technology-advisor

[technology-advisor]

6Technological Advancements in Medical fields that will Revolutionize the Future

Our modern life is more comfortable because of technology. f we want our daily life to be more comfortable, then technological advancements are most important. In recent years, technological advancements in the medical field give us hope to live without anxiety. Today we will discuss five technological advancements in medical fields that will revolutionize the future.

GENETIC EDITING

Treatments for genetically based diseases

When Chinese scientist He Jianku announced in November that he had manipulated twins’ DNA to not develop AIDS, all alarms went off. The situation imagined by many science fiction authors had materialized. Technology always advances at more speed than social debate and legislation. The use in human embryos of the genetic editing technique used by He, known as CRISPR/Cas9 or simply CRISPR, is heavily regulated. It allows DNA fragments to be cut and pasted at will and has been available since 2012. Besides, as it is cheap and straightforward, it is used in any laboratory that needs it, representing a breakthrough.

CRISPR technology’s main limitation is the lack of control over process errors, leading to unwanted genetic variations. According to Lluís Montoliu, a researcher at the CSIC’s National Centre for Biotechnology, “cutting can be controlled very well in the DNA sequence, but the same cannot yet be done with the repair.”

Drug development

Despite these limitations, this technique has already revolutionized biomedical research. It will continue to do so in the future, particularly in drug development and the treatment of diseases caused by genetic alterations. It is estimated that a single mutation causes about 10,000 diseases, so the technique’s potential is enormous. “All genetically based diseases are likely to be treated with CRISPR -says Montoliu-, although there are cases in which it can be easier or more difficult.”

Genetic editing allows, for example, to enhance a research technique known as knockout screening. By altering a gene, you can check what effects it causes, which can be used to identify targets for new drugs. Another thing that can be done is to solve resistance problems with certain medications. Gene silence allows us to see what genetic conditions cells are most sensitive to treatment so that compounds can be designed that act on the proteins produced thanks to the genes involved in resistance. This could improve, for example, chemotherapy in cases of pancreatic cancer. Another application of genetic editing is the possibility of introducing in mice the mutations that cause disease in a specific patient. Thus, treatments and ways to relieve symptoms can be tested accurately and personally.

But perhaps the area in which CRISPR technology is most promising is gene therapy. One way to implement this therapy is to extract the patient’s cells, edit them, select those that have not suffered any unwanted alteration, and re-inject them to the patient with the security that will not cause any unforeseen effect. This is already being used to treat blood diseases such as sickle cell anaemia and beta-thalassemia and boost immunotherapy in cancer cases. And it is expected that in the future this range of conditions will be expanded.

Clinical trials are also being carried out today to treat genetic diseases that affect sight. In this case, genetic editing tools are introduced directly into the eye. In this sense, explains Montoliu, “the eye is an accessible organ, which is isolated from the rest of the body and in which these therapies have already been tested, so doing so is relatively safe.”

ASSISTED REPRODUCTION

Three-person DNA embryos to treat infertility

Some arising from delayed maternity problems are forcing innovation in assisted reproduction treatments, increasing the effectiveness of treatments, and reducing their side effects. One of the main lines of research involves optimizing results. The success rate of embryo implantation is 30%, which can grow to 60% with a genetic diagnosis. “The personalization of reproductive medicine – with genetic diagnosis to determine which are the best embryos or with a genetic profile of the uterus to know what is the best time to transfer them – allows to increase the implantation rates,” explains Xavier Santamaria, Igenomix researcher and deputy scientific director of IVI, who augurs that in ten years it will be possible to reach “implementation rates of 90%”.

Other research lines have to do with tissue regeneration, big data, or ovarian rejuvenation. The most revolutionary is the nuclear transfer technique or maternal spindle transfer, which is popularly referred to as the embryo of three genetic parents. It uses the DNA of three people. It is about extracting the nucleus from the mother’s egg and introducing it into the donor’s egg, from which the original nucleus has previously been extracted. The result is an egg with the cytoplasm free of defective mitochondria and a nucleus with the mother’s inheritance. It is then fertilized in vitro with the father’s sperm and implanted in the mother’s uterus. This technique, however, has only been used within the framework of clinical trials. The United Kingdom was the first country to give the green light to prevent the transmission of mitochondrial diseases. The world’s first baby conceived like this was born in 2016 in Mexico. The novelty is that it has now been used not to prevent disease but to solve infertility problems: on April 9, the first child was born in Athens thanks to the collaboration of the Institute of Life assisted reproduction centre in Athens and Embryotools, the company based at the Barcelona Science Park that has developed the technique. “It has an important application because many couples with fertility problems now have no solution unless it is with conventional oocyte donation. It works very well, but genetically these babies are not related to the mother, which causes couples difficulty accepting it,” says Nuno Costa-Borges, scientific director of Embryotools. The child resulting from this assisted reproduction technique is related to the biological father and mother by more than 99% since the donor only provides mitochondrial DNA, which accounts for less than 1% of the cell. That is why Costa-Borges refuses to talk about “children of three parents” because it “leads to confusion.”

Ethical debate

However, the technique is still in the experimental period – the pilot trial is being conducted in Greece – and it would take the endorsement of the National Commission for Assisted Human Reproduction to apply it in Spain. It is a technique not without controversy since many of these fertility problems could be solved with donated eggs without the need to modify them to introduce the mother’s nuclear DNA. Besides, some voices warn that the baby’s consequences are unknown, although Costa-Borges assures that the former has been born healthy. “Science is advancing faster than laws, and it is important that Spain, a leading country in egg donation, can allow it in a regulated area,” he says. In any case, it cannot be incorporated into clinical practice overnight, as special technology and training are needed.

TISSUE BIOPRINTING

Custom fabrics thanks to bioprinting

At present, the only known cases of organs printed in the laboratory and successfully implanted in people are those of five Chinese children affected by microtia, a deformation of the ear of genetic origin. A team of Chinese scientists explained a year ago that they had managed to combine 3D printing with cultivation techniques to generate ears that they successfully implanted in five cases.

Although we are still far from creating organs such as kidneys in the laboratory and transplanting them into a person, current tissue printing technology opens up a set of new applications. First, it is now possible to recreate patients’ laboratory tissues from images of the real tissue. This allows complicated testing surgeries in the laboratory so that when the patient intervenes, the procedure is safer. It is being done thanks to the new bioengineering departments in hospitals such as Sant Joan de Déu or Clínic de Barcelona and is expected to increase.

This technology also creates low-vascularized body parts, such as heart valves, skin, tendons, and cartilage. These objects are printed with an ink that mimics the protein structure of real tissue. In the case of heart valves and tendons, they are already being tested in mice. “We can do it thanks to all the basic research on these tissues that have been developed over the last few years,” explains Núria Montserrat, a researcher at the Institute for Bioengineering of Catalonia (IBEC).

Thanks to this knowledge, in the future personalized tissues, can be printed from real images of the tissue to be regenerated so that the fit between the implant and the receiving organism improves considerably. In this sense, Montserrat and her team also work to obtain materials with which fabrics that do not generate rejection can be printed when they are implanted.

Bioprinting also opens a new pathway in drug testing. There are already companies that print tissues such as the liver, in which the toxicity of certain drugs can be studied so that, in the future, the process of creation and pharmacological trial can be shortened.

MICROBIOTA AND IMMUNE SYSTEM

Modulation of the body’s defence system

In recent years, the set of microorganisms that live in the guts, especially bacteria, has a significant impact on health. Known as microbiota, they help develop the guts’ anatomy, stimulate the immune system of babies, participate in food digestion and vitamin production, and play an essential role in assimilating drugs. The study of the relationship between the microbiota and the immune system is an incipient field of research that can improve vaccine efficiency, cancer treatments, allergies, and autoimmune diseases.

“We are starting to see a relationship between the immune system response and the nature of the microbiota,” explains Roger Paredes, a researcher at the IrsiCaixa AIDS Research Institute. For example, in mice, it has already been observed that there are eleven species of bacteria that stimulate an immune response capable of fighting HIV and some cancers. According to the researcher, “moving from mice to humans is complicated, but this knowledge is promising.”

Scientists’ idea is to modulate the immune system response depending on the disease by administrationing the good bacteria. In this way, this response could be intensified in cases of infections and cancer and attenuate it in allergies and autoimmune diseases. “We’re talking about bacteria that still can’t be bought in pharmacies,” Paredes clarifies. The research carried out so far in the laboratories opens up new and exciting perspectives.

CELL THERAPY LULAR FOR CANCER

CAR-T, a promising strategy to treat leukaemias

Car-T cell therapy (Chimeric Antigen Receptor T-Cells) has been a “step forward” in curing certain haematological cancers but has not yet developed its full potential. “We have not removed all the juice,” acknowledges Josep Maria Ribera, head of haematology at the Catalan Institute of Oncology (ICO) Badalona and expert in cell therapy. CAR-T cell therapy consists of genetically modifying the cells of the same patient’s immune system to make them recognize and attack tumour cells. A specific type of cells are selected, T lymphocytes – immune system cells extracted from the patient’s blood and treated to introduce genes made into the laboratory, which act as a kind of “weapon” to specifically identify tumour cells attack them more aggressively. “We modify them to destroy tumour cells,” explains Ribera. These modified cells are siphoned to the patient intravenously.

When all options failed

This therapeutic strategy brings together one of the three most cutting-edge lines in the approach to cancer: immunotherapy, targeted therapy, and genetic editing. And it has become one of the most promising therapeutic approaches for haematological cancers -basically lymphoma, acute lymphoblastic leukemia, and myeloma-. The challenge is that it can be transferred to solid tumours. CAR-T therapy is reserved for cases where the rest of the treatments have failed because, as Ribera acknowledges, it has “lights and shadows.” On the one hand, it has proven very useful in the short term, but it plays against its toxicity, and that there is still a lack of data to determine its long-term effectiveness. “We are seeing patients relapsing, and that makes us think it is not the ultimate weapon. It is effective and has a great future, it will be an advantage for many patients, but from here to cure cancer, there is still a long way”.

Ribera calls the advance “substantial” – especially since it is a hope for patients who could only be offered palliative care – but says it will have to be time to say if it is a revolution. “The possibility of development is immense, but I trust more in the CAR-T of the future than in those of the present. The story of the CAR-T is yet to be written; we have only begun it,” he concludes.

‘BIG DATA’ AND VIRTUAL REALITY

Artificial intelligence to help the doctor decide

“There is no other sector in which data generation is as high and goes at as much speed as medicine,” says Carolina Garc��a Vidal, a specialist in the infectious diseases service at Hospital Clínic. And now, this data can already be used for the benefit of the patient. “Artificial intelligence is present, and the creation of automated algorithms helps us to make clinical decisions,” explains García Vidal, who highlights that it is an “innovative” approach. “We are able to use large volumes of data from electronic clinical histories to create algorithms for predicting what will happen to our patients,” he adds. An example is the algorithm they have created to predict with a reliability of 98% which cancer patients will develop infections by multiresistant microorganisms and which will not, which allows to adjust the initial treatments to the real need and minimize side effects. It is estimated that one in four of these patients with multiresistant infection receives incorrect treatment. This figure is reduced to 2% with the algorithm, resulting in reduced antibiotic consumption, less toxicity, and lower economic costs.

Artificial intelligence also has applications in imaging techniques. There are experiences to diagnose skin, breast, and lung tumours and eye diseases or interpret scanners or resonances. For García Vidal, this is the beginning of a story that will “revolutionize medicine,” since now the prediction of the patient’s evolution is based on experience and what the medical literature says. At the same time, “in the future-present, we will have a lot of data processed by artificial intelligence that will make accurate predictions and personalized treatments.” They will not replace; however, the doctors: “They will complement the doctor’s mind; they will make our lives easier.”

Virtual reality to reduce pain Another example of technology applied to medicine is virtual reality to reduce patients’ pain and distress when faced with medical procedures such as surgical intervention. The Hospital Mútua de Terrassa has done a pilot test to reduce cancer patients’ pain when they leave the operating room, and the SJD Barcelona Children’s Hospital uses it for children who undergo magnetic resonances. Immersive technology has a promising potential as a painkiller effect and is also a useful tool for treating phobias, as they do at the Quirón Dexeus University