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- "Neurodegenerative diseases are increasingly being diagnosed in young people"
"Neurodegenerative diseases are increasingly being diagnosed in young people"
Neurotechnologies are rapidly developing in Russia, many of them already go beyond laboratories: from eye tracking and VR rehabilitation to thermogenetics and neuroprostheses capable of transmitting tactile sensations. At the same time, brain diseases themselves are getting younger, and this poses new challenges for science. In an interview with Izvestia, a Russian neuroscientist, director of the Federal Center for Brain and Neurotechnology of the Federal Medical and Biological Agency, Chairman of the scientific Committee of the National Prize in Medicine, told how the brain pays for sleep disorders and what technologies today give a chance not just to treat the consequences of diseases of the nervous system, but to influence the mechanisms of disease development. areas of future technologies "Challenge" Vsevolod Belousov.
"Smartphones are knocking us out of the rhythm of life that is familiar to biological beings"
— Vsevolod Vadimovich, how are the statistics on brain diseases in Russia changing today, for example, the age structure?
— You can often hear from various sources that a stroke is getting younger, but here the situation is rather stable and even moving towards improvement. But neurodegenerative diseases are increasingly being diagnosed in young people. We do not yet know for sure whether cognitive dysfunctions have really become younger or whether we have simply learned to identify them better.
The fact is that Parkinson's disease, which used to be considered exclusively for the elderly, now occurs in fairly young patients — among people 40+ and 50+. The same is true for Alzheimer's disease, amyotrophic lateral sclerosis, and a wide class of neuroimmune and neuroinflammatory diseases such as multiple sclerosis.
— What could this be related to? Are there any key factors that science is currently looking at as possible causes of the age-related shift in these diseases?
— We can only assume. This is stress, lack of or abnormal sleep patterns. During the day, small "breakdowns" and waste products accumulate in the brain, and it is during sleep that the brain gets rid of them. Therefore, quality sleep is absolutely crucial.
In modern people, especially in megacities, the system of excitation and inhibition is seriously disrupted. Both the light mode and gadgets are to blame for the malfunction of the nervous system. The widespread use of smartphones leads to sleep disorders, which means that micro-damage accumulates at the molecular level. The immune system tries to "clean up" these damages, but its activity carries risks of inflammation. Cascades of molecular events that reinforce each other arise, and, apparently, they lead to the fact that these diseases become younger.
— So smartphones are a risk factor for the brain?
— It cannot be said that gadgets are a direct cause of Parkinson's disease, for example. Rather, smartphones knock us out of the rhythm of life that is familiar to biological beings. This is one of the factors.
— Previously, medicine mainly struggled with the consequences, but now they are increasingly talking about the impact on the mechanisms of the disease. Is it possible in the field of brain pathologies?
— Where we begin to understand the molecular mechanisms, medicine is really moving forward. For example, in the field of neurodegenerative diseases and epilepsy, there are hereditary cases where we clearly know that a specific mutation in a particular gene leads to pathology, and we can act either pharmacologically or with the help of gene therapies. But if we take the entire spectrum of neurodegenerative diseases, then hereditary forms account for only 5-10%. The rest are sporadic cases. There may be some genetic abnormalities that increase predisposition, but there are many of them, and we still can't say for sure why one patient got sick and the other didn't.
Artificial intelligence systems that can work with large amounts of data and see patterns that are inaccessible to the human eye can help us here. Early diagnosis methods are also important. Even if we don't know why the pathological process starts, we can detect it at a pre—symptomatic stage - 10-20 years before the appearance of obvious signs of the disease — and significantly slow down the progression.
"Many of the modern techniques came from rehabilitation"
— The Federal Center for Brain and Neurotechnology of the FMBA unites fundamental science and a clinic. What recent developments have already emerged from the laboratories and are beginning to be used in the treatment of patients?
— One of these projects is the Center for Cognitive and Psychoemotional Health of the FMBA of Russia, established in 2024 on behalf of the head of the agency Veronika Skvortsova. Its goal is to identify the initial forms of cognitive decline in practically healthy people at an early stage. If we find them, we use a whole arsenal of methods: cognitive training, physical exercises — all this is selected individually.
For example, if memory is impaired, then training will be aimed specifically at improving it. If attention suffers, we work with attention. It's a kind of fitness for the brain. And such training can actually significantly slow down the progression of the disease. Especially if we simultaneously normalize sleep, nutrition, and reduce stress levels, including through biofeedback technologies.
— What else is new in terms of technology appearing in the arsenal of neurologists?
— Many of the modern techniques have come from rehabilitation, where they have been successfully used for a long time. It turned out that they also work well to slow the progression of neurological diseases — even before the appearance of severe functional disorders, such as problems with walking or speech.
Among the most promising are brain—computer interface technologies, primarily non—invasive, based on electroencephalography. Biofeedback methods are also actively developing. They allow you to literally "teach" the patient to re-control his body.
— Tell us in more detail how such systems work.
— For example, a person's arm does not move after a stroke, although the limb itself is healthy. The problem is that the area of the brain responsible for controlling this arm is damaged. We need to retrain the brain so that other areas of it can take over this function. Virtual reality technologies come to the rescue here: we put VR glasses and an EEG helmet on the patient. The task of electroencephalography is to detect the moment when a person is just trying to move his hand.
In virtual reality, the hand moves — even if in reality it remains stationary. This sends a signal to the brain about the success of the action and forms an important feedback loop. In the next step, we connect a robotic device that helps the hand make a real movement in response to an impulse from the brain. Gradually, we remove the robotic support, and the person begins to use his own hand. This combination of VR, neural interfaces, and robotic support is already being used in clinical practice.
— Do you develop rehabilitation systems using the power of thought or gaze?
— An important area for us is eye tracking, that is, tracking eye movements. These technologies can be both diagnostic and therapeutic. Using micro-movements of the eyes, it is possible to accurately diagnose certain conditions when the brain is malfunctioning.
Eye tracking is especially valuable for patients in the early stages of rehabilitation, when they are still immobilized, for example, after a cervical injury or stroke. They can only move their eyes, and with the help of a communicative eye tracker, they can type text on the screen or select answers by moving their eyes. It is not only a way of communication, but also a training of cognitive functions.
We develop such devices ourselves in cooperation with the Rosatom State Corporation. They are now close to mass production.
— Neuroprosthetics is another area that is actively developing. Tell us, what is happening in this direction?
— We have opened a Center for Cybernetic Medicine and Neuroprosthetics, a joint project with the Motorika company, one of the leading manufacturers of bionic prostheses in the world. These prostheses allow a person to perform grips, encode gestures, removing information about movement from the muscles of the stump using electromyography.
But we have gone further and are developing prosthetics that can sense objects and transmit this information directly to the nerves. This is a multicomponent technology: VR is needed here for pre-prosthetic training, and work with phantom pains that often occur in patients after amputation.
Phantom pain is associated with a ruptured nerve: normally, it constantly receives sensory "recharge" and understands that everything is in order. When this recharge disappears, a pain syndrome occurs. One of the technologies to combat this is the installation of implants and neurostimulators in the peripheral nerve. The stimulator sends signals that "trick" the nervous system and relieve pain.
— When will these technologies become available to a wide audience?
— According to our plans, the first production models may appear by 2029-2030. We are also creating new prosthetic control systems, functional electrical muscle stimulation systems for verticalization of patients with spinal cord injuries, as well as a digital assessment system for motor disorders in Parkinson's disease. The goal is for different doctors to give the same scores on the scales when examining the same patient. To do this, we use mathematical tools and artificial intelligence technologies. This will make it possible to unify the diagnosis for other disorders.
— Tell us about technologies for people who are severely injured and immobilized. Do you have such developments underway?
— Verticalization systems for patients with spinal injuries are an important area of our work. We have a whole range of technologies: instrumental verticalization, implantation of electrodes into the spinal cord to stimulate the centers of walking activity, as well as a drug based on mesenchymal stem cells. We have now started clinical trials of this drug. Its purpose is to reduce inflammation in the lesion site during the acute period of injury.
— Your research interests are optogenetics, that is, the control of living cells using light, and thermogenetics, when temperature is used for the same purposes. What is happening in these areas now and how are they approaching practice?
— Optogenetics is used all over the world and in Russia in attempts at retinal photoprosthetics: with its help, the remaining nerve cells are taught to perceive light — this will not restore perfect vision, but it will help a person navigate. The main problem is the immune response to foreign proteins (for example, proteins from microorganisms) that are used in technology.
As for thermogenetics, we have made serious progress here. And, perhaps, we are the world leaders in this field. In mice, we have learned how to control neurons using human thermoreceptors — they do not cause an immune reaction in humans. We are currently testing the approach on models of epilepsy.: The system with electrodes will detect pathological activity and automatically suppress it with a laser or ultrasound until an attack occurs. In the near future, we plan preclinical trials on large laboratory animals.
"So far, there are no really effective drugs in the world for the treatment of neurodegeneration"
— Let's return to the problem of neurodegenerative diseases. Is it possible, in principle, to create a non-symptomatic treatment for such pathologies?
— So far, there are no really effective drugs in the world for the treatment of neurodegeneration. Strategies based on the removal of protein aggregates using therapeutic antibodies cause a stir in the early stages and show good results. But in the third phase of clinical trials, many such drugs fail, either because of side effects or because of insufficient efficacy.
— So there is still no "pill for dementia"?
— So far, apart from cognitive training, physical therapy, physical therapy and lifestyle normalization, we do not have strategies that effectively affect neurodegeneration at an early stage. But if effective drugs appear, they are likely to be universal: different neurodegenerative diseases have many common molecular mechanisms (accumulation of pathological proteins, oxidative stress, neuroinflammation, etc.). Influencing these common mechanisms can help with several diseases at once.
— This year you headed the scientific committee of the National Prize in the field of future technologies "Challenge". What can we say about this year's bid company? Are there many applications related to neurotechnology and what kind of projects are these?
— There are a lot of applications — more than 1,400, which is about twice as many as last year. Applications came from 48 countries. I would like to note separately that about half of them are from young scientists and specialists. Interestingly, the Engineering Solution nomination received the largest number of applications for the first time. This is a good signal: it indicates that applied engineering science is becoming more visible and in demand. From the very beginning, we singled out this nomination because developments that are actually implemented often escape attention, even in the scientific community.
Neuroapplications are not the overwhelming majority, but they are there, and among them are very strong works. They are highly likely to be included at least in the shortlist. The final decisions, of course, will be made by the scientific committee during the planned work.
— How do you assess the success of the Challenge Award in the international arena?
— The growth in the number of applications and their geography is the best indicator. The award is becoming more and more recognized abroad. Russian science has historically occupied a prominent place in the global landscape, and this status remains.
— If you look back at fiction, from books to movies, where the brain lives separately from the body, and technology blurs the line between man and machine, what of this can really come to life in the foreseeable future?
— Let's take prosthetics. Why shouldn't a hand have six fingers or be replaced with a specialized instrument controlled via a neural interface? Now we are taking the first steps — we are trying to "sensitize" the prosthesis, to fuse it with the nervous system.
The second promising direction sounds almost like science fiction, but it is based on biology: in the future, we will be able to control diseases through the nervous system. Nerves permeate the entire body and are involved even in the development of peripheral tumors — they can indirectly "feed" them, helping to bypass the immune response. This means that in theory, by influencing the necessary neural pathways, it is possible to influence pathological processes.
Interestingly, traditional Chinese medicine has empirically come up with a similar idea: acupuncture and acupressure are essentially the stimulation of the peripheral nervous system to trigger the necessary reactions in the body. Now, knowing the anatomy and mechanisms of nerve function, we can translate these approaches into evidence-based medicine.
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