Surgeons face significant challenges when performing procedures near nerves, as they must work cautiously to avoid causing nerve damage, which can complicate the patient's recovery. Electrophysical monitors and anatomical knowledge are essential in identifying and protecting nerves, but they often lack the precision needed for safe, efficient surgery. The lack of clear visibility of nerves, especially during delicate surgeries, can increase the risk of injury. Now, a first-of-its-kind drug that binds to nerve tissue and fluoresces enables surgeons to see the nerves more clearly, thus improving the odds of safer surgery.

This breakthrough drug, developed at the University of New Mexico (Albuquerque, NM, USA) in collaboration with other institutions and known as bevonescein, is a short chain of amino acids attached to a fluorescing molecule. It was created to enhance visibility during surgeries by making nerve tissue more visible to surgeons. The drug is infused intravenously before surgery and binds to nerve tissue, making it visible under specific light conditions in the operating room, where it fluoresces as yellowish-green structures that thread through the surrounding tissue. In a clinical trial involving 27 cancer patients, bevonescein was tested to evaluate its safety and efficacy during surgeries such as neck dissection, parotid surgery, and thyroid surgery.

The results of the small Phase 1-2 study, published in Nature Communications, showed that bevonescein successfully highlighted nerve tissue during surgery, significantly improving the chances of avoiding nerve injury. A larger Phase 3 study is currently underway to assess whether use of the imaging agent meaningfully improves overall surgical outcomes. If successful, bevonescein could FDA approval and be used in a wide range of surgical procedures, not just in head and neck surgeries. Researchers are also exploring the use of magnifying loupes, a more portable option for surgeons, to test bevonescein in real-world settings.

“The way that I explain this drug to patients is that I think if we can help surgeons see things better, they can do faster, more efficient, safer surgery,” said Ryan Orosco, MD, UNM.

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