Future treatment for chronic health problems could be as simple as an annual doctor’s appointment, due to advances in bioelectric medicine at Carnegie Mellon University.
In just a few years, treatment for diseases that impact tens of millions of Americans -- like Type 2 diabetes, obesity and thyroid disorders - could require just one trip to the doctor’s office a year.
"With a push of a button on their phone, a patient can get their chronic condition under control," said Tzahi Cohen-Karni , a professor of biomedical engineering and materials science and engineering in Carnegie Mellon University’s College of Engineering.
These advances could one day give people with chronic conditions access to an implantable device that delivers treatment automatically, reducing their dependence on costly medications or frequent doctor visits. The approach could also lead to better outcomes by providing precise care exactly when it’s needed.
A ’living pharmacy’ within the body
Cohen-Karni’s is one of several bioelectric medicine projects at CMU that use electronic tools to treat diseases. Their goal is to develop implantable devices the size of a AAA battery that act as a miniature pharmacy inside the body.
"The implanted device contains engineered cells to treat a wide range of chronic diseases," Cohen-Karni said.
The cells can also act as tiny disease sensors.
"These cells are engineered either by modifying their DNA or by differentiating them from stem cells, so that they can sense signs of disease and precisely produce therapeutic molecules," said Burak Ozdoganlar , a mechanical and biomedical engineering professor at CMU. He is leading a large team that uses the implantable, cell-based systems to treat thyroid disorders and a host of other hormonal diseases and chronic conditions using bioelectric medicine.
The technology is minimally invasive and has the ability to deliver patient-specific therapy to manage the disease. This unique therapy delivers treatment in a remarkable way - without synthetic drugs or medication.
"The approach here is to treat the disease more naturally," Ozdoganlar said. "The living cells inside the implanted device will produce hormones as they do in a healthy body. It’s really a replacement of either the organ itself or the function of the organ."
This more natural approach will reduce side effects patients might feel from traditional pills or injections, according to Ozdoganlar.
Helping doctors better understand patient needs
While one group of cells within the implant delivers therapy to treat the disease, Ozdoganlar’s research team is also developing a second system called a "living sentinel." The cells inside the living sentinel continuously monitor biomarkers - indicators of disease activity in the body - for critical changes in the disease.
These devices will be implanted in the patient’s arm, belly, or chest and can also send real-time updates to them and their doctor.
"The patient will be able to know whether their disease is under control or if they need to deploy more therapy," Cohen-Karni said. "They will also be able to share side effects they’re experiencing with their doctor, who can then fine-tune the dosage of what’s being released into the patient’s body."
These snapshots can give doctors a more accurate picture of diseases like Type 2 diabetes or thyroid disorders, which the researchers believe will lead to more effective treatment. For example, right now doctors monitor patients with thyroid disorders by analyzing blood tests every six months.
"When they test a patient’s blood, what they see is only valid for a few days," Ozdoganlar said. "It’s a very inefficient, inaccurate means of approaching this problem."
With these implantable devices, they’ll have data on what the disease looks like at any given moment.
"Doctors would immediately know the patient’s condition, and based on the parameters they set, the device can take corrective action right away," Ozdoganlar said. "Therefore, we expect the clinical outcomes to be far better. People will be treated better overall. The whole idea is to make things simpler, make the clinical outcomes much better overall, and lower the costs - both immediate and long-term - not only to the patient, but to the entire society."
These advances in bioelectric medicine offer such promise that Cohen-Karni, Ozdoganlar, and their collaborators received substantial federal funding from the Advanced Research Projects Agency for Health (ARPA-H) to support their research and discoveries.
Clinical trials for both Ozdoganlar and Cohen-Karni’s projects are expected to begin in four years.
Huge cost savings in a small device
Researchers hope these devices will save patients money. Because the devices will only need to be replaced once a year, people will be able to get lifesaving treatment at a fraction of the cost.
Cohen-Karni estimated that the current medical expenses a patient pays in any given month could be reduced to what they pay over the course of an entire year.
"The clinician on our team, who sees hundreds of patients from different backgrounds, said many of her patients can’t afford to pay for treatment," said Cohen-Karni. "This device would be more affordable by an order of magnitude."
By significantly reducing the cost of care and eliminating the complex daily routines required by traditional approaches, these advances could also benefit people who don’t have reliable access to medical care.
And while these projects are focused on 12-month treatments, they’re just scratching the surface of what bioelectric medicine could offer.
"What if we can create a version that lasts a lifetime?" Ozdoganlar said.
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