Tag: surgery

Biomedical Breakthroughs: “Biological” Pacemakers

biologicalpacemakersSince they were first developed some forty years ago, pacemakers have served an invaluable medical function. By stimulating the heart with electrical stimulation, they ensure that the recipients heart continues to beat at a steady rate. However, the implantation process calls for a major medical procedure, and the presence of the machine inside the body can lead to complications – i.e. infections.

Little wonder then why researchers are looking to create a better design to replace it with. However, up until now, proposed upgrades have focused on eliminating batteries (that require additional surgery to be replaced) with perpetual motion or piezeoelectric-powered devices. But this most recent proposal, which comes from the Cedars-Sinai Heart Institute in Los Angeles, looks to use the heart’s own cells to regulate it and keep it in working order.

piezoelectric-pacemakerIn an effort that was apparently the result of “dozens of years” worth of research, Dr. Eduardo Marbán and his research team used genes injected into the defective hearts of pigs to convert unspecialized heart cells into “biological pacemakers”. The pigs, all of which suffered from complete heart blocks, had the gene TBX18 injected into their hearts via what is described as a minimally invasive catheter procedure.

This caused some of the existing unspecialized cardiac cells to transform into sinuatrial node cells, which consist of tissue that initiates the electrical impulses that set the rhythm of the heart. The day after the procedure, the recipient pigs’ hearts were already beating faster than those of a control group and lasted for the duration of the 14-day study – indicating that the treatment could be a longer-term solution than previously thought.

biomedicineInitially, Marbán and his colleagues conceived of it more as a temporary fix for patients who were having problems with their man-made pacemakers. Now, they’re considering the possibility that it could be a long-term biological treatment. It could also be used on infants still in the womb, who can’t currently receive mechanical pacemakers. And while the research has so far been confined to pigs, human clinical studies could begin in as soon as three years.

In keeping with a trends in modern medicine, this gene therapy offers a potential third alternative to medical machiners and biomimetics. The one seeks to enhance the workings of our biological bodies through the addition of machinery while the other seeks to create machinery that mimics the bodies natural functions. But by simply programming the body to perform the role of machinery, we can cut out the middle man.

Sources: gizmag.com, cedars-sinai.edu

The Future is Here: FDA Approves Human Suspended Animation

prometheus-cryotubeWe’ve all heard about it, read about it, and seen it in the movies. Suspended Animation. The ability to put someone in a tank and chill them to the point where their heart rate, breathing, and metabolism are reduced to an absolute minimum, preserving their life or prolonging it artificially. It’s a common science fiction concept, but could such a technique ever be made feasible? That is what a team of researchers from UPMC Presbyterian Hospital in Pittsburgh, with FDA approval, are attempting to answer.

The purpose of this research is to see if suspended animation can deliver on its main promise – namely, keeping a patient alive long enough to receive life-saving treatment or surgery. Oftentimes with disease and traumatic injuries, the difference between life and death is a simple matter of timing. And for those patients who simply cannot be helped with the current level of technology and pharmacology, it is also a race against time, trying to stay alive long enough to see science catch up with the illness.

EPRThis Emergency Preservation and Resuscitation (EPR) technique isn’t quite as extreme as what we’ve come to know from science fiction franchises. Instead of reducing a patient’s temperature to near-freezing levels, it involves reducing body temperature to 10 degrees Celsius (50 degrees Fahrenheit) by inserting a cannula into the aorta and flushing cold saline into the system. This will slow the blood flow, which will prevent the body from bleeding out and slow other biological processes as well.

So far, the result have been pretty subdued – with the EPR state of induced hypothermia only being sustainable for about two hours. While this isn’t as dramatic as some may have expected, that could easily provide enough time for surgeons to perform emergency lifesaving surgery. Trauma patients who suffer cardiac arrest have a 7% chance of survival, and administering this technique could have some very real and amazing implications.

suspended-animationThis technique was first tested by Peter Rhee in 2000 using 40 pigs, the results of which were published in 2006. After inflicting a lethal wound to simulate real-world trauma scenarios, the pigs were cooled down so the surgeons could operate then resuscitate them. While all of the control pigs died, the surgeons were able to save 90% of the pigs who had undergone suspension. None of the surviving pigs were reported to have sustained cognitive or physical impairment either.

And as per usual, animal testing is followed by human trials to see if success can be replicated. Due to the extremely time-sensitive and dire nature of the injuries of the test subjects, the FDA has declared that the surgeons will not require informed consent. As a precaution, the team took out advertisements to inform the public of the upcoming study, and even set up a website that would allow people to opt out, if desired. As of yet, nobody has opted out.

alien-stasis-suspended-animationThe plan for testing this process is for the team to the technique on 10 trauma patients whose injuries would be otherwise fatal. That group will be compared against 10 other patients who are not able to undergo EPR, due to the surgical team not being available. After the first increments of 10 EPR and 10 control patients, the technique will be analyzed and refined until enough data points have been collected which will allow them to analyze the efficacy of suspending life in this manner.

Should things work out, we can expect to see EPR becoming a regular part of modern medicine. And with further refinements, it may even be possible to place people in suspended animation for longer (or even indefinite) periods of time. If not, then I guess it will be just become one more of those many, many sci-fi fantasies that (like a patients in a story) will be put away until such time as the technology catches up to the fantasy.

Sources: dailycaller.com, iflscience.com

 

The Future of Medicine: Gene Therapy and Treatments

DNA-1Imagine a world where all known diseases were curable, where health problems could be treated in a non-invasive manner, and life could be extended significantly? Thanks to ongoing research into the human genome, and treatments arising out of it, that day may be coming soon. That’s the idea behind gene therapy and pharmacoperones – two treatment procedures that may make disease obsolete in the near future.

The first comes to us from the Utah School of Medicine, where researcher Amit Patel recently developed a non-invasive, naked DNA approach to deal with treating heart problems. His process was recently tested o Ernie Lively, an actor suffering from heart damage, who made a full recovered afterwards without ever having to go under the knife.

gene_therapyIn short, Patel’s method relies on a catheter, which he used to access the main cardiac vein (or coronary sinus), where a balloon is inflated to halt the flow of blood and isolate the area. A high dose of naked DNA, which codes for a protein called SDF-1, is then delivered. SDF-1, which stands for stromal cell-derived factor, is a potent attractant both for stem cells circulating in the bloodstream, and for those developing in the bone marrow.

Stromal cells, which manufacture SDF-1, are the creative force which knit together our fibrous connective tissues. The problem is they do not make enough of this SDF-1 under normal conditions, nor do specifically deliver it in just the right places for repair of a mature heart. By introducing a dose of these cells directly into the heart, Patel was able to give Lively what his heart needed, where it needed it.

gene_therapy1Compared to other gene therapies, the introduction of SDF-1 into cells was done without the assistance of a virus. These “viral vector” method have had trouble in the past due to the fact that after the virus helps target specific cells for treatment, the remnant viral components can draw unwanted attention from the immune system, leading to complications.

But of course, there is still much to be learned about the SDF-1 treatment and others like it before it can be considered a viable replacement for things like open-heart surgery. For one, the yield – the number or percentage of cells that take up the DNA – remains unknown. Neither are the precise mechanisms of uptake and integration within the cell known here.

Fortunately, a great deal of research is being done, particularly by neuroscientists who are looking to control brain cells through the use of raw DNA as well. Given time, additional research, and several clinical trials, a refined version of this process could be the cure for heart-related diseases, Alzheimer’s, and other disorders that are currently thought to be incurable, or require surgery.

pharmacoperones-protein-foldingAnother breakthrough treatment that is expected to revolutionize medicine comes in the form of pharmacoperones (aka. “protein chaperones”). a new field of drugs that have the ability to enter cells and fix misfolded proteins. These kind of mutations usually result in proteins becoming inactive; but in some cases, can lead to toxic functionality or even diseases.

Basically, proteins adopt their functional 3-D structure by folding linear chains of amino acids, and gene mutation can cause this folding process to go awry, resulting in “misfolding”. Up until recently, scientists believed these proteins were simply non-functional. But thanks to ongoing research, it is now known their inactivity is due to the cell’s quality control system misrouting them within the cell.

protein1Although this process has been observed under a microscope in recent years, a team led by Doctor P. Michael Conn while at Oregon Health & Science University (OHSU) was the first to demonstrate it in a living laboratory animal. The team was able to cure mice of a disease that makes the males unable to father offspring, and believe the technique will also work on human beings.

The team says neurodegenerative diseases, such as Alzheimer’s, Parkinson’s and Huntington’s, as well as certain types of diabetes, inherited cataracts and cystic fibrosis are just a few of the diseases that could potentially be cured using the new approach. Now working at the Texas Tech University Health Sciences Center (TTUHSC), Conn and his team are looking to conduct human trials.

DNA-molecule2One of the hallmarks of the coming age of science, technology and medicine is the idea that people will be living in post-mortality age, where all diseases and conditions are curable and life can be extended almost indefinitely. Might still sound like science fiction, but all of this research is indicative of the burgeoning trend where things that were once thought to be “treatable but not curable” is a thing of the past.

It’s an exciting time to be living in, almost as exciting as the world our children will be inhabiting – assuming things go according to plan. And in the meantime, check out this video of the SDF-1 gene therapy in action, courtesy of the University of Utah School of Medicine:


Sources: extremetech.com, gizmag.com