• JoJo

Michelin Stars and Neurotech Research Collide

What is the best dish in the world? The food that is at once elegant and sophisticated but soul-warming, unpretentious and… perfect? It’s a different recipe for everyone, but few would argue that Joël Robuchon curated an empire on such perfection. Upon hearing his name, most of the eaters who have been fortunate enough to experience a Robuchon meal will expound upon their devotion to his “Pommes Puree” – also referred to as “butter with truffles and potatoes” due to the ratio of one pound of butter for every two pounds of potatoes. While the pommes puree is other-worldly, my mouth waters over his “La Caille” – quail breast poached in chicken broth, glazed with honey and soy sauce, stuffed with foie gras (please hold the political commentary – I know, I know) and roasted until the delicate skin crackles under fork. To add to the culinary ecstasy, la caille is served with a dollop of pommes puree. L’Atelier de Joël Robuchon. Heaven.

Joël Robuchon earned 32 Michelin stars; at the time of his death, no chef had ever earned more. Robuchon put the kitchen at center stage of his restaurants and made the food the star. His command of ingredients and demand for perfection are legendary. A Robuchon kitchen is orderly. It is above reproach. It is filled with the best tools for every recipe that could possibly come through the kitchen. The talent at every station is the best. It produces perfection because it is perfection.

“Wait, wait, wait, JoJo. This is supposed to be about neurotech – not food porn,” you say?

Have a little faith my friend, I’m getting there. Joël Robuchon has been compared to a general leading an army and a conductor guiding the world’s best musicians through complex and moving sonatas. His imagination, his vision, and his talent were critical to his success, but so was his ability to source the best talent and the best ingredients, and to bring them together in a way that made his food into an artform. He envisioned, and led, and orchestrated, and assembled masterpieces. Grégoire Courtine is the Joël Robuchon of neurotech.

While Courtine may not compare himself to Robuchon, he did agree with me that there are many shared elements between cooking and neurotech. “There is an incredible similarity between cooking – high level cooking, gastronomy – and science,” he explained. “When you look at the people, people start training as an apprentice and then become a chef. And often you leave and go abroad to these other very well known houses, so you get your Ph.d., your postdoc, and you learn. And then, when you are good enough, you get your own laboratory – assistant professor, or you start your own restaurants, and then you start doing this work of being creative – using your own background, what you learned from this exposure to another world, to make your own integration. At the end of the day, you need to be the one who created this new integration. It is your artistry that can take you to the level of a three-star Michelin chef.” (Please tell me you read that quote with a suave French accent.)

“Atelier” in French means workshop. Robuchon had a workshop. Courtine has a workshop. “Many people, when they come work in my lab, feel like it’s a toy store,” Courtine said. You have the mice, the rats, the monkeys, and you have the humans. You have all of this technology. If you have a problem and ask ‘what should I do?’ I say ‘Ok, you go see this person, and this person, and this person,’ and in our case, those people are in-house.”

At the age of 29, Robuchon ran a kitchen in the heart of Paris with 90 chefs; many of his progeny have gone on to become masters themselves. Eric Ripert chef and co-owner of Le Bernardin, has three of his own Michelin stars, won multiple James Beard Awards, and called Robuchon “the most rigorous, precise, demanding, ultra-gifted king of all chefs.” Michael Caines trained under Robuchon and is one of two black Michelin-starred chefs. He also lost his dominant arm at the elbow and sports a state-of-the-art prosthetic, oh and he was made a Member of the Order of the British Empire. If you think Gordon Ramsay is a handful, well, Robuchon thought so, too and once threw a plate of langoustine ravioli at his underling. To be clear, I’m not suggesting that Courtine shares Robuchon’s violent demand for perfection; they simply share the pursuit of it. Robuchon was the best because he hired the best.

Courtine also has an eye for spotting talent. He has a vision and he does everything within his power to attain it. “I know what I want to do in technology,” Courtine said “and I’m not afraid to go for it. I have a very multidisciplinary training – physics, neuroscience, and I have never been afraid of developing or using technology with which I am not familiar. I hired a postdoc who was so much better than me in a topic. I am not ashamed. I have no problem with this. I think many scientists feel that they need to be the specialist, otherwise they feel insecure,” he continued. “We have a huge advantage. As you can see, we developed the robot, the electrodes, the stimulation, we do anatomy and you see the breadth of technology that we have in my lab. This is what makes the difference. My specialty is integration. I take what is the best out there and put it together as a puzzle and make sure that people communicate with each other.”

To stay competitive in the world of gastronomy, one must perpetually reinvent himself while maintaining his artistic integrity. Presentation is a part of the experience. A meal at a Robuchon establishment is an unforgettable journey of flavors and of presentation. I saw Courtine present at a conference for the very first time earlier this year. Few who have seen one of his talks could deny that they are filled with an infectious excitement and a Steve Jobs-level of style and flare. I asked Courtine how he maintains enthusiasm and inspiration in his presentations. “I am an enthusiastic person and I love science. I love to share science,” he effused. “As you see, the slides, my videos are quite curated.” It’s true. They are excellent. They are Cannes while the rest of the world is showing homemade movies. “I care greatly about the aesthetic. I always tell my team, ‘we never sacrifice elegance for pragmatism.’ It’s important as a scientist to be able to communicate and share this enthusiasm.

“It can be a double-edged sword; you have to calibrate well depending on the audience – the scientists, the lay public – but I think the same information can convey excitement if they are well presented. Or… it could be boring, and you don’t even realize that you’ve just seen good science,” he continued. “If it’s just dry with graphs – in this presentation there were hardly any graphs – I’m telling a story. It helps to convey the story. Then, if they are really interested, then they can go and look at the publications.”

Science and gastronomy have divergent outlooks on collaboration and competition. Too many cooks in the kitchen and all that. Courtine encourages collaboration within his lab, with other institutions, and with his commercial endeavors as well. You may have seen that Courtine's GTX Medical recently merged with US-based NeuroRecovery. With regards to research collaborations among institutions, Courtine sees several new lines of relationships starting to form and has a particular focus on integrating regeneration and stem cells. “I think that what we do will be a treatment to improve, not to cure, we need to have more regeneration and I would think that this is the next challenge – to combine neurotechnology with neuroregeneration – not only for SCI, but for all neurological disorders, especially neurotraumas,” he explained. “The challenge is not simple. Many people have addressed this by adding regeneration and then training, or some stimulation and then regeneration, but the mathematics I think are much more complex and we need to think about how to have synergies among these approaches.”

Courtine’s confidence and cool demeanor make it difficult to believe that he finds anything terribly challenging. To the contrary, he embraces a good mystery. “Even the simple challenge of providing a tool that any physical therapist in the world can use conveniently is a challenge,” he lamented. On top of accessibility, affordability, deployability, there are issues of having the right tools at the right phases immediately after trauma as well as basic availability of therapists. “You can have a stimulation that enables people to walk, but it will not be used if it is too complicated. People don’t have time, it’s too expensive, etcetera. It’s a tremendous challenge.

“Of course, you have the technological challenges of building the electronics, optimizing algorithms, integrating the brain into the loop… Many different challenges. Cool! I’m young. I need challenges.”

Many of the challenges that Courtine is undertaking will benefit the field of neuroprosthetics and SCI research at large. Neurotherapies relying on mapping, BCI technologies, and closed-loop technologies could see tremendous opportunity in Courtine’s focus on adding regenerative therapies. Imagine combining the therapeutic need with the appropriate therapy – reading from the brain in order to write to the brain – and accelerating the peripheral resilience with regenerative medicine. You could achieve the most effective treatment yet. But I’ll leave that to the real scientists (like Doug Weber.)

"Courtine is a true pioneer in the use of spinal cord stimulation to improve locomotor function after spinal cord injury," said Weber. "His ability to work across the entire spectrum from fundamental to translational research is rare and serves as an inspiration to many in the field."

I’m sure you’ve noticed by now that I haven’t talked much about Courtine’s specific research. It was intentional. I was trying to see if I could steal a page from his style book and get you excited about who he is and inspire you to go and seek out the science for yourself (over a dish of pommes puree. Courtine can pull that off with confidence. Me? Not so much, so I’ll go ahead and spill.

Courtine’s lab seeks to restore motor function – walking in particular – to SCI patients. In 2012 he found a way to give paralyzed rats the ability to move again. His “Digital Bridge” records the activity from the cerebral cortex and enables the person to control the stimulation at the lumbar region, below the site of the injury. The stimulation amplifies the signal that is corrupted by the lesion and allows the signal to reach the muscles again. His latest work has allowed three paralyzed people to walk again several years post-injury. Not only that, Courtine has brought the system beyond the lab setting and allowed his patients the freedom to walk outside in the real world – far away from the controlled environment of the lab.

After his initial success in the rat model, Courtine and his team took the time to identify the mechanism of action. From this exercise they learned to target the individual roots to activate the spinal cord in the way that the brain would naturally do it. The stimulation must be synchronized with the movement, which is now done wirelessly and in real time. Courtine has also noticed that his process allows for neurological recovery and allows the growth of new nerve fibers and a massive reorganization of neural connections. This remodeling is not restricted to the site of the injury; it occurs throughout the central nervous system including in the brain stem where Courtine observed a 300% increase in the density of the fibers coming from the brain.

In ten years Courtine hopes to have a minimally invasive closed loop system of spinal electrodes and a BCI, or Brain Spine Interface. He also aims to get patients to start training on the system as soon as possible after injury in order to begin the repair process. He is committed to reaching 1,000 patients with his system.

Courtine closes his presentations with an inspirational quote “You’re only as great as your imagination and as big as your dreams.” You can actually feel how much he believes in this statement. He applies this not only to his research, but also to his practice of engaging people with talent that is different and sometimes greater than his own. While Courtine clearly has a great imagination and big dreams, he recalls Reggie Edgerton, his postdoc advisor, as the inspiration. When Courtine presented his novel idea of awakening the dormant neural networks in the spinal cord below the site of the injury, Edgerton’s response was “Why don’t you try?” Courtine credits that single vote of confidence as a great awakening, “I realized that a great leader believes in young people with new ideas.”

Although Courtine does not have a Michelin star (I recently learned that he did have dreams of going to cooking school, so maybe I should say he doesn’t have a Michelin star, yet), he was awarded one of only five prestigious Rolex Awards in June 2019. So fitting for a man who exudes confidence, style, and imagination.

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