Medicine music: how an earbud could treat arthritis and migraines

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pple’s AirPods have been a massive success story. The wireless earphones made the tech giant £5.6bn in 2019 alone. But while they’re attractive, hands-free and convenient for listening to music on the go, that’s about the limit of their innovation. Neuroscientists in San-Francisco have developed earbuds that go much further.

They look and feel like ordinary headphones, but you can’t listen to Stormzy on them. In fact, no sound comes out of them at all. Instead, the device produces an electrical field to treat a disease that occurs when the immune system goes awry.

That’s the aim of start-up Nēsos at least. The organisation wants to harness the power of the brain to regulate immune function in order to treat a variety of conditions from migraines to joint disorders. The company has just launched out of stealth mode, announcing $16.5m in funding and promising results from a pilot clinical trial testing its earbuds in rheumatoid arthritis patients.

Rheumatoid arthritis is a debilitating condition that causes flare-ups of pain, swelling and stiffness in the joints. It is an auto-immune disease triggered when the immune system mistakenly attacks healthy body tissue. The main treatment options for rheumatoid arthritis are limited to medication, such as over-the-counter anti-inflammatory pills like ibuprofen or strong biologic immunosuppressants.

Medications that affect the immune system usually come with undesirable side effects, such as increased susceptibility to infection. And few people enjoy injecting the medicines. Worse still, many patients don’t get clinically meaningful relief from the drugs. Nēsos co-founder Konstantinos Alataris wanted to develop an alternative treatment that didn’t involve tablets or injection.

Fifty years ago, scientists believed the brain and the immune system were entirely separate entities. More recent research has found that not to be the case. The systems are actually in constant communication with each other. 

The brain influences the immune system through specific neural networks called the cholinergic anti-inflammatory pathway. “Our vision is to hack the brain – using its own electrical language – to restore the function of this pathway and create a new therapeutic option,” Alataris reveals. 
 
Specifically, the earbuds target the vagus nerve. Dubbed the nervous system’s superhighway, the vagus nerve connects the brain to major organs such as the heart, lungs and digestive tract. 

Previous attempts to tap into the power of this nerve have often involved implanted devices such as those placed in the chest to prevent epileptic seizures. With Nēsos’s product, there’s no need for invasive surgery.

Simply placing the device in the ear canal allows it to send electrical impulses to brain regions that have been found to control the immune response. The brain then sends signals back down the vagus nerve to the spleen which dampens down the production of inflammatory molecules that cause pain and other problems in autoimmune diseases.

Alataris calls this treatment approach ‘e-mmunotherapy’. He hopes the earbuds will become the first wearable, non-invasive treatment to be approved for an immune system disorder.

Nēsos earbuds. Credit: Nēsos

Early findings suggest the mission may not be so farfetched. The earbuds have already been tested in a small pilot clinical trial, published in the Lancet Rheumatology in February. The treatment was found to reduce disease severity in a study of 30 rheumatoid arthritis patients who hadn’t responded to conventional drug therapy.

Participants wore the earbuds for a few minutes a day, every day for 12 weeks. After three months, half of the patients had experienced a clinically significant improvement in their symptoms – 37% of patients achieved low disease activity, while 23% achieved remission.

“If this data is validated in further clinical testing, e-mmunotherapy can provide a viable new therapeutic option for rheumatoid arthritis patients,” said rheumatologist and principal investigator Sara Marsal from University Hospital Vall d’Hebron in a statement. “The potential for meaningful clinical benefit plus an improved side effect profile, compared to biologic therapies or synthetic disease-modifying antirheumatic drugs will drive future development efforts.”

The results will need to be validated in larger trials but Alataris says he hopes the earbuds will prove a safer alternative to current rheumatoid arthritis drugs – many of which carry black box warnings from the US Food and Drug Administration.

Before Nēsos, Alataris founded Nevro, a company that makes neuromodulation devices for treating chronic pain – research he says laid the groundwork for his new venture. “It followed similar ways of dealing with brain pathways and retraining them in order to remove the plasticity that comes with chronic pain.”

If Nēsos’s earbud device is shown to provide relief to more arthritis patients in clinical trials, it could open the door for treating other inflammatory conditions too. Alataris says the company is also developing a migraine prevention product and one that could potentially help new mothers suffering with postpartum depression.

“Targeting pathways that affect the regulation of immune function non-invasively through electrical fields is exciting,” He sums up. “Promising data is already flowing through so that's enough for us to keep going.”