Hello, and welcome to the Physics World Weekly podcast. Heart failure is a serious condition in which a damaged heart loses its ability to pump blood around the body. The damage usually gets progressively worse so that 5 years after a diagnosis, about 50% of patients with heart failure will be dead. The disease affects as many as a 100,000,000 people worldwide.
And in the UK, about 1 to 2 percent of the National Health Service budget is spent on managing the disease, with most of the expenditure related to hospitalization. So it's not surprising that scientists are looking for new ways to improve the outlook for people with heart failure and perhaps even cure the disease.
This podcast features the biomedical engineer, Stuart Plant, and the physicist, Ashok Chowhin, who work for Sirix Medical, a UK based company that's developed a bioelectronic system that helps patients with heart failure. Stewart is the company's CEO, and Ashok is its senior scientist. Here they are in conversation with Physics World's Margaret Harris.
As well as chatting about the company's work on treating heart failure, Ashok and Stewart also talk about other applications of bioelectronics and the challenges and rewards of developing medical technologies within a small company. Okay. So first question, Stuart. What medical problem is CERiX trying to address here? Well, the first, medical problem we're looking to address, and there are actually multiple applications
for our technology. But in the first instance, we're looking at a disease called called heart failure. Now heart failure occurs when you've had, you know, heart attack, you've had chronic hypertension. Maybe, you know, these days you have to think about COVID and infections that that can affect the the muscle of the of the heart. But basically some incident has caused caused damage to the heart and the muscle has been has been damaged. Some of it
may have died. Some of it has become dysfunctional or at least immobile, but your heart basically can't work as, as well as it, as it once did. So it means that it's not supplying as much blood to the body and your body doesn't like this. So it kind of activates various compensatory mechanisms. It will push your blood pressure up and increase the volume of, of, of fluid basically in your body. And it will cause your heart to beat harder and it will cause it to be beat faster.
Now this is one of the nature's quite good at these types of mechanisms. And it does, it does provide compensation for that decrease in cardiac output from the, from the damaged, damaged heart. So it is kind of restoring its blood supply. But now you've got a heart which is damaged already, which has been made to work harder. And as with any muscle, if you don't rest it, once it's been damaged, the the injury just gets worse.
So heart failure occurs when the body reacts to this initial initial injury and drives the heart on. And then over a period of time, that injury just gets worse and worse and worse. And the structure of the heart becomes more abnormal and the function of the heart just becomes poorer and poorer. And what this means for patients is that eventually they start to experience feelings of breathlessness. They can't exercise in the
way that they once they once did. But as the heart gets worse and worse, eventually you can't even get out of a chair. Making a cup of tea becomes exhausting exhausting. And ultimately, these patients, you know, they end up on oxygen 24 hours a day. They end up in bed. They end up in hospice care. And then unless they get something extreme like a heart transplant or maybe a, an LVAD heart pump device, ultimately, they'll they'll sadly, they'll die.
So at the moment, there's about, you know, if, I mean, if you Google it, it's it says that there's about 30,000,000 people in the world with with heart failure. That's a bit of a European US centric number, right, I'd say. I mean, on average, there's about 2% of the adult population has heart failure. So it's probably more like a 100,000,000 people worldwide currently have heart failure. And the survival rates for these patients are
pretty poor. So on average, 5 years after diagnosis, 50% of the patients with heart failure will be dead. And in fact, in the 1st year, 30% will will probably die after the initial diagnosis. Moment the, you know, medications are directed towards, you know, trying to control the symptoms of heart failure. So they'll try and, you know, give you a better quality of life, improve your exercise tolerance. And a lot of them are trying to, you know, maybe slow the
heart down. They give you beta blockers, slow the heart down. They'll give you ACE inhibitors, dilate your blood vessels. And that's trying to relieve the strain on the heart. So trying to release the extra strain on the heart and try and prolong the, the lifespan of the, of the heart itself. But they're not really getting to the core of the disease itself and trying to, trying to treat and basically reverse and cure this disease. And that's why Ceryx is, is a, is a bit different.
So you've talked a little bit about what the existing treatment is in terms of oxygen, ultimately a heart transplant or a physical device to help the heart continue to beat. How is Ceryx's technology different from that? How is your solution different from that, I should say? Well, CERECS came to this problem, I I suppose in a bit of a convoluted way, really, to be honest. I mean,
I I I we're 2 academic founders. 1 was a cardiac physiologist in Bristol, and he was studying a phenomenon called respiratory sinus arrhythmia. Now this is a natural synchronisation between the heart and the lungs. Your heart and the lungs are linked. So that when we're, when their system's healthy, they'll work together to optimise the performance of both of those organs. And put simply, when we, when we breathe in our hearts accelerate, our heart rate goes up
very slightly. And when we breathe out, our heart rate goes down very slightly. Now it'd been known for us, you know, it's a couple of 100 years since this phenomenon was first identified, but no one really examined as to why, why the body would bother to do this. More recently in the, you know, the recent decades, people have started to look at why this phenomenon occurs and have discovered that it actually brings quite a lot of benefits to both organs.
So most obviously, you know, when we breathe in our lungs fill with oxygen, so our heart accelerates to to to pump as much blood as possible around the lungs to aid with the gas exchange. Also, you know, our lungs are in our chest. When we breathe in, we lower the pressure in our chest to allow the air into our lungs. Of course, our heart is in our chest as well. So now the heart's in beating the lower pressure environment, so it takes less energy for the, for the, for the heart to be.
And now there's a growing body of evidence in the literature around, you know, the all these little benefits that RSA bring to their cardiovascular assist, cardio respiration. Now Julian was looking at well, he was looking at this phenomenon in itself and he was also looking at the we have this RSA when we're young and healthy and we it's enhanced in athletes. It's also present in all vertebrae animals. So even, you know, even fish display some RSA type mechanism.
You know, so that when we get diseases like heart failure, you lose this, this RSA mechanism, the synchronisation between the heart and the lungs. So Julian's hypothesis was, if you could put RSA back into patients with RSA, would it restore the benefits of this mechanism and could that potentially be therapeutic? And the problem Julian has was that restoring this link is actually bit of a more of a complicated problem than it than it might first appear.
But fortunately, he he kind of received an email from a physicist at at Bath University, who is looking at synchronization between nonlinear oscillating systems. Now where you get a lot of nonlinearity is in is in biology. Biology seems to love nonlinearity. So although it's not a natural place for maybe a physicist to be looking, they they tended to look towards biology and looked at
things like your legs. Your legs to a physicist in in in in their field would is just, are just a couple of oscillators. Not linear oscillator, like, but it's keeping synch, allow us to walk and then to run. And how is the body able to to do that? How are we able to change our gait? How are we able to go from walking to running, trip on a stick, and actually not fall over? And I suppose it is is an interesting physics problem.
So So the physicist in question was Alan Nogaret at Bath and he had, you know, been studying this for some time and had come up with, basically, a paper, an electronic representation of the MEC control systems that the body uses to control these nonlinear oscillators. And now he had these devices and he sent out a blanket email, I think, to Bath and Bristol University saying, I've got this technology. Does anybody have any ideas of what I should do with it? Now, fortunately,
Julian saw the email, got in touch. And that's really how how, Cerrits came about. So we spent, you know, that, that was, well, I always started from 2016, but I think those guys have been working on it prior to, to that. But we've spent since about 2016, trying to develop Alan's technology into something which we could eventually use to re, reestablish this connection between the heart and lungs, restore RSA.
And at the moment we're trying to identify whether, whether doing this has a therapeutic effect on patients with heart failure. Okay. I wanna bring in the ASH Lock here. You know, can you tell us a bit more about the technology and how that actually works? So as Stuart just touched on the respiratory sinus arrhythmia, how it is beneficial to the body, and you find that in healthy, humans. But in heart failure, that respiratory sinus arrhythmia doesn't exist.
And another aspect of, respiratory sinus arrhythmia is that, heart rate variability, which is a good sign, again, present in healthy humans. So that heart rate variability is lost in heart failure in patients. So our technology, what it does is it mimics neural networks in the body, called central pattern generators, and these neural networks have specific tasks. They can generate rhythms without rhythmic inputs.
And so, our electronics basically emulates those neural networks, and it generates rhythms, in coordination with restoration, and other, inputs. And it does it breath by breath Okay. To provide those subtle, respiratory sinus arrhythmia. And we we re so this way, we reinstate the healthy respiratory sinusoid pneumonia in the heart failure patients. And the, physiological improvements found was the increase in cardiac output by about 18 to 20% in the heart failure.
Just to give a reference, 3% is considered significant. So, yeah, if you if you could put this in a pill form, it would be flying off the shelves and selling out. Yeah. So what does it actually look like in a patient? I mean, I guess you've you've done some animal studies so far? Yes. So the studies have been done in small animals and large animal models. And in both cases, we had similar amount of increase in the cardiac output.
And, so in the the initial prototypes of the technology were just the electronic circuit on board and the trialed, in in the labs. But for the large animal trials, these were, again, in the static conditions in the lab. So what we're now trying to do is make them, we've got an external, pacemaker now. So and then the next stage is to make implantable, pacemaker out of this. And the electronics remains the same, but it shrinks,
of course, a bit. Okay? Yeah. So you you've got potentially something you would wear on the outside, and then the next step is to make it so you can actually implant it. Implant it. Yes. I see. Okay. And you told me a little bit, Stuart, about how the company got started. How did you get involved in it? Because you're you're not you're not one of the 2 sort of the physicists and the physiologist, or clinicians, founders. I had I had kind of an interesting
job. I mean, I'm a I'm a scientist by background, but at the time I was working for a company, it was essentially a a venture capital investment company.
Now their USP at the time was that they had relationships with universities and they signed contracts with these universities, which would allow them to go in and meet the academics, look at the, research that they were doing, look at the IP that they were producing, and then they'd have kind of first dibs on potentially investing in that technology and, and, and, and spinning it out, essentially. So my role was to, I was the guy that went into the, into the university.
So part of my patch within the, within the UK at the time to the Southwest and some of the London universities. So I'd go in all these universities, meet everyone and anything like the look of, I'd take it back to IP group at the time and, you know, pitched that we should, we should be backing this technology. So when I saw, when I saw this technology in 2016, I, I, it was, I mean, it was, I mean, I say this now, but I mean, it was the best
thing I I'd seen with the universities. I mean, this is the the RSA, as a therapy for heart failure in itself is is massively exciting. You know, this is it is one of the big healthcare challenges. The expenditure on it on the heart failure is is, you know, it's only comparable by with cancer, to be honest, at the amount it costs that the health systems at the moment. And it's as with any disease, I suppose, you know, the world's getting older, the oil's getting fatter,
and the problem's only getting worse. So that in itself is a is a is a big target. But the technology underneath is interesting. I mean, I'm not a physicist by background and I admit that, you know, I still struggle with with some of that with some of the theory behind how our devices our devices work, I could comprehend enough to see that this actually had the potential to be really a new approach to medical devices more
more generally. I mean, I think as Ashok was saying and I was mentioning earlier, I mean, it it really does look at biology. How does, how is biology able to control the complex processes that go on within, within the system? Within the, within the body. And medical devices up to this point, we've kind of taken you know, electronic technology. So the same technology in your phones or your computers. And we kind of impose that on, on the body. And the 2 things don't communicate very well. One's
a basic level. One's a digital system, communicating ones and zeros. One is a very complex analog system. So everything's, everything's 1, no everything in between. And the, and the body, that's how the body functions and trying to control that process of trying to correct biological processes using digital system in some ways, doesn't really make sense. So when you first saw what Alan and Julian were doing, you go, well, actually that makes sense. That's a sort of seamless connection
between the human body. You can feed, biological signals into this technology and it can process it as part of its natural, natural functions. Whereas, you know, digital systems, you've got to take the, take the biological signal, you've got to filter it, you've got to process it to enable it to, to maybe to feed it into the, into the medical device itself. And what that means is you get very crude, you get very
crude systems. I mean, most medical devices at the moment, a bit harsh, they just electrocute. They just electrocute in every of the body. I mean, the pacemaker today, you just get 60 electrocute the heart 60 times a second, 60 times a minute rather to control rate. You know, Parkinson's disease brain implants, it's mostly just as simple stimulation in particular area of the brain. There's not a lot of complexity there. There's not a lot of feedback.
So I thought that, you know, this first application in heart failure is incredibly exciting, but there's more to it there. I think that, you know, further down the line, certainly Ceryx's more biomimetic approach, create mimic the systems that they're trying to to control, makes makes a lot of sense. And that's kind of the premise that that it came from. So I, yeah, getting back to your question, I mean, I, I, you know, I found the technology in 2016. I
continued to work for IP Group. We, we did some early investments into, into CEREC after we spun out of, of Bath and Bristol Universities. And then in 2019, say IP group, you decided to take a different route. It's got moved away from the university model. They didn't want to, they couldn't, can we work with the universities in the same way they had before? So when they went off in that direction, not I stayed behind, and I left IP group and and joined CEREC full time.
Yeah. That's how I came about. And, Ashlag, you you are a physicist by background. How did you get interested in this this technology and and get involved in helping to make it it work? So I was a doctoral student of professor Nagar in University of Bath. And, when I was finishing my PhD, there was a this project had, was going on. And so there was a position for postdoctoral researcher in in that group, on that project. So
I found it fascinating. So I joined the project, and I spent few years developing actually the hardware and the technology and working between the labs labs of professor Norbert and professor Julian. And what was the most difficult part of that task instead of developing the technology? As there are 2 different disciplines involved, there
are challenges from both disciplines. 1st was, actually making the hardware designs and studying the dynamics that will be, dynamics of the network that will be more useful in coordinating respiration and heartbeat. And then bring bringing it, for physiological application and actually saying, for example, tuning the parameters and the range and the rate of adaptation, those kind of technical details that you have to work out from the scratch in in a different
lab, which is physiology lab. And I wasn't a a physiologist from background. So it was a learning process on 2 different levels, but, eventually, we got there. And, Stuart, what will you say in terms of what was the most difficult challenge you had from the business side of things to get this this company to where it where it is now? I'm not sure. I put I should put this out in a in a podcast, but, I mean, the the biggest problem for any any start up is always funding.
It's so so much effort is put into just, just feeding cash into, into, into the business. I mean, we're, we Ceryx has been quite, efficient, I think in the way that he's done things. You know, we've got a very, we've got a small but highly experienced team. We've also been quite smart in how we've been using sort of external subcontractors just to kind of keep sort of overheads overheads down and proceed as, as efficiently as possible.
So our cash requirements have been kept to a minimum, but it's but it's just been so difficult to to raise the to raise the money. I mean, one of the things that you want to do with any development program is is to keep momentum. You've got to keep pace up. And sometimes doing that alongside funding timescales is just really, really hard. I mean, on the one hand you have, you have grants. Sometimes they have like ludicrous process which can take, you know, 12 months or so.
And, you know, that just doesn't fit with a fast moving, startup. You know, we've, we've 12 months' time, we'll have we're in a completely different place than where we were 12 months ago. Trying to plan that ahead is quite difficult.
Investment in the account I mean, I think that we, you know, we were unlucky, I think, in that, you know, when we really started to move around sort of 2018, 2019, we started getting into the sort of pandemic type period and then everything became a lot more difficult. Funding became a lot more difficult. I mean, even now, you know, investors tell me that they're having difficulty raising money. So us raising money from then, everything was quite difficult. I mean, we were
we did well. We wrote we closed a pretty large round, nearly nearly 3 years ago now where we we wrote oversubscribed. But even then, it was, you know, it was it was a 14 month process, I think, to to to. I do think as well that, you know, working in the space where, that we are, I mean, investors have a, to be fair, I mean, I've been one, so I know that investors have a hard time with it. They, they look at a lot of technologies, a lot of companies, there's a lot of
information that they take in. And very often, you know, they, they they're dealing with the business side and they come from a financial background. And I'll sit them down in front of a physicist and just go, come on, why don't you appreciate how brilliant this is? And it's really hard for them to do that. But I mean, it is particularly hard, I think for CEREX because we, as Ashok said,
we encompass so many different aspects. We've got, you know, cardiovascular physiology, we've got electronics, we've got physics, we've got mathematics. And part of the beauty of what we do is in the complexity of the technology. It's why, you know, it's why we've been able to achieve what we have with RSA with other other people may not have been able to because it is, it is quite complex and that's
what's great about it. But trying to communicate that message in a way that people just don't investors in particular, don't just turn off and just go, no, actually this one's too hard. I'll look at the next, I'll look at the next technology. At least I slightly understand it is, is a difficult problem. I mean, and yeah, so that's my long winded answer to say, yeah, just, just, just cash. But I think any, any startup probably in the world will say
exactly the same thing. Just, just sourcing funding for, for even, it doesn't matter how brilliant your idea is. Getting getting cash to fund it is always the challenge. And I understand you're you're about to enter, a new and and differently challenging phase for the company. You're you're starting your first in human trials. What sort of challenges does that bring? Maybe, Ashlag, you wanna go first? So some of that are the regulatory
approval we need. It takes a very long time and longer document preparation. And even before that is the preparation for the technology that will be evaluated for regulatory approval. So we again, then we have to coordinate, as Sushu said, electronics, physics, and mathematics, and everything. And we have to commit to a design of the technology. There can be other versions, improved versions later on, but we have to then commit to a certain design before
we file for the regulatory approval. So that was a challenging part from my side, and I think Stew can add further. So from from the clinical side, I mean, we as I said, we've we've been pretty efficient, I think, in the development. We went from a we went pretty much from a standing start to a, an MHRA approved class c medical device in about 2 years, which is pretty good going. And then we thought, right, we just gotta just gotta put it on a patient now. It's all been approved.
And, it actually is been incredibly incredibly challenging. I mean, obviously, you know, the patients we're dealing with are really quite really quite sick. I mean, heart failure is a serious condition. For this clinical study, we're taking patients who have got heart failure, who are going in for a coronary artery bypass graft operation. Now why we were interested in these patients is because these patients as part of standard clinical care
are fitted with an external pacing device. So when they go in, they go in for the procedure and just when the surgeons finish, you'll put a couple of pacing wires, 1 in the atrium, 1 in the ventricle. And these wires then just come out through a through a hole in the chest and a patient is stitched up. And when they get taken down to the ICU, they'll they'll have a an external pacing box. And that just controls their heart rhythm as a
surgeon who recovered from the anesthesia. They can be at sort of high risk for arrhythmias there, so that prevents that from happening. But generally what will happen the next day is the cardiologist's surgeon will come round. They'll turn down the pacing on this device. And if that patient's got a normal sinus rhythm, they'll turn that pacing box off. Generally, the wires stay in for a couple more days
just in case the pacing's needed. But eventually, the nurses will just come around and they'll just basically just tug on the wires and it they come off the outside of the heart and they'll stitch them up and away they go. So we were interested there because that's an opportunity for us to where pacing is huge without having to implant the device into the patients. What we've done for this first study is taken our technology and integrated it with an existing external pacing
device. So they can be fitted with that pacemaker when they come out surgery and just give a normal pacing. And then when they're ready to come off that pacemaker, we switch it over and then it gives them their delivers RSA pacing. And we'll just leave that on for the duration that patient remains in hospital, which is, you know, typically about sort of 5 days or so. So I'll give this first indication of the kind of safety
and feasibility of RSA patient in patients. But maybe also we'll get some early indications of efficacy. You know, we're that's what we're hoping. But lot there's a lot going on there. I mean, these patients, as I say, these patients got heart failure. They were going in for a coronary artery bypass. There are risks to that, to that, to that operation.
So, you know, getting that ulcer approval as Assoc Sheikin said is quite challenging, but then also getting the patients into the study are quite difficult. One problem that we didn't expect that we've found in these early weeks of the study is that often these patients are being admitted to hospital several weeks before they have their surgery.
Now sometimes they've kind of got themselves in a bad way because maybe they haven't been able to manage their diseases as well as they, as well as they might. One of our first candidates had quite severe diabetes and hadn't been very good at managing that diabetes. So of course, when they came into the hospital, the nurses were all over them. They they optimized their their their therapy. They monitored their
diabetes properly. And what we found was that this patient was quite unwell when they came into hospital. By the time they came out and had the surgery, they were actually too healthy to be included in our study. So it's great for them, but, yeah. And actually that's happened quite a few times now. So it was this problem of the it was basically the hospital was doing the job too well. They were we're, like, making these patients well for us.
And then, you know, occasionally you get complications from the surgery, you know, one guy unfortunately got a bit of a bleed after the surgery, had to be readmitted. I mean, he was fine after the surgeons had another go, but, but, you know, it excluded him from the study. So it's it's it's a it's an interesting but frustrating period. You know, as scientists, we used to set up our experiment and then we do
the experiment. Here we've got, you know, health systems and patients and medicine getting in the way and it's, it's, it's, yeah. It's making me call my hair out at the moment, but we're getting there. How long has this clinical trial's meant to last, and then what happens after that? So we're gonna we're gonna look for a sort of a we're looking sort of 12, 18 month recruitment period. We've we've actually gone quite large with, with this study.
So normally as a sort of first in human evaluation, we go for about sort of 15 patients. Based on the data we saw from the preclinical work, we've kind of pushed it to 30 patients because we sort of based on the human animal data, maybe if we recruited that many patients, we might start to see some, some significant indications of efficacy in these, in these patients. Now there's 2 ways that this could go after, after this study.
We've, we've sort of, you know, this is a first in humans, so we just want to show that RSA pacing is safe and that provides us as a gateway to then take the next step, miniaturize our technology and implant it with patients with more straightforward heart failure, and then pace them over a longer period of time. That gives us a much that gives us, you know, months of therapy rather than the days of therapy that we're getting this study.
And then we should get an indication of the full effect of of RSA therapy. However, there is the possibility. I mean, all patients that go in for, for, for heart surgery generally have depressed cardiac function when they come out. The heart's been, you know, your chest has been open. The heart's been messed around with its, you know, it doesn't like. It. So your cardiac output probably is going to be down for a few days to, you know, few days to a few weeks post surgery.
Now with most patients, it slowly recovers and the patients will feel better as that, as that comes around. But there are patients about 15% of patients where that, that recovery never really happens. And there'll have to be additional interventions to try and, make up for this, this deficit in cardiac function.
So if we had a device whereby, you know, these patients are getting pacemakers anyway, if you fitted them with an RSA pacemaker, we'd not only protect them against those arrhythmias, but would also improve their cardiac function. Would that mean that those 15% of patients never, you know, get that prolonged depressed, cardiac function. And also all patients, the quicker you can improve their cardiac function, the quicker they're going to recover and the better they're
going to feel. So maybe it would be a solution for all patients having, having reduced cardiac, having cardiac surgery. So there is there is kind of 2 possibilities for this study. 1, you know, it's just the, you know, the first stepping stone in our development for long term therapy for heart failure, but also potentially it's a new therapy for all patients going in for cardiac surgery. And we'll just have to,
just wait and see. Now I understand that that, you know, this is you're looking at at cardiac applications of this sort of, you know, your the core technology in the first place. Are there any other areas where this, you know, sort of I guess you could see appreciation of of the nonlinear nature of the body signals could and and coupling an external or implanted electrical device to that. Are there other applications where that could also be effective clinically?
Yeah. So, I mean, if if you know, just to throw a few examples out there. I mean, you know, you said, you know, the body's full of nonlinearity, and we think our technology will be ideally suited to a more physiological control to these mechanisms. So one area that Ashford's been looking at is, a condition called dysphagia, which where you ability to swallow. And this most commonly occurs after people have had a had a stroke.
Now swallowing is is a coordination of about a dozen muscles within the within the throat, And they all have to have, they all have a rhythmical contraction, which needs to be coordinated. There are medical device therapies out there for dysphasia, but they tend to be, you know, a single point, electrical stimulation of the throat or they are special foods that makes it easier for the for the patient to to swallow.
Whereas our technology, we're really good at taking input from those 12 muscles, which were currently dysfunctional and then coordinate their contraction into the appropriate rhythm to to enable swallowing. There obviously are the your di rest of your digestive tract also is coordinate is a coordination of multiple muscle, give that peristaltic motion. And there are certainly plenty of patients out there that have, problems with the, lower digestive tract.
The example that I started with of your legs is, I suppose, is the most obvious one. And that's really the kind of ultimate application for our technology. I mean, Ashok talked about central pattern. Right? Is those those networks of of neurons in your in your spine are are amongst the most complicated ones that we thought we might we might tackle. But, I'm a little cat story. I had, people have told me to stop telling the cat
story, but it's a bit off tangent. But basically if you go, if you go on YouTube, there is, and you can find it, there's a black, grainy black and white image, video really. And I imagine it's black and white because you probably can't do these experiments anymore, but what they've done to it, they've taken it out and they've decerebralized the cat. So basically severed the connection between the cat's brain and
the cat's legs. So you would assume this cat to be paralyzed, but what they do is they take the cat and they put it onto a treadmill. And as soon as the cat's feet touch the treadmill, it starts to start to walk and they'll turn the treadmill up and the cat will start to run. And they, for some reason, they put a little trolley on the back of it
and they pull the car. I don't know the necessity of doing that, but it just shows that it can change the gait, I suppose, of, of the animal, even though there's no connection there between the brain and the, and the, and the legs. Now I'd always assume that your brain had something to do with your ability to walk, but it seems that you just like where you want to go and then your legs kind
of control themselves. And the way they do that is they send sensory inputs up to the spine, the central pattern generators process that information, then send the, the stimulator impulses down to your legs. And that provides the coordination of the muscles, which allows us, which allows us to walk. And that experiment that they performed, which is demonstrating that the legs is mediated by the nerves within the spine, rather than also
the brain. So for us, that means that someone who's had a, a spinal cord injury, maybe it's even severed to the spinal cord, we could set we could rep those central pattern generators in the spine and restore the ability to to walk. Like Stuart explained, so these are central pattern generators that control the rhythms and then stimulate the muscles, and that generates different gait for the legs. And if there's somebody's amputated, and they can be used to control those artificial legs.
But the control of arms is even more complex where you have different, fingers and different grip sizes. So this nonlinear dynamics of the central pattern generators can then be used to control the movement of arms with different crypt levels. If you imagine the complexity of the network, it can be extended by adding more neurons to it. And this would presumably require quite a lot of computational power as well.
It would. And if it's to be done digitally, but in analog systems, it can be done much more efficiently, because it'll be real time, as it's a nonlinear and continuous time signals generation. So the and lots of parameters are already defined so that you, ma'am, you'd you won't have to look for the certain level of inputs and then make decisions. It will be much more dynamic than that. So that's where the true power of the continuous systems, will be in nonlinear systems, will it?
Well and so final question for for both of you, actually. You know, what do you know now that you wish you knew when you started this journey back in 2016, in your case, Stuart, and when you're starting on your your postdoc Ashok? I mean, it's certainly the I mean, there are some of the boring ones and you can fill them out. So, I mean, I think the I think the clinic I think the clinical side of things has been a
bit little bit of surprise. I mean, I think that when we when we when we can we thought the message the biggest challenge was gonna be the regulatory approval for the device, but we were actually pretty pleased with the way with the speed with which, you know, the the authorities processed, and evaluated our technology. And that was really straightforward.
Getting into the clinic, I was warned, I think, that it would take 6 months from that point to, to getting the first patient in, and I didn't believe them. And they were right. And they were right. And, yeah. And I, I didn't appreciate that the just what is involved with what seemed to be a relatively straightforward straight. In terms of starting out the I think that it took us a little bit of time.
I mean, the the thing about our technology is that the the clever bit is the is the, you know, this this this this core technology, I say, that's actually the the tech. The rest of the device, you know, we talked about this the the clinical study being involving an external pacing system that we've modified with our technology. So 99% of the device is is just a standard pacemaker and the implantable will be exactly the same. It's just a pacemaker with our with our chip
in place. So I think we started with the premise that, you know, let's let's go and talk to Medtronic or one of the other big corporates. They'll give us their pacemaker. We'll put our chip in it. And there we go. That's, that's, that's, that's kind of done. And there were 2 things that we've learned over the years. 1, they're not prepared to do that.
And 2, we don't need them to do that actually because because this technology has been around since the fifties, most of the most of what's required is there is available from particular support. The technology and the challenge of putting them together is not, is not that great. So I think we're much more self sufficient now than we were, you know, 3 or 4 years ago. When we in terms of the route that we're choosing to develop this technology, it's like, you know,
no one's gonna help you do this. You just gotta do it yourself, but actually, doing it yourself is probably the most efficient way to do it anyway. So Ashok, do you have anything to add to that? I I would add from my point of view, I think transition from academia to industry has been a big learning, although you hear lots of suggestions, they're all valid, but experiencing them and actually, dealing with them is a slightly different
story. But, especially with the start ups, things are very dynamic. And the key difference between academia and industry is the pace at which you can do the things. Of course, a lot of academic work has been done. And when you're making a product, even if it is that level of complexity going into human body, you can do things much faster than in academia. And so you need to be mentally prepared for that dynamism in the startups. And, the other is the communication.
So especially in our case, because there have been multiple disciplines involved. And as Stuart mentioned, investors who are not from science background or physics background, to convince them. So you need to speak at multiple levels, of complexity and the details. Oh, and it's a learning process. I'm still learning, and then but I think I've come a long way. There's a long way to go as well. Well, thank you both for for, coming and and and talking to me today. I really
appreciate it. Stuart Naschach, thank you very much for joining us in the Physicworld podcast. Brilliant. Thank you very much. I'm afraid that's all the time we have for this week's podcast. Thanks to CRX Medical's Stuart Plant and Ashok Chowan for a fascinating discussion, And also thanks to Margaret Harris for asking the questions, and to Fred Iles for producing the audio in this podcast. We'll be back again next week.