By KIM BELLARD
One of my frequent laments is that here we are, a quarter of the way into the 21st century, yet too much of our health care system still looks like the 20th century, and not enough like the 22nd century. It’s too slow, too reactive, too imprecise, and uses too much brute force. I want a health care system that seems more futuristic, that does things more elegantly.
So here are three examples of the kinds of things that give me hope, in rough order of when they might be ready for prime time:
Floss sensor: You know you’re supposed to floss every day, right? And you know that your oral health is connected to your overall health, in a number of ways, right? So some smart people at Tufts University thought, hmm, perhaps we can help connect those dots.
“It started in a collaboration with several departments across Tufts, examining how stress and other cognitive states affect problem solving and learning,” said Sameer Sonkusale, professor of electrical and computer engineering. “We didn’t want measurement to create an additional source of stress, so we thought, can we make a sensing device that becomes part of your day-to-day routine? Cortisol is a stress marker found in saliva, so flossing seemed like a natural fit to take a daily sample.”
The result: “a saliva-sensing dental floss looks just like a common floss pick, with the string stretched across two prongs extending from a flat plastic handle, all about the size of your index finger.”
It uses a technology called electropolymerized molecularly imprinted polymers (eMIPs) to detect the cortisol. “The eMIP approach is a game changer,” said Professor Sonkusale. “Biosensors have typically been developed using antibodies or other receptors that pick up the molecule of interest. Once a marker is found, a lot of work has to go into bioengineering the receiving molecule attached to the sensor. eMIP does not rely on a lot of investment in making antibodies or receptors. If you discover a new marker for stress or any other disease or condition, you can just create a polymer cast in a very short period of time.”
The sensor is designed to track rather to diagnose, but the scientists are optimistic that the approach can be used to track other conditions, such as oestrogen for fertility tracking, glucose for diabetes monitoring, or markers for cancer. They also hope to have a sensor that can track multiple conditions, “for more accurate monitoring of stress, cardiovascular disease, cancer, and other conditions.”
They believe that their sensor has comparable accuracy to the best performing sensors currently available, and are working on a start-up to commercialize their approach.
Nano-scale biosensor: Flossing is all well and good, but many of us are not as diligent about it as we should be, so, hey, what about sensors inside us that do the tracking without us having to do anything? That’s what a team at Stanford are suggesting in A biochemical sensor with continuous extended stability in vivo, published in Nature.
The researchers say:
The development of biosensors that can detect specific analytes continuously, in vivo, in real time has proven difficult due to biofouling, probe degradation and signal drift that often occur in vivo. By drawing inspiration from intestinal mucosa that can protect host cell receptors in the presence of the gut microbiome, we develop a synthetic biosensor that can continuously detect specific target molecules in vivo.
“We needed a material system that could sense the target while protecting the molecular switches, and that’s when I thought, wait, how does biology solve this problem?” said Yihang Chen, the first author of the paper. Their modular biosensor, called the Stable Electrochemical Nanostructured Sensor for Blood In situ Tracking (SENSBIT) system, can survive more than a week in live rats and a month in human serum.
“This work began more than a dozen years ago and we have been steadily advancing this technology,” said Tom Soh, senior author of the paper. “This order-of-magnitude improvement in whole-blood sensor longevity over existing technologies is a huge advancement toward next-generation biosensors.”
The researchers believe their approach can lead to a new medical paradigm – “one where we can not only detect disease earlier but also potentially tailor treatments in real time.” Amen to that!
In vivo CAR-T therapies: If you follow cancer treatments, you’re familiar with CAR-T therapies, which engineer immune cells to fight cancer cells. They’re very promising, but very expensive, and time-consuming to make. “This whole process, it’s just inefficient,” Saar Gill, a haematologist and oncologist also at the Perelman School of Medicine, told Cassandra Willyard in Nature. “If I’ve got a patient with cancer, I can prescribe chemotherapy and they’ll get it tomorrow.”
Ms. Willyard profiles the approach of engineering the CAR-T cells in vivo. The potential, she reports, is enormous: “Treatments that deliver a gene for the CAR protein to cells in the blood could be mass produced and available on demand — theoretically, at a much lower price than current CAR-T therapies. A single dose of commercial CAR-T therapy costs around $500,000. A vial of in vivo treatment might cost an order of magnitude less.”
“If it’s efficacious and safe, it could really challenge the current paradigm,” Joseph McGuirk, a haematologist and oncologist who studies cellular therapies at the University of Kansas Medical Center, told her. And “we need to challenge the current paradigm”.
Obviously, this is not simple. “The stumbling block is, how do you get it to the right cell, the right place, right time?” said Michel Sadelain, a genetic engineer and director of the Columbia Initiative in Cell Engineering and Therapy at Columbia University. Ms. Willard describes different approaches that different companies are trying to accomplish this. Some companies, for example, are using viral vectors, while others use nanoparticles to deliver RNA into T cells. Other companies are skipping T cells and inserting the RNA into macrophages and other immune cells.
Human trials are underway, although with small numbers of participants. “I think 2025 and 2026 are going to be two very busy years in this area,” one CEO told Ms. Willyard. Let’s hope so.
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Each of these is promising, and certainly in the right direction. Add these to, say, 3D printing in vivo using sound or programming smart cells, and forgive me if I get excited. We’re seeing glimpses of the future.
So next time someone wants to stick a needle in you for a blood test, put you through a colonoscopy, or start you on a grueling chemotherapy regime, ask yourself: would I be doing this in the 22nd century?
Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor
