healthcare technology

Cardiologists in Los Angeles have developed a gene-therapy technique that allows them to transform working heart-muscle cells into cells that regulate a pigs’ heartbeat. This procedure, described today in the Science Translational Medicine, restored normal heart rates for two weeks in pigs that usually rely on mechanical pacemakers. The experiment, researchers say, could lead to lifesaving therapies for people who suffer infections following the implantation of a mechanical pacemaker.

"We have been able for the first time to create a biological pacemaker using minimally invasive methods and to show that the new pacemaker suffices to support the demands of daily life," Eduardo Marbán, a cardiologist at the Cedars-Sinai Heart Institute and lead author of the study, told the press yesterday. The approach is practical, added Eugenio Cingolani, a cardiogeneticist also at Cedars-Sinai and a co-author of the study, because "no open-heart surgery is required to inject this gene."

In the study, researchers injected a gene called Tbx18 into the pigs’ hearts. This gene, which is also found in humans, reprogrammed a small number of heart-muscle cells into cells that emit electrical impulses and drive the beating of the heart. The area in which this change occurred — about the size of a peppercorn — doesn't normally initiate heartbeats.

"We were able to get the biological pacemaker to turn on within 48 hours," Marbán said. To get the gene to the heart, the researchers sent a modified virus into the right ventricle through a catheter. The viral vector isn’t harmful, the researchers said, because the virus they employed was engineered to be "replication deficient" — meaning that it will not reproduce and spread beyond the heart.

Overall, the results of the study demonstrate that the pigs who received the gene therapy experienced an increase in heart rate that allowed them to be much less dependent on backup pacemakers. In contrast, the backup pacemakers were responsible for more than 40 percent of the beats in pigs who didn’t receive the gene therapy, but still underwent surgery.

more at http://www.theverge.com/2014/7/16/5906563/biological-pacemakers-gene-therapy-heart-muscle-cells

The buzz about 3D printing can at times give the impression that the technology is a panacea that makes all manufacturing cheaper. The truth is 3D printing has one very specific use case: It makes prototypes and custom, one-of-a-kind items cheaper and faster to make.

Medicine would seem like a prime beneficiary of this technology, potentially using 3D printing to provide patients with custom-made implants and stents. Yet, to date, medical researchers have focused on the most ambitious goals for the technology, such as replacement organs printed from a patient’s own stem cells, which need years of development before they reach average patients.

Recently, a somewhat more modest medical device — and one that could find its way relatively quickly into treatment protocols — was created using 3D printing. Researchers Igor Efimov from Washington University in St. Louis and John Rogers from University of Illinois at Urbana-Champaign used MRI and CT scans of rabbit and human hearts to 3D-print custom-fitting flexible mesh sacs that fit each heart perfectly and stayed in place as it beat.

“Each heart is a different shape, and current devices are one-size-fits-all and don’t at all conform to the geometry of a patient’s heart,” said Efimov.

Inside its fabric, the mesh can also hold sensors that monitor for signs of trouble and deliver electrical pulses, if needed. The sensors are embedded in the fabric using technology similar to what Google has said it will use in sugar-monitoring contact lenses, only more nuanced.

Doctors can position the sensors or electrodes more precisely using the wrap than by attaching them directly to the heart with sutures or adhesives, Efimov and Rogers state in a recent paper in Nature Communications. They demonstrate in the paper that sensors attached to the mesh (or multifunctional integumentary membrane) accurately measure temperature, mechanical strain and pH, and could deliver pulses of electricity.

Depending on the sensors used, the heart wrap could improve treatments for a range of disorders; it could also be used to deliver medication directly to where its needed. But the device was conceptualized specifically to treat ventricle deformities and arrhythmias. The arrhythmia atrial fibrillation affects about 4 million Americans; patients often undergo a surgery that destroys the heart’s own drummer, the atrioventricular node, and subsequently receive a pacemaker.

Researchers and collaborators of the Soh lab at UC Santa Barbara have developed an implantable device to monitor real time concentrations of medications in the blood. The device, called the MEDIC (Microfluid Electrochemical Detector for In Vivo Concentrations), aims to address an increasingly identified problem in medicine – that people metabolize and respond to the same medication at the same dose in very different ways.

A chance connection over the internet has spawned multiple efforts to provide 3D printed hands at an extremely low cost.

Around the world, there are people who have lost all or part of their hand, or were born without one. There are also people and institutions with 3D printers. Pair the two, and you can print a custom mechanical hand for $20-150 — thousands less than the typical prosthetic.

e-NABLE, which functions through a website, Facebook page and Google+ page, stepped up to connect the two after site founder Jon Schull came across work by American prop maker Ivan Owen, who made a metal mechanical hand for South African carpenter Richard Van As. Van As had lost four of his fingers in a carpentry accident.

Owen was then contacted by a mother whose 5-year-old son needed a hand. He again made a metal hand for the boy. But then he turned to 3D printing. MakerBot gave both Owen and Van As a 3D printer.

The pair developed a 3D printed hand for the boy and then posted the design to Thingiverse, where anyone could download and print it.

Van As and Owen’s efforts toward developing 3D printed hands live on via the Roboand project, which has created more than 200 hands and now branched into prosthetic fingers and arms. But Schull was interested in connecting people who needed hands with individual makers and institutions that had 3D printing skills, but potentially idle printers.

He started a Google+ page, and then a Facebook page and website. More than 300 makers make their services available to people who contact e-NABLE about a hand. Just a quick scroll through posts on the Facebook page reveals many, many people who have a use for a hand.

Inspired by tiny particles that carry cholesterol through the body, MIT chemical engineers have designed nanoparticles that can deliver snippets of genetic material that turn off disease-causing genes.

This approach, known as RNA interference (RNAi), holds great promise for treating cancer and other diseases. However, delivering enough RNA to treat the diseased tissue, while avoiding side effects in the rest of the body, has proven difficult.

The new MIT particles, which encase short strands of RNA within a sphere of fatty molecules and proteins, silence target genes in the liver more efficiently than any previous delivery system, the researchers found in a study of mice.

"What we're excited about is how it only takes a very small amount of RNA to cause gene knockdown in the whole liver. The effect is specific to the liver - we get no effect in other tissues where you don't want it," says Daniel Anderson, the Samuel A. Goldblith Associate Professor of Chemical Engineering and a member of MIT's Koch Institute for Integrative Cancer Research.

more at http://www.medicalnewstoday.com/releases/272481.php

Finger pricks and careful eating are an important part of the daily routine for most people with diabetes. While automated glucose meters are a growing option, they can still create discomfort and other inconveniences.

Google wants to go in a totally different direction with a project announced today:smart contact lenses that can detect glucose levels via the wearer’s tears and alert them when levels dip or rise.

This isn’t the first smart contact lens, and several options already exist for people interested in monitoring glaucoma. But Babak Parviz, who also leads the Google Glass team, is a smart contact pioneer and Google which is a secretive division of Google dedicated to difficult, future-looking projects, has a reputation for ably pursuing projects like this.

The lens works via a small wireless chip and glucose sensor embedded between two pieces of soft material. The current prototype puts out a reading once a second. Google is also interested in integrating an LED light, which could light up to alert the wearer of dangerous glucose levels.

The lab is now looking for parters to help bring the lens to market. It would also like to develop an app that would help wearers read and manage the data the lens takes in.

The lens could help people with diabetes monitor their daily health and recognize dangerous situations.

more at http://gigaom.com/2014/01/16/google-testing-contact-lens-that-can-monitor-glucose-levels/

A credit card-sized chip can diagnose HIV infection and provide T cell counts to guide treatment, according to a recent paper in Science Translational Medicine.

The fluid-processing chip provides accurate test results in less than 20 minutes using a single drop of blood that goes directly into the testing chamber and does not require trained handling.

The chip is designed to work in a battery-powered handheld device that would “deliver simple HIV diagnostics to patients anywhere in the world, regardless of geography or socioeconomic status,” the researchers say in the paper.

Nearly 7 in 10 HIV-infected people live in poor parts of the world. Many have to travel long distances to get to a clinic, making coming back for test results a major ordeal.

Every year IBM makes predictions about 5 technology innovations that stand to change the way we live within the next 5 years. 

This year, one of those 5 is Personalized Cancer Treatment.

In five years, doctors will routinely use your DNA to keep you well. Cancer will be treated on a DNA level in both the patient and tumor, at a scale and speed never before possible. 

If 2013 was the year of wearables and health apps, what’s on tap for 2014?

Here are five exciting health tech trends to keep an eye on for the new year.

You’re one of a kind. Wouldn’t it be nice if treatments and preventive care could be designed just for you, matched to your unique set of genes?

The story of personalized medicine begins with the unique set of genes you inherited from your parents. Genes are stretches of DNA that serve as a sort of instruction manual telling your body how to make the proteins and perform the other tasks that your body needs. These genetic instructions are written in varying patterns of only 4 different chemical “letters,” or bases.

The same genes often differ slightly between people. Bases may be switched, missing, or added here and there. Most of these variations have no effect on your health. But some can create unusual proteins that might boost your risk for certain diseases. Some variants can affect how well a medicine works in your body. Or they might cause a medicine to have different side effects in you than in someone else.

The study of how genes affect the way medicines work in your body is called pharmacogenomics. 

“If doctors know your genes, they can predict drug response and incorporate this information into the medical decisions they make,” says Dr. Rochelle Long, a pharmacogenomics expert at NIH.

It’s becoming more common for doctors to test for gene variants before prescribing certain drugs. For example, children with leukemia might get the TPMT gene test to help doctors choose the right dosage of medicine to prevent toxic side effects. Some HIV-infected patients are severely allergic to treatment drugs, and genetic tests can help identify who can safely take the medicines. 

“By screening to know who shouldn’t get certain drugs, we can prevent life-threatening side effects,” Long says. 

Pharmacogenomics is also being used for cancer treatment. Some breast cancer drugs only work in women with particular genetic variations. If testing shows patients with advanced melanoma (skin cancer) have certain variants, 2 new approved drugs can treat them. 

New tools for analyzing genes are allowing doctors to personalize treatment for some lung cancer patients.

Imagine your doctor being able to scan your DNA from a biopsy and pinpoint the medicine that will work best for you. This type of high-tech approach is a clinical reality for advanced lung cancer at The Ohio State Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).

The technology, known as next generation "multiplex" gene sequencing, analyzes 50-plus genes in DNA extracted from a tumor biopsy for particular genetic mutations.

Knowing which mutations are present in lung tumors can help doctors tailor a patient's treatment to the unique genetic features present in his or her cancer cells.

The knowledge can also help in the development of new drugs that target previously unrecognized gene mutations in lung tumors. I often compare these genes to the gas pedal in a car — when activated, these genes make the cancer grow. By breaking the linkage between the gas pedal and the motor (or interfering with these "driver" mutations) with specific targeted drugs, doctors can stop this growth and often make the cancer shrink.

That's especially important in lung cancer because the majority of patients with this disease are diagnosed in the later stages, meaning it's important to start effective therapies quickly.

For example, a patient could be given a standard chemotherapy and expect a 25- to 30- percent response rate/shrinkage of a tumor. But if the treatment team knows that a patient has a mutation in a gene called EGFR, we can offer him or her a pill (erlotinib and afatinib are approved for this use in the United States), which has a 75-percent response rate and fewer side effects.

Gene sequencing is now considered the standard of care for stage-4 lung cancer patients at The OSUCCC – James and a handful of other centers across the United States — and several clinical trials evaluating molecular targeted therapies for patients with stage-3 lung cancers will soon start at The OSUCCC – James.

On December 5, 2011, Andrew Meas wiggled his toes for the first time since a motorcycle accident four years earlier paralyzed him from the chest down. Within a week, he was beginning to stand. Meas’s remarkable (albeit partial) recovery comes courtesy of a groundbreaking use of an electrode array implanted over his spinal cord. 

For decades, researchers have been seeking ways to help the millions of people with spinal cord injuries regain control of their limbs, with frustratingly little success. The new device provides a rare glimmer of hope. Scientists at the University of Louisville’s Kentucky Spinal Cord Injury Research Center, where Meas and three other patients received their im­plants, speculate that the stimu­lation may be reawakening connections between the brain and the body. “There’s residual circuitry that we can recover that no one realized was possible to do,” says Reggie Edgerton, director of the Neuromuscular Research Laboratory at the University of California, Los Angeles. “We were shocked.” 

Some of the benefits, such as better bowel and bladder control and improved blood pressure, remain even when the device is switched off. Electrical stimulation isn’t a cure, of course. The patients still can’t walk. And the stimulation must be customized for each individual, a time-consuming process. But it’s an enormous advance nonetheless. Says Edgerton, “It opens up a whole new mechanism of recovery.” 

more at http://www.popsci.com/article/science/how-it-works-system-reverses-paralysis

If genomes are going to revolutionize personalized medicine, the first step will be sequencing the genome accurately.

It bears repeating just how far this tech has come: the price of sequencing a genome is rapidly coming down, as is the time it takes to do a sequence. It’s getting so easy that the price point is already well within the means of many middle class Americans, and the technology might soon prove useful enough to save lives. Proponents say that, in the future, personalized medicine will allow doctors to determine the specific genetic variants that predispose their patients to certain diseases, which will then help doctors to devise individualized—and more effective—treatments.

But with roughly six billion base pairs in the human genome, creating a truly accurate gene sequence is no easy task. Even the best sequencing techniques can have an error rate around 1 percent, which adds up to hundreds of thousands of errors. When diseases depend on single nucleotide insertions or changes, those errors can mean the difference between a misdiagnosis and an accurate one.

A group of researchers with the US government’s National Institute of Standards and Technology is trying to solve that problem with a program called Genome in a Bottle. With academic and commercial partners, the group is trying to create what is essentially one “perfect” human genome that can be a reference for sequencing labs. Though every genome is different, the places where sequencing errors most commonly happen are fairly well understood, and by comparing one sequence with a reference genome, doctors and researchers would be able to tell if they’ve made a mistake.

“We’re sitting here with billions of data pairs—it boggles the mind try to get that much information accurately determined,” said Marc Salit of NIST’s Genome Scale Measurements Group. “Even when we think we’re getting it right, a few missing bases or additional ones can make a huge difference.”

Salit and his colleague, Justin Zook, recently published a study in Nature Biotechnologydiscussing their solution to the problem. According to Salit, by sequencing the same genome many times and comparing the base pairs, they can create a reference that is much more accurate than what we already have.

more at http://motherboard.vice.com/read/if-we-cant-get-genome-accuracy-right-personalized-medicine-is-a-pipe-dream

Stars, diamonds, circles.

Rather than your average bowl of Lucky Charms, these are three-dimensional cell cultures that can be generated by a new digital microfluidics platform from researchers at U of T’s Institute for Biomaterials and Biomedical Engineering (IBBME).

Published this week in Nature Communications, the tool can be used to study cells in cost-efficient, three-dimensional microgels. This may hold the key to personalized medicine applications in the future.

“We already know that the microenvironment can greatly influence cell fate,” saidIrwin A. Eydelnant (IBBME PhD 1T3), recent doctoral graduate from IBBME and first author of the publication. “The important part of this study is that we’ve developed a tool that will allow us to investigate the sensitivity of cells to their 3D environment.”

“Everyone wants to do three-dimensional (3D) cell culture,” explained co-authorAaron Wheeler (IBBME), Professor and Canada Research Chair in Bioanalytical Chemistry at IBBME, the Department of Chemistry, and the Donnelly Centre for Cellular and Biomolecular Research (DCCBR) at the University of Toronto.

“Cells grown in this manner share much more in common with living systems than the standard two-dimensional (2D) cell culture format.” But more naturalistic, 3D cell cultures are a challenge to grow.

more at http://www.engineering.utoronto.ca/About/Engineering_in_the_News/3D_Microgels__On-demand__Offer_New_Potential_for_Cell_Research__the_Future_of_Personalized_Medicine.htm

We are all familiar with "scratch-and-sniff" products. They have been around since the 1970s - mainly in the form of stickers. But these products are yesterday's news. Researchers have now created a device that could allow us to "text-and-sniff." It is called the oPhone.

Created by David Edwards and colleagues at the Harvard School of Engineering and Applied Sciences in Massachusetts, the oPhone enables odors - labeled "oNotes" - to be sent via email, tweet or text to other oPhones using bluetooth and smartphone attachments.

Edwards, also a student at Michigan Technological University, says the technology may be useful in the world of health care - particularly for the treatment of Alzheimer's disease and mental illness.

The oPhone does not work like a normal cell phone. It does not transmit or receive sounds.

Instead, the cylinder-shaped device consists of a set of disposable "oChips" that can store and emit hundreds of different odors for between 20 and 30 seconds.

The fragrances are created by Marlène Staiger, an aroma expert at a laboratory in France called Le Laboratoire. She deconstructs the scents before capturing them in wax.

A small pellet could be implanted under the skin along with an injected vaccine; later, instead of a booster shot, a pill taken orally would signal the pellet to release a second dose, researchers at the University of Freiburg demonstrated in a paper.

Eliminating all booster shots would reduce the number of shots babies get by two-thirds, according to CDC recommendations.

And in developing countries, patients could be sent home with instructions to take the signal pill at a certain time, improving compliance.

The researchers used a pellet made of hydrogel, a polymer similar in texture to human tissue, to hold the second dose. This particular hydrogel was formulated to respond to fluorescein, an organic compound which is already FDA-approved for use in humans. An oral dose of fluorescein stimulated the pellet to release its vaccine payload.

A booster dose of a vaccine against the human papillomavirus delivered this way was as effective in mice as one injected.

This year, when patients throughout the United States begin downloading the world’s first doctor-prescribed smartphone app, mobile health care will finally get what big-time medicine most requires: a way to get insurance companies to pay for it.

The app, called BlueStar, helps people with Type 2 diabetes (the most common kind) by suggesting, in real time, when to test their blood sugar and how to control it by varying medication, food, and exercise. That it requires a physician’s prescription is actually an advantage, because it means insurance companies will reimburse BlueStar’s fee.

Each of our bodies is utterly unique, which is a lovely thought until it comes to treating an illness -- when every body reacts differently, often unpredictably, to standard treatment. Tissue engineer Nina Tandon talks about a possible solution: Using pluripotent stem cells to make personalized models of organs on which to test new drugs and treatments, and storing them on computer chips. (Call it extremely personalized medicine.)

Home self-diagnostic tools for blood cholesterol monitoring have been around for over a decade but their widespread adoption has been limited by the relatively high cost of acquiring a quantitative test-strip reader, complicated procedure for operating the device, and inability to easily store and process results. 

Forget those clumsy, complicated, home cholesterol-testing devices.

David Erickson and co-workers from Cornell University in New York  have developed a simple system that enables people to routinely monitor their blood cholesterol levels, using a smartphone.

They have created the Smartphone Cholesterol Application for Rapid Diagnostics, or “smartCARD,” which employs your smartphone’s camera to read your cholesterol level.

A deeper look at five technologies that are currently advancing exponentially and radically reshaping healthcare. In other words, for the long suffering, there is plenty of hope to go around.

3-D printing 

3D printing is already making its presence felt in medical device world. Ninety-five percent of all hearing aids are today 3D printed. This tech is also pushing into prosthetics. There are custom-made back braces for scoliosis patients and casts for broken bones (perforated with holes so people can finally scratch through their casts) and, in the latest development, 3D printed facial prosthetics (noses, ears, etc.).

Human interaction with robots is about to get a little more personal. Meet 'Furhat', the face of tomorrow's interactive technology.

An increasingly important – and sometimes frustrating – part of daily life is dealing with so-called “user interfaces”. Whether it’s a smartphone or an airport check-in system, the user’s ability to get what they want out of the machine relies on their own adaptability to unfamiliar interfaces.

But what if you could simply talk to a machine the way you talk to a human being? And what if the machine could also ask you questions, or even address two different people at once?

These kinds of interactive abilities are being developed at KTH Royal Institute of Technology with the help of an award-winning robotic head that takes its name from the fur hat it wears.

With a computer-generated, animated face that is rear-projected on a 3D mask, Furhat is actually a platform for testing various interactive technologies, such as speech synthesis, speech recognition and eye-tracking. The robot can conduct conversations with multiple people, turning its head and looking each person straight in the eye, while moving its animated lips in synch with its words.

Furhat’s ability to turn its face to multiple people in a conversation is enabled by face-tracking software. But its ability to make eye contact is achieved through projection.

Unlike a 2D image, which can appear to be looking at everybody in the room at once – a phenomenon known as the “Mona Lisa effect” – Furhat appears to shift its gaze because the face is projected onto 3D-printed model of a human face.“When we first experimented with this, the effect was strong immediately,” Al Moubayed says. “You could bond with, or relate to, the face.“It is an avatar that can really be present in the physical environment.”

Such technologies are being explored as a potential therapeutic tool for children with autism and other disorders that affect social interaction, he says. The technology can also be used for telepresence applications in which 3D replicas of people’s faces become the screens that we look at when conducting a video conference call.

more at http://www.nanowerk.com/news2/robotics/newsid=33519.php

Although nanomedicine is a promising area of research, scientists have been unable to figure out a way to deliver drugs using nanoparticles other than by injection, which is both distasteful and inconvenient for patients. Now, a team of researchers from MIT and Brigham and Women's Hospital (BWH) have developed a new nanoparticle that can be absorbed through the digestive tract, allowing patients to take a pill instead of receiving injections.