Recent advances in facilitating the translation of bioelectronic medicine therapies

Bioelectronic medicine is a growing field which involves directly interfacing with the vagus, sacral, enteric, and other autonomic nerves to treat conditions. Therapies based on bioelectronic medicine could address previously intractable diseases and provide an alternative to pharmaceuticals. However, translating a bioelectronic medicine therapy to the clinic requires overcoming several challenges, including titrating stimulation parameters to an individual's physiology, selectively stimulating target nerves without inducing off-target activation or block, and improving accessibility to clinically approved devices. This review describes recent progress towards solving these problems, including advances in mapping and characterizing the human autonomic nervous system, new sensor technology and signal processing techniques to enable closed-loop therapies, new methods for selectively stimulating autonomic nerves without inducing off-target effects, and efforts to develop open-source implantable devices. Recent commercial successes in bringing bioelectronic medicine therapies to the clinic are highlighted showing how addressing these challenges can lead to novel therapies.