Grégoire Courtine (Dijon, France, 1975) has a guiding principle that shapes his entire scientific career: "Suffering from paralysis should no longer be a life sentence." This mathematician turned neuroscientist is the main architect of the advances that have occurred in recent years in such a cutting-edge field as motor neurorehabilitation. In other words, thanks to his experiments, Courtine is able to restore the ability to walk to patients who were condemned to spend the rest of their lives in a wheelchair.
In just a decade, the team at the Swiss Federal Institute of Technology in Lausanne (EPFL) that he leads alongside neurosurgeon Jocelyne Bloch has succeeded in helping about thirty patients regain mobility through various techniques. Perhaps the most striking case was that of Dutchman Gert-Jan Oskam, a cyclist who lost mobility from the neck down after an accident in China in 2011. A digital bridge between his brain and spinal cord provided him with voluntary and more natural control of his motor ability. In 2023, Oskam was able to walk again with the help of a walker equipped with a system that allowed him to go much further than with simple physical rehabilitation.
Also making headlines worldwide was the treatment of 62-year-old Frenchman Marc Gautier, whose Parkinson's disease prevented him from walking normally. In his case, targeted epidural stimulation in the spinal cord improved his motor function and balance. A neuroprosthesis corrected movement problems associated with his disease, such as gait disturbances, balance issues, and freezing episodes while walking.
Prior to this, targeted epidural electrostimulation was used in a group of nine people with severe paralysis. The treatment focused on locomotor neurons that promote recovery in individuals with spinal cord injuries. After five months, all were able to walk with the assistance of a walker.
Each of these small steps has been celebrated by society and endorsed by the scientific community through publication in specialized journals. "There is no cure for paraplegia, but we have changed the way society perceives the permanence of paralysis," asserts the Frenchman, who has become a global reference in the field of neurorehabilitation. "It's not just about getting them to stand up and walk, which is the most striking, but also about improving their quality of life with invisible yet crucial changes in their daily lives."
Courtine thus highlights the studies published this Wednesday in the journals Nature and Nature Medicine. In them, he addresses other significant obstacles, in addition to lack of mobility, faced by individuals with spinal cord injuries: their inability to regulate blood pressure. "There are many imperceptible consequences to the eyes of others in individuals with motor paralysis," emphasizes the neuroscientist, who sits on the other side of the screen to discuss the latest advances from his laboratory.
Regarding the inability to regulate blood pressure, Courtine explains why correcting it is important. "When people go from lying down to sitting up, gravity pulls the blood downward," he explains. "In a healthy person, the brain compensates by constricting blood vessels to increase pressure. We only notice it when we get up quickly and feel a bit dizzy. Well, this sensation remains constant in people with quadriplegia."
To address this, Courtine's team has designed a new electrostimulation system, "different from the one that repairs paralysis." In this case, the purpose of spinal cord stimulation is to compensate for the brain not activating the neuron to constrict blood vessels. "This completely changes their life," he states. "Patients activate the stimulation in the morning, blood pressure rises, they have more energy, and can reintegrate into normal life."
Another side effect of this stimulation is that, by targeting the trunk muscles, an area where they usually have very limited control, it helps them be "more comfortable" in their wheelchairs. "Some even resume some sports activities," highlights the neuroscientist.
The therapy for hypotension has been validated in 14 patients through four clinical studies in Switzerland, the Netherlands, and Canada, each treated by independent clinical teams. "The international deployment demonstrates that surgery and therapy are safe and effective, regardless of local practices," states Jocelyne Bloch, Courtine's great collaborator. "It is a key milestone for the broad availability of this technology."
In fact, Courtine and Bloch form the "perfect pair" in the field of neurorehabilitation. They are the duo shaping their scientific advances: NeuroRestore is the academic center they founded in 2019, while Onward Medical, the publicly traded spin-off, is the company that patents and commercializes their devices.
Grégoire Courtine alongside Dutch patient Gert-Jan Oskam.
They met when Courtine had already demonstrated his neurorehabilitation skills in animals, first with mice (2012) and later with monkeys (2016). "It was a challenge to make the leap, but I found a clinical partner like Jocelyne," he says about the alliance that allowed him to combine surgical skills with devices that had already proven effective in the laboratory. "It was a big step in developing the complex technology required for humans and translating the concepts we had already developed to people, as well as designing the implanted technology."
For the scientist duo, it was crucial to "understand the complexities of the underlying mechanisms of a disease" as complex as paralysis. "I have been guided in developing neuromodulation therapies based on mechanisms that are transformative for people living with quadriplegia," he emphasizes.
A career full of "stimuli" to stand out
Before arriving at the Swiss school, the Frenchman passed through several institutions where he shaped his career. After his initial training in Mathematics and Physics, he obtained his Ph.D. in Experimental Medicine from the University of Pavia (Italy) and the National Institute of Health and Motoricity (INSERM) in 2003. It was there that his interests took shape. "Movement has always been central in my life," confesses this climber who enjoys defying gravity, both inside and outside the laboratory.
At 50, Courtine has not abandoned this hobby, dedicating time to it outside the laboratory up to three times a week. "I became a scientist because I found it fascinating to understand the complexity that encompasses all the muscles of the cerebral system to move," he states.
Between 2004 and 2007, Courtine held a postdoctoral fellowship at the Brain Research Institute at the University of California, Los Angeles (UCLA), under the supervision of Reggie Edgerton, and was an associate researcher at the Christopher and Dana Reeve Foundation (CDRF), led by the legendary actor who portrayed the first Superman and was paralyzed by an accident. "There I discovered the potential of spinal cord stimulation, which I later developed in my own laboratory in Zurich," he says. "Being part of all the work the foundation was doing then was inspiring."
Courtine's return to Europe in 2008 marked the recovery of a research talent that could have stayed in the United States like many others. His return was marked by the opportunity to open his own laboratory. "I landed at the University of Geneva and then settled at the Swiss Federal Institute of Technology in Lausanne (EPFL)," he recalls. In 2012, he was appointed associate professor at the Swiss center, where he holds the International Foundation for Paraplegia (IRP) chair in spinal cord repair at the Center for Neuroprosthetics and the Brain-Mind Institute, where he has established his workplace.
Courtine has received numerous awards for these achievements. He has received numerous honors and awards, such as the UCLA Rector's Award in 2007 for postdoctoral research excellence and the Schellenberg Award in 2009 for his innovative research on spinal cord injuries, granted by the International Foundation for Research in Paraplegia. He has also been recognized by the Rolex Awards for Enterprise in Science and Health in 2023.
Since then, he has presented successful proof of concept against various types of paralysis, although the challenge is to make them accessible to those who need them most. Courtine does not forget that economic investment in research programs that bet on these life-changing innovations is "much needed." "Science has always been the solution to the challenges facing humanity," he states.
Regarding the public promotion of his research area that took place almost two years ago with the announcement of Neuralink implants developed by one of Elon Musk's companies, he celebrates that "they are in the media spotlight." Although he shows some disbelief in the gesture on the other side of the screen, he appreciates the publicity it also brings to their work as researchers. "It sheds some light on the importance of this work and its potential."
However, it is important to clarify the differences: the implants used by NeuroRestore compared to those of Neurolink. "Our devices are non-invasive and do not have a purpose of mind control beyond limited functions," he states. "Our systems are limited to extracting a very simple signal. We do not read the minds of patients; we only detect if the person wants to perform a left or right step flexion or extension."
This distinction is key when ethical issues associated with neuro-rights arise. "Deeper decoding of the mind is indeed associated with certain fears that the population may have," he states. "BCI [Brain-Computer Interface] technology that allows direct communication between the brain and an external device does require that regulation."
New Tools: Gene Therapies
Beyond devices, Courtine works in the laboratory to once again make a breakthrough in the fight against paralysis. "We already have a digital bridge that we want to maximize results with the repair of the residual fiber remaining in the spinal cord," he says. "We are awaiting approval from regulatory agencies for its commercialization."
How does this technology work? "We are working on gene therapy that will combine the strength of implants and stimulation with the previous restoration of the spinal cord: it is about harnessing the synergy between biological repair and electrostatics," he explains simply about a complex process that would - he assures - enhance the quality of results in patients.
Because they do not cure, he repeats, but rather correct "to the extent possible damage that exists in each person." This is where managing expectations comes into play. Many patients have a maximum potential with normal rehabilitation. "We add a percentage more to that recovery," he explains. "It's like in medicine: not everyone reacts the same to a drug, nor does it have the same effect. The value of what we do is that it is as replicable as possible in a population where any change they experience is a significant advancement."
Now his goal is to turn each of his small achievements into significant opportunities. "The transformation of proof of concept in a few humans into a therapy available to all." Courtine hopes that this will be his greatest legacy.