Chronic electrical stimulation with a peripheral suprachoroidal retinal implant: a preclinical safety study of neuroprotective stimulation

PurposeExtraocular electrical stimulation is known to provide neuroprotection for retinal cells in retinal and optic nerve diseases. Currently, the treatment approach requires patients to set up extraocular electrodes and stimulate potentially weekly due to the lack of an implantable stimulation device. Hence, a minimally-invasive implant was developed to provide chronic electrical stimulation to the retina, potentially improving patient compliance for long-term use. The aim of the present study was to determine the surgical and stimulation safety of this novel device designed for neuroprotective stimulation.MethodsEight normally sighted adult feline subjects were monocularly implanted in the suprachoroidal space in the peripheral retina for 9–39 weeks. Charge balanced, biphasic, current pulses (100 μA, 500 µs pulse width and 50 pulses/s) were delivered continuously to platinum electrodes for 3–34 weeks. Electrode impedances were measured hourly. Retinal structure and function were assessed at 1-, 2-, 4-, 6- and 8-month using electroretinography, optical coherence tomography and fundus photography. Retina and fibrotic thickness were measured from histological sections. Randomized, blinded histopathological assessments of stimulated and non-stimulated retina were performed.ResultsAll subjects tolerated the surgical and stimulation procedure with no evidence of discomfort or unexpected adverse outcomes. The device position was stable after a post-surgery settling period. Median electrode impedance remained within a consistent range (5–10 kΩ) over time. There was no change in retinal thickness or function relative to baseline and fellow eyes. Fibrotic capsule thickness was equivalent between stimulated and non-stimulated tissue and helps to hold the device in place. There was no scarring, insertion trauma, necrosis, retinal damage or fibroblastic response in any retinal samples from implanted eyes, whilst 19% had a minimal histiocytic response, 19% had minimal to mild acute inflammation and 28% had minimal to mild chronic inflammation.ConclusionChronic suprathreshold electrical stimulation of the retina using a minimally invasive device evoked a mild tissue response and no adverse clinical findings. Peripheral suprachoroidal electrical stimulation with an implanted device could potentially be an alternative approach to transcorneal electrical stimulation for delivering neuroprotective stimulation

An in vitro model of developmental synaptogenesis using cocultures of human neural progenitors and cochlear explants

In mammals, the sensory hair cells and auditory neurons do not spontaneously regenerate and their loss results in permanent hearing impairment. Stem cell therapy is one emerging strategy that is being investigated to overcome the loss of sensory cells after hearing loss. To successfully replace auditory neurons, stem cell-derived neurons must be electrically active, capable of organized outgrowth of processes, and of making functional connections with appropriate tissues. We have developed an in vitro assay to test these parameters using cocultures of developing cochlear explants together with neural progenitors derived from human embryonic stem cells (hESCs). We found that these neural progenitors are electrically active and extend their neurites toward the sensory hair cells in cochlear explants. Importantly, this neurite extension was found to be significantly greater when neural progenitors were predifferentiated toward a neural crest-like lineage. When grown in coculture with hair cells only (denervated cochlear explants), stem cell-derived processes were capable of locating and growing along the hair cell rows in an en passant-like manner. Many presynaptic terminals (synapsin 1-positive) were observed between hair cells and stem cell-derived processes in vitro. These results suggest that differentiated hESC-derived neural progenitors may be useful for developing therapies directed at auditory nerve replacement, including complementing emerging hair cell regeneration therapies

Soft, flexible freestanding neural stimulation and recording electrodes fabricated from reduced graphene oxide

There is an urgent need for conductive neural interfacing materials that exhibit mechanically compliant properties, while also retaining high strength and durability under physiological conditions. Currently, implantable electrode systems designed to stimulate and record neural activity are composed of rigid materials such as crystalline silicon and noble metals. While these materials are strong and chemically stable, their intrinsic stiffness and density induce glial scarring and eventual loss of electrode function in vivo. Conductive composites, such as polymers and hydrogels, have excellent electrochemical and mechanical properties, but are electrodeposited onto rigid and dense metallic substrates. In the work described here, strong and conductive microfibers (40-50 μm diameter) wet-spun from liquid crystalline dispersions of graphene oxide are fabricated into freestanding neural stimulation electrodes. The fibers are insulated with parylene-C and laser-treated, forming brush electrodes with diameters over 3.5 times that of the fiber shank. The fabrication method is fast, repeatable, and scalable for high-density 3D array structures and does not require additional welding or attachment of larger electrodes to wires. The electrodes are characterized electrochemically and used to stimulate live retina in vitro. Additionally, the electrodes are coated in a water-soluble sugar microneedle for implantation into, and subsequent recording from, visual cortex

Broadband onset inhibition can suppress spectral splatter in the auditory brainstem.

In vivo intracellular responses to auditory stimuli revealed that, in a particular population of cells of the ventral nucleus of the lateral lemniscus (VNLL) of rats, fast inhibition occurred before the first action potential. These experimental data were used to constrain a leaky integrate-and-fire (LIF) model of the neurons in this circuit. The post-synaptic potentials of the VNLL cell population were characterized using a method of triggered averaging. Analysis suggested that these inhibited VNLL cells produce action potentials in response to a particular magnitude of the rate of change of their membrane potential. The LIF model was modified to incorporate the VNLL cells' distinctive action potential production mechanism. The model was used to explore the response of the population of VNLL cells to simple speech-like sounds. These sounds consisted of a simple tone modulated by a saw tooth with exponential decays, similar to glottal pulses that are the repeated impulses seen in vocalizations. It was found that the harmonic component of the sound was enhanced in the VNLL cell population when compared to a population of auditory nerve fibers. This was because the broadband onset noise, also termed spectral splatter, was suppressed by the fast onset inhibition. This mechanism has the potential to greatly improve the clarity of the representation of the harmonic content of certain kinds of natural sounds

Intracellular data, 8 cells

The zip file contains 8 text files. Each text file is associated with a single intracellular cell recording, and contains either 3 or 4 columns. The 3rd column is the cell membrane voltage in volts, and the 4th column of numbers is the auditory stimulus data. The time step between rows is 50 microseconds

Electrical stimulation of retinal ganglion cells with diamond and the development of an all diamond retinal prosthesis

Electronic retinal implants for the blind are already a market reality. A world wide effort is underway to find the technology that offers the best combination of performance and safety for potential patients. Our approach is to construct an epi-retinally targeted device entirely encapsulated in diamond to maximise longevity and biocompatibility. The stimulating array of our device comprises a monolith of electrically insulating diamond with thousands of hermetic, microscale nitrogen doped ultra-nanocrystalline diamond (N-UNCD) feedthroughs. Here we seek to establish whether the conducting diamond feedthroughs of the array can be used as stimulating electrodes without further modification with a more traditional neural stimulation material. Efficacious stimulation of retinal ganglion cells was established using single N-UNCD microelectrodes in contact with perfused, explanted, rat retina. Evoked rat retinal ganglion cell action potentials were recorded by patch clamp recording from single ganglion cells, adjacent to the N-UNCD stimulating electrode. Separately, excellent electrochemical stability of N-UNCD was established by prolonged pulsing in phosphate buffered saline at increasing charge density up to the measured charge injection limit for the material

The response of the cell population under the influence of onset inhibition.

<p>The behavior of the separate populations of neurons is shown in response to a 65 dB, 4 kHz stimulus of 100 ms, with a 200Hz saw tooth auditory envelope. This stimulus is shown above the plot. (A) The population of primary-like cells responding to the stimulus. The lines overlayed on the plot show the frequency bands used in the calculation of the metric <i>γ</i>, a measure of the prominence of the carrier. The total number of spikes contained in the inner band is divided by the total number of spikes contained by the two outer bands. (B) The Cell-C population without its inhibitory input. The only input is via the excitatory synapses from the primary-like cells shown in (A). The results show that these model Cell-C neurons require coincidence among excitatory inputs to produce an action potential. (C) Cell-C response with the inhibition reinstated. The inhibitory input is delayed by 1.2 ms, and with the excitatory input total delay of 1.6 ms this means that the inhibitory input precedes the excitatory input by 0.4 ms. (D) The <i>γ</i> measure as a function of the delay associated with the inhibitory input to the circuit. Note that the total delay of the excitatory input of 1.6 ms is shown by the vertical line. These simulations were completed three times to indicate the low variability from trial to trial; all three resulting data-sets are presented.</p