Jan-Erik Juto was not really going to become a physician. He studied at KTH Royal Institute of Technology and graduated in engineering physics. His master’s dissertation was about mathematics, a subject far from the clinical reality that would one day become his everyday life.

But something was bothering Jan-Erik while studying mathematics, physics and chemistry. At the same time, his identical twin Nils, was studying medicine at Karolinska Institutet.

It was when Jan-Erik was leafing through his brother’s books that he realized that this – people and their well-being – was what he wanted to devote his life to.

Jan-Erik never pursued an engineering career. At least he never had the title of Civil Engineer on his business card – but that hasn’t stopped him from using what he once learned during his years at KTH.

Instead of an engineering career, he continued his studies, this time at Karolinska Institutet. There he eventually earned his medical degree, and over time came to specialize in ear, nose and throat diseases. In that role, he became known for handling complicated surgeries that others avoided. Perhaps it was his technical interest and talent that shone through.

“In a way, surgery is like fixing bicycles,” he says. “But of course, the consequences of failure are much, much worse. There’s no alternative to success.”

His medical career also led him into research. And that’s where the story of INMEST began.

The harvests of chance

Jan-Erik became interested in nasal congestion. Simply put, he began researching nasal congestion and its causes. This was during the “sick building” epidemic that emerged – or at least was discovered and brought to attention – in the 1990s.

It seemed that nasal mucous membranes could react to levels of moisture and mold that were well below the limit values that applied at the time. But there was no good way to objectively measure the swelling.

Thanks to his engineering training and a certain amount of persistence, Jan-Erik managed to design a measuring device that addressed this shortcoming. He built the first versions of the equipment himself.

Using the equipment, he was able to see that the nasal blood vessels of people who had stayed in schools damaged by dampness – one of the most common and well-known types of sick buildings – were leaking fluid too easily. Eventually, he also saw signs that there was a connection between the nervous system and inflammation, and that inflammation could be affected by irritating the nervous system.

Immunology for the layperson

Before we continue with the story of INMEST, it may be appropriate to provide an orientation on how the immune system works.

The immune system consists of two parts. The non-specific immune system is the one that first attacks an infectious agent that enters our body. The specific immune system is slower in getting started, but on the other hand becomes extremely effective once it is in place. It is the one that learns to recognize different infectious agents that it has previously encountered.

Unfortunately, the immune system can also start to react to things that are not actually dangerous at all. Sometimes the immune system can even start to attack the body’s own tissues, known as an autoimmune reaction. Exactly what causes the immune system to act in such a way, no one knows. One theory is that certain viruses can confuse the immune system to the point that it can no longer keep track of friend and foe. But that is just one of several hypotheses so far.

Whatever causes the autoimmune reaction, it causes inflammation. It’s basically the same phenomenon as when you prick yourself on a rose thorn and your fingertip gets hot and starts to throb. This type of reaction is seen in a variety of autoimmune diseases, such as psoriasis, inflammatory bowel disease, rheumatoid arthritis, and many others.

There are indications that many, or perhaps all, of these diseases have similar or the same causes. One such sign is that the same type of medicine helps against very many of them. There are even researchers who have considered whether the different diagnoses can be considered different manifestations of the same disease.

Many of the body’s functions are controlled in whole or in part by the autonomic nervous system via the vagus nerves. The immune system is no exception. Therefore, it is not surprising that stimulation of the parasympathetic system also has effects on the immune system and inflammation. This is known as the so-called cholinergic anti-inflammatory pathway.

Not INMEST – but almost

The insight that stimulation of the nervous system could affect inflammation led to new considerations. Could this be used to treat disease? How do you actually stimualte a nervous system in the best way?

As a natural continuation of Jan-Erik’s studies of nasal congestion in the 90s, non-allergic nasal congestion was the first disease for which there was a clinical trial with the treatment principle of stimulating the nasal sensory nerves with vibrations. The study showed reduced nasal congestion after treatment.

Jan-Erik’s colleague neurophysiologist Rolf Hallin, heard about the technology early on and suggested that the treatment should be tested on migraine patients. This led to a pilot study on migraine. A number of patients were treated, with results ranging from good to fabulous. Clearly, they were onto something!

An easier treatment and improved equipment

Treating through the nose means that the treatment is given in a rather narrow and sensitive area.

The first version of nasal stimulation with vibrations was very low-tech, originating from a modified aquarium pump. The equipment has evolved significantly since then, but the principle is still the same. Variable air pressure in a tube causes a balloon or bladder at the end of the tube to vibrate. By pressing the bladder against the nerve cluster high up in the nose, nerves leading to the hypothalamus and vagus nuclei are stimulated.

Nowadays, the pump is calibrated so that the vibrations are at the frequency that has been shown to give the best response. The entire device has been reduced in size, so that it fits into a unit that is easily held in one hand. The probe – the tube with the bladder – is now made in one piece and so small that it causes minimal discomfort when the probe is inserted into the nose.

But the principle is exactly the same as with the prototype Jan-Erik once built in the kitchen at home.

Better results

However, one thing that separates today’s INMEST from its aquarium pump-driven origins is the research results. Back then, more than ten years ago, there were certainly a lot of success stories from patients with various autoimmune inflammatory diseases who were treated with the technology, but results from medical studies were lacking.

Today we have those. Much remains to be done, of course, the research is, as they say, only in its infancy. But the results of the studies that have been carried out so far are just as promising as Jan-Erik hoped at home in the kitchen.

And more studies are underway!

You can read more about completed and upcoming studies here.

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