Two-Year Outcomes of Vagal Nerve Blocking (vBloc) for the Treatment of Obesity in the ReCharge Trial

Apovian, Caroline M.; Shah, Sajani; Wolfe, Bruce M.; Ikramuddin, Sayeed; Miller, Christopher J.; Tweden, Katherine S.; Billington, Charles J.; Shikora, Scott A.

doi:10.1007/s11695-016-2325-7

Cited by 123 publications

(105 citation statements)

References 15 publications

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“…Gastric electrical stimulation is used to help patients with delayed stomach-emptying of solid foods (gastroparesis), which is commonly observed in patients with diabetes (Abell et al 2003). Vagal nerve block (vBloc) therapy was recently approved by the FDA for certain patients with morbid obesity (Apovian et al 2017). Clinical trials on vBloc therapy reported improvements in blood glucose control for patients with obesity and type 2 diabetes but were not sustained after 24 months (Herrera et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Electrical stimulation of renal nerves for modulating urine glucose excretion in rats

et al. 2018

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Background: The role of the kidney in glucose homeostasis has gained global interest. Kidneys are innervated by renal nerves, and renal denervation animal models have shown improved glucose regulation. We hypothesized that stimulation of renal nerves at kilohertz frequencies, which can block propagation of action potentials, would increase urine glucose excretion. Conversely, we hypothesized that low frequency stimulation, which has been shown to increase renal nerve activity, would decrease urine glucose excretion. Methods: We performed non-survival experiments on male rats under thiobutabarbital anesthesia. A cuff electrode was placed around the left renal artery, encircling the renal nerves. Ureters were cannulated bilaterally to obtain urine samples from each kidney independently for comparison. Renal nerves were stimulated at kilohertz frequencies (1-50 kHz) or low frequencies (2-5 Hz), with intravenous administration of a glucose bolus shortly into the 25-40-min stimulation period. Urine samples were collected at 5-10-min intervals, and colorimetric assays were used to quantify glucose excretion and concentration between stimulated and non-stimulated kidneys. A KruskalWallis test was performed across all stimulation frequencies (α = 0.05), followed by a post-hoc Wilcoxon rank sum test with Bonferroni correction (α = 0.005). Results: For kilohertz frequency trials, the stimulated kidney yielded a higher average total urine glucose excretion at 33 kHz (+ 24.5%; n = 9) than 1 kHz (− 5.9%; n = 6) and 50 kHz (+ 2.3%; n = 14). In low frequency stimulation trials, 5 Hz stimulation led to a lower average total urine glucose excretion (− 40.4%; n = 6) than 2 Hz (− 27.2%; n = 5). The average total urine glucose excretion between 33 kHz and 5 Hz was statistically significant (p < 0.005). Similar outcomes were observed for urine flow rate, which may suggest an associated response. No trends or statistical significance were observed for urine glucose concentrations. Conclusion: To our knowledge, this is the first study to investigate electrical stimulation of renal nerves to modulate urine glucose excretion. Our experimental results show that stimulation of renal nerves may modulate urine glucose excretion, however, this response may be associated with urine flow rate. Future work is needed to examine the underlying mechanisms and identify approaches for enhancing regulation of glucose excretion.

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Section: Introductionmentioning

confidence: 99%

Electrical stimulation of renal nerves for modulating urine glucose excretion in rats

et al. 2018

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“…The block of nerve conduction by kHz HFBS has been approved by FDA for human application to treat obesity or amputation limb pain . Therefore, HFBS block of the pudendal nerve is expected to be safe for restoring bladder function after SCI because it will only be used for a short period during voiding that only occurs five to eight times per day for 2 to 5 minutes each time.…”

Section: Discussionmentioning

confidence: 99%

Low pressure voiding induced by a novel implantable pudendal nerve stimulator

Cai

Morgan

Pace

et al. 2019

Neurourology and Urodynamics

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Aim To validate the functionality of an implantable pudendal nerve stimulator under development for Food and Drug Administration approval to restore bladder function after spinal cord injury. Methods In nine cats under anesthesia, two tripolar cuff electrodes were implanted bilaterally on the pudendal nerves and one bipolar cuff electrode was implanted on the right pudendal nerve central to the tripolar cuff electrode. The pudendal nerve stimulator was implanted subcutaneously on the left lower back along the lumbosacral spine and connected to the cuff electrodes. In five cats, a double lumen catheter was inserted into the bladder through the urethra to infuse saline and measure bladder pressure and another catheter was inserted into the distal urethra to perfuse and measure the back pressure caused by urethral contraction. In four cats, a bladder catheter was inserted into the bladder dome and the urethra was left open so that voiding could occur without urethral outlet obstruction. Results The implantable pudendal nerve stimulator was controlled wirelessly and successfully provided the required stimulation waveforms to different cuff electrodes. Pudendal nerve stimulation (PNS) at 5 Hz increased bladder capacity to about 200% of control capacity. PNS at 20 to 30 Hz induced large (80‐100 cmH2O) bladder contractions under isovolumetric conditions. When combined with ipsilateral or bilateral pudendal nerve block induced by 6 to 10 kHz stimulation, PNS at 20 to 30 Hz elicited low pressure (<40 cmH 2O) efficient (70%) voiding. Conclusions The implantable stimulator generated the required stimulation waveforms and successfully induced low pressure efficient voiding in anesthetized cats.

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“…Gastric stimulation was associated with decrease caloric intake and gastric accommodation, but weight loss was not measured in this study because a temporary pacing device was used [42]. Of note, there is a surgically placed device of this kind in use (vBloc, EnteroMedics, St. Paul, MN, USA), which has shown 21% EWL (8% total weight loss) after 2 years [43]. …”

Section: Endoscopic Bariatric Techniquesmentioning

confidence: 99%

Current and cutting-edge interventions for the treatment of obese patients

Vairavamurthy

Cheskin

Kraitchman

et al. 2017

European Journal of Radiology

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The number of people classified as obese, defined by the World Health Organization as having a body mass index ≥30, has been rising since the 1980s. Obesity is associated with comorbidities such as hypertension, diabetes mellitus, and nonalcoholic fatty liver disease. The current treatment paradigm emphasizes lifestyle modifications, including diet and exercise; however this approach produces only modest weight loss for many patients. When lifestyle modifications fail, the current “gold standard” therapy for obesity is bariatric surgery, including Roux-en-Y gastric bypass, sleeve gastrectomy, duodenal switch, and placement of an adjustable gastric band. Though effective, bariatric surgery can have severe short- and long-term complications. To fill the major gap in invasiveness between lifestyle modification and surgery, researchers have been developing pharmacotherapies and minimally invasive endoscopic techniques to treat obesity. Recently, interventional radiologists developed a percutaneous transarterial catheter-directed therapy targeting the hormonal function of the stomach. This review describes the current standard obesity treatments (including diet, exercise, and surgery), as well as newer endoscopic bariatric procedures and pharmacotherapies to help patients lose weight. We present data from two ongoing human trials of a new interventional radiology procedure for weight loss, bariatric embolization.

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Two-Year Outcomes of Vagal Nerve Blocking (vBloc) for the Treatment of Obesity in the ReCharge Trial

Cited by 123 publications

References 15 publications

Electrical stimulation of renal nerves for modulating urine glucose excretion in rats

Electrical stimulation of renal nerves for modulating urine glucose excretion in rats

Low pressure voiding induced by a novel implantable pudendal nerve stimulator

Current and cutting-edge interventions for the treatment of obese patients

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