hypotensive complications in people with SCI, removed the necessity for conservative treatments, improved quality of life and enabled superior engagement in activities of daily living. Central to the development of this therapy was the head-to-head demonstration in the same participants that EES must target the last three thoracic segments, and not the lumbosacral segments, to achieve the safe and effective regulation of blood pressure in people with SCI. These findings in 14 participants establish the path to designing a pivotal device trial that will evaluate the safety and efficacy of EES to treat the underappreciated, treatment-resistant hypotensive complications due to SCI. A purpose-built implantable system based on biomimetic epidural electrical stimulation of the spinal cord reduces the severity of hypotensive complications in people with spinal cord injury and improves quality of life.

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Title: An implantable system to restore hemodynamic stability after spinal cord injury
Creators: Aaron A. Phillips - University of Calgary
Aasta P. Gandhi - École Polytechnique Fédérale de Lausanne
Nicolas Hankov - École Polytechnique Fédérale de Lausanne
Sergio D. Hernandez-Charpak - École Polytechnique Fédérale de Lausanne
Julien Rimok - University of Calgary
Anthony V. Incognito - University of Calgary
Anouk E. J. Nijland - Sint Maartenskliniek
Marina D’Ercole - ONWARD Medical
Anne Watrin - ONWARD Medical
Maxime Berney - University of Lausanne
Aikaterini Damianaki - University of Lausanne
Grégory Dumont - École Polytechnique Fédérale de Lausanne
Nicolò Macellari - École Polytechnique Fédérale de Lausanne
Laura De Herde - École Polytechnique Fédérale de Lausanne
Nadine Intering - École Polytechnique Fédérale de Lausanne
Donovan Smith - University of Calgary
Ryan Miller - University of Calgary
Meagan N. Smith - University of Calgary
Jordan Lee - University of Calgary
Edeny Baaklini - École Polytechnique Fédérale de Lausanne
Jean-Baptiste Ledoux - University of Lausanne
Javier G. Ordonnez - École Polytechnique Fédérale de Lausanne
Taylor Newton - Foundation for Research on Information Technologies in Society
Ettore Flavio Meliadò - University Medical Center Utrecht
Léa Duguet - ONWARD Medical
Charlotte Jacquet - ONWARD Medical
Léa Bole-Feysot - École Polytechnique Fédérale de Lausanne
Markus Rieger - ONWARD Medical
Kristen Gelenitis - ONWARD Medical
Yoann Dumeny - ONWARD Medical
Miroslav Caban - ONWARD Medical
Damien Ganty - ONWARD Medical
Edoardo Paoles - ONWARD Medical
Thomas Baumgartner - University of Lausanne
Cathal Harte - École Polytechnique Fédérale de Lausanne
Charles David Sasportes - École Polytechnique Fédérale de Lausanne
Paul Romo - University of Calgary
Tristan Vouga - TWIICE
Jemina Fasola - TWIICE
Jimmy Ravier - École Polytechnique Fédérale de Lausanne
Matthieu Gautier - École Polytechnique Fédérale de Lausanne
Frédéric Merlos - École Polytechnique Fédérale de Lausanne
Rik Buschman - Medtronic
Tomislav Milekovic - École Polytechnique Fédérale de Lausanne
Andreas Rowald - University of Lausanne
Stefano Mandija - University Medical Center Utrecht
Cornelis A. T. van den Berg - University Medical Center Utrecht
Niels Kuster - Foundation for Research on Information Technologies in Society
Esra Neufeld - Foundation for Research on Information Technologies in Society
Etienne Pralong - University of Lausanne
Lorenz Hirt - University of Lausanne
Stefano Carda - University of Lausanne
Fabio Becce - University of Lausanne
Etienne Aleton - University of Lausanne
Kyle Rogan - University of Calgary
Patrick Schoettker - University of Lausanne
Grégoire Wuerzner - University of Lausanne
Nelleke Langerak - Sint Maartenskliniek
Noël L. W. Keijsers - Radboud University Medical Center
Brian K. Kwon - International Collaboration On Repair Discoveries
James D. Guest - Neurological Surgery
Erika Ross - ONWARD Medical
John Murphy - ONWARD Medical
Erkan Kurt - Radboud University Nijmegen
Steve Casha - University of Calgary
Fady Girgis - University of Calgary
Ilse van Nes - Radboud University Medical Center
Kelly A. Larkin-Kaiser - University of Calgary
Robin Demesmaeker - École Polytechnique Fédérale de Lausanne
Léonie Asboth - École Polytechnique Fédérale de Lausanne
Jordan W. Squair - École Polytechnique Fédérale de Lausanne
Onward Team
Jocelyne Bloch - École Polytechnique Fédérale de Lausanne
Grégoire Courtine - École Polytechnique Fédérale de Lausanne
Publication Details: Nature medicine, Vol.31(9), pp.2946-2957
Publisher: Nature Publishing Group US
Number of pages: 12
Grant note: The authors would like to thank the study participants for their commitment and trust. All participants gave their informed consent for the publication of their images. The authors would also like to thank M. Boulingre, J. Bourgeot, K. Charlong, M. Kameni-Hekam, C. Magrini, L. Mathews, L. McCracken, C. Parcheminey, M. Pedone, C. Perrin, M. Picek, K. Plesniar, C. Schiff and K. Tourigny for various contributions, including data collection, support in patient logistics, patient care and regulatory affairs; I. Benrikane, A. Di Russo and Y. Qin for their contributions in data analysis. This work was financially supported by the Eurostars project (E!113969 PREP2GO to G.C.), DARPA subaward A21-0795-S001 (P.O. 1083297 to G.C.), Eurostars (E!1748 IMPULSE to G.C.), Medtronic (ERP-2020-12543 to G.C. and J. Bloch), ONWARD Medical NV (to G.C., J. Bloch and I.V.), PHRT-279 (to G.C.), the Defitech Foundation (to G.C. and J. Bloch), Canadian Institutes of Health Research CIHR (to A.A.P.), Cumming Medical Research Fund (to A.A.P.), Edith Rodie Estate (to A.A.P.), Hotchkiss Brain Institute (to A.A.P.) and Libin Cardiovascular Institute (to A.A.P.).
Academic Unit: UMMG Dept of Neurological Surgery; Miller School of Medicine; Miami Project to Cure Paralysis
Language: English
Resource Type: Journal article
PMID: 40962906
Record Identifier: 991032798691302976