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Posts Tagged medicine

A nose for the future Robert Hickson Oct 23

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It’s been a big time for noses recently. Who would have picked that?

First up, a paper in PLOS ONE  indicated that losing one’s sense of smell may be a predictor (statistically speaking) of your demise (at least if you are older than 57). The authors speculate

Olfactory function is thus one of the strongest predictors of 5-year mortality and may serve as a bellwether for slowed cellular regeneration or as a marker of cumulative toxic environmental exposures.

Many folk, young and old, have sniffed at these results, proclaiming that they can’t smell a thing and have been hale and hearty for many a year. That’s not surprising, since the research only demonstrated an increase in risk not a deterministic consequence.

If its true then lets hope that treatments can be developed so it will be even more desirable to stop and smell the roses.

On a more life affirming note there was the widely reported story of the paralysed man with a severed spinal cord learning to walk again after a transplant of olfactory ensheathing cells  and some nerve tissue from his ankle. The ensheathing cells help bridge the cut cord and protect the nerve cells, helping to re-establish electrical contact. The nose it seems is a more dynamic environment than most of us suspect.

Transplant of nasal stem cells several years ago into the spine of a paraplegic woman wasn’t successful, and later a tumorous mass of nasal cells had to be removed.

Nasal tissue may be a good source of new cartilage for knees, potentially helping many people with arthritis as well as those with joint injuries.

And dogs are being used to sniff out cancer as a step to identifying the chemicals that may be indicative of their presence. A range of other illnesses may also be detectable through scent.

Odor biometrics may be an emerging field too. We all apparently have our own unique smell, regardless of what products we use.

Zach Challies from Victoria University of Wellington recently won a design award for a 3D printed nose prosthetic.

A more sophisticated model of a dog’s nose has also been printed to help study the aerodynamics of sniffing. This could lead to better sensor technologies for the detection of bombs, drugs, and other dangerous or unwanted things.

There are already a range of electronic noses – such as NZ’s Syft Technologies. And, naturally, a robotic nose has been developed which could be used for a range of applications.

But, as these nasal examples illustrate, it is to be expected that greater mimicry or co-option of nature will help create more effective electronic systems (some perhaps more welcome than others) and medical treatments.

Growing “naughty bits” in the lab Robert Hickson Oct 08

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Biology has truly started conjugating with engineering now. All sorts of food and body parts are now being generated in the lab.

While genetically modified crops and farm animals make the headlines, and raise concerns about environmental impacts, food safety, and ethics, there is a quieter synthetic biology revolution going on in labs.

Synthetic biology is being used in attempts to produce “animal-free” milk products,  as well as  replacements for some plant flavourings, and algal substitutes  .

There are also chemical and physical, as opposed to biological, ways to create animal product food replacements.

Synthetic meat has survived a taste test, though it’s a long way from economic viability and general consumer acceptability.

But the headline that, understandably, attracted my attention this week was “The lab-grown penis” .

As the Guardian (or rather it’s sister paper, The Observer) notes

 “[this] work would fulfil a real need for men who have lost their penis through genital defects, traumatic injury, surgery for aggressive penile cancer, or even jilted lovers exacting revenge.”

As you’d expect, there isn’t much enthusiasm, or success, in transplanting donated penises.

Previous research has resulted in some male rabbits with bioengineered penises produce offspring. Anthony Atala, the scientist behind the research, hopes to undertake a human transplant within five years.

The Guardian article helpfully points out that bioengineered bladders and vaginas have previously been created, and some successfully transplanted.

Coincidentally, this past week there was also a report of a Swedish woman who had a transplanted womb (from a donor not a culture flask) successfully (if prematurely) gave birth. So transplants are becoming ever more sophisticated (I noted in an earlier post that a few folk have an interest in eventually being able to do brain transplants).

Retinal cells are being printed, though not yet transplanted. As are parts of kidneys.

Lungs have also been grown, and attempts are underway to grow a heart in vitro.

Eventually these developments (if successful) will mean that more people will probably be able to live more active, fulfilling and longer lives.

Combine these synthetic tissues and organs with gene therapy, bionic prosthetics, wearable implants, and cognition-enhancing drugs. What will societal attitudes be to what is natural or even human? A range of transplants and implants are already widely accepted. As with blood transfusions, some people will probably have religious or ethical objections to some. But many others may start to feel that the term “natural” (and that will likely be defined in various ways) with respect to our bodies and abilities becomes less and less relevant or meaningful.

It’s not our constituent parts but the whole that is important.

 

As an aside, but connecting to another technology trend. One factor driving the creation of bioengineered organs is their potential (if the recipients own cells are used) is to reduce the chance of rejection. As populations come to have more older people the demand for transplants also rises, and there are not enough donors now to meet existing demands.

This could also be exacerbated in some countries if autonomous vehicles become common – that could further reduce the number of organ donors  If the US ever tightens up gun control that is likely to have a much more dramatic effect, since more donated organs come from homicide victims than car fatalities.

In NZ the autonomous vehicle effect may be significant. We have a low rate of organ donation, and while relatively few organ donations come from vehicle fatalities, even a small decrease in vehicle deaths could make sourcing suitable organs more difficult if more people don’t start opting in for donation.

 

 

The Future of Healthcare Robert Hickson Dec 16

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I’m still preparing my end of year trend posting, so for now I’ll just point you in the direction of a short article on the future of healthcare that I wrote for  Pharmac’s (the New Zealand government’s pharmaceutical purchasing agency) Annual Review (PDF, 1.5 MB).

The Pharmaceutical industry is in an interesting period of change. About US$100 Billion “patent dividend” is anticipated over the next few years as some major blockbuster drugs come off patent, so pharmaceutical companies are looking to where they could generate new income. Some companies are big on mergers and acquisitions, others are trying out more open innovation models. Some Big Pharma companies are moving into generic medicines, others are heading upstream to become more involved in diagnostics, and some may transform into healthcare management companies. Smaller pharmaceutical firms and biotechnology companies are producing more of the pharmaceuticals now.

Meanwhile regulators and pharmaceutical purchasers around the world are demanding more information on the comparative effectiveness of new medicines. Better outcomes, not just more pills is what they are looking for.  Generating that information adds more time and money to developing new treatments. Some patient lobby groups though are wanting access to drugs quicker, even if critical clinical data is lacking.

“Electronic medicine” is being viewed as a means to help reduce (or at least better contain) healthcare costs, through better management and smarter use of patient medical records (NZ doctors are already good users of electronic records). The amount of information about patients is set to skyrocket, so there is going to be a lot more information to manage, and mine for better treatment options. IBM, though, has noted that doctors now often have more information than they know what to do with [PDF, 0.9 MB].

Lots of applications for smart phones and tablet computers are appearing. These are intended to help folks better manage their own health. However, the  health apps field has been called the “wild west” because many of the apps have not demonstrated clinical validity or sought FDA approval.

The future will be interesting. Patients will be  expecting more personalised care, while major healthcare providers will be ever more involved in number crunching and analytics to determine the treatment options that best meet their performance requirements.

Stem Cell Therapies Robert Hickson Nov 17

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The US Biotech company Geron was the first company to get FDA approval for an embryonic stem cell trial (in 2009). It has just announced that it is ending the trial, and will instead focus on cancer therapies. Stem cell therapies have been a bright hope as a way to treat or cure many illnesses for several decades (an exception being bone marrow transplants, a common and less sophisticated way of adding stem cells). However, scientific challenges and ethical concerns have resulted in slower clinical use of stem cells than many had anticipated.

Drivers: Technological progress, combat injuries

Trends: Increasing number of stem cell trials & other forms of regenerative medicine applications

Opportunities: Treating or curing diseases and serious injuries

Challenges: Demonstrating long term benefit and safety. Securing funding for trials.

Geron’s trial was on repairing spinal cord injuries, and was a phase I clinical trial that was solely to assess safety. Geron state that they are cutting the trial short not because of safety reasons, but because they are having trouble raising money to keep the trial going.

Does this mean stem cell therapies have had a major setback? No. The issue doesn’t appear to be one of safety, but of finance. Some researchers were sceptical of Geron’s chances of success before the trial started.

The FDA and some other regulators are taking a cautious approach to embryonic stem cell trials, because of the newness of the field and concerns that stem cells could create tumours. They have approved only one other embryonic stem cell trial — one by Advanced Cell Technology that is attempting to repair an eye disorder. There are though many other trials (Phase I and II) underway in the US and elsewhere involving adult or foetal stem cells; the Financial Times stated ‘more than 2,700 trials’ worldwide (unsourced, but presumably using info partly from http://www.clinicaltrials.gov/).

Firms like Geron, as well as some patient advocacy groups, have criticised the cautiousness of the FDA in their approach to stem cells. However, regulators recall deaths and other unexpected outcomes in the 1990s from another novel approach; gene therapy. Plus there are quite a few dodgy stem cell treatments are being offered by dubious companies and physicians.

Greater caution is warranted because stem cells are not the same as a pharmaceutical. They are living complex biological entities whose behaviour in our (or a mouse’s) body we don’t fully understand and can’t control. A recent review by Trounson et al. notes the wide variety of stem cell trials underway. While these trials have all demonstrated safety, they haven’t all demonstrated that the treatments work, or will have sustained curative benefit. Trounson and colleagues also comment in their paper that the initial hope of induced pluripotent stem cells as an ethically acceptable treatment option has been tempered due to abnormalities that result when they are used.

Approved human treatments probably won’t be available for another decade or more. But for those who have the money, treatments for pets are already available. The North American Veterinary Regenerative Medicine Association is also interested in veterinary applications. Meanwhile, lab-grown meat, created from stem cells, is also a (distant) possibility.

While now 5 years old, a Futurewatch report from MoRST – ‘Stem Cell Research in New Zealand’ — describes both the medical and agricultural stem cell research (not trials) that was underway in New Zealand a few years ago. AgResearch is interested in using stem cells as part of its livestock breeding programme.

Some of the recent human stem cell trials initiated around the world include treatments for heart disease, stroke, multiple sclerosis and eye disorders . Red blood cells have also been created from stem cells. Stem cells may be able to be collected and banked from your teeth for future use.

This recent activity in stem cell therapies is part of a surge in the field of regenerative medicine. This involves not just treating diseases, but growing replacement body parts —be they pituitary glands, blood vessels or muscle. Technologies such as 3D printing and nano-structured materials are helping provide scaffolds for tissues and organs to grow upon.

The US’s Armed Forces Institute of Regenerative Medicine, a consortium between the army, universities and medical centres, is being particularly assertive in developing and testing treatments to repair burns, replace limbs, and treat other traumas resulting from the wars in Iraq and Afghanistan. Others are also interested in using stem cells as part of reconstructive or cosmetic surgery.

The non-biological challenges, as Geron has found, are that such trials will take considerable financial backing, which is currently in short supply, and lengthy regulatory oversight. However, the variety and pace of developments signal that a range of new options are emerging to both repair, replace or enhance bits of our bodies. Which are going to be acceptable (and affordable), and which aren’t?

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