Patch that delivers drug, gene and light-based therapy to tumor sites shows promising results

Approximately one in 20 people will develop colorectal cancer in their lifetime, making it the third-most prevalent form of the disease in the U.S. In Europe, it is the second-most common form of cancer.

The most widely used first line of treatment is surgery, but this can result in incomplete removal of the tumor. Cancer cells can be left behind, potentially leading to recurrence and increased risk of metastasis. Indeed, while many patients remain cancer-free for months or even years after surgery, tumors are known to recur in up to 50 percent of cases.



Conventional therapies used to prevent tumors recurring after surgery do not sufficiently differentiate between healthy and cancerous cells, leading to serious side effects.

In a paper published today in the journal Nature Materials, researchers at MIT describe an adhesive patch that can stick to the tumor site, either before or after surgery, to deliver a triple-combination of drug, gene, and photo (light-based) therapy.

Releasing this triple combination therapy locally, at the tumor site, may increase the efficacy of the treatment, according to Natalie Artzi, a principal research scientist at MIT’s Institute for Medical Engineering and Science (IMES) and an assistant professor of medicine at Brigham and Women’s Hospital, who led the research.

The general approach to cancer treatment today is the use of systemic, or whole-body, therapies such as chemotherapy drugs. But the lack of specificity of anticancer drugs means they produce undesired side effects when systemically administered.

What’s more, only a small portion of the drug reaches the tumor site itself, meaning the primary tumor is not treated as effectively as it should be.

Indeed, recent research in mice has found that only 0.7 percent of nanoparticles administered systemically actually found their way to the target tumor.

“This means that we are treating both the source of the cancer — the tumor — and the metastases resulting from that source, in a suboptimal manner,” Artzi says. “That is what prompted us to think a little bit differently, to look at how we can leverage advancements in materials science, and in particular nanotechnology, to treat the primary tumor in a local and sustained manner.”

The researchers have developed a triple-therapy hydrogel patch, which can be used to treat tumors locally. This is particularly effective as it can treat not only the tumor itself but any cells left at the site after surgery, preventing the cancer from recurring or metastasizing in the future.

Firstly, the patch contains gold nanorods, which heat up when near-infrared radiation is applied to the local area. This is used to thermally ablate, or destroy, the tumor.

These nanorods are also equipped with a chemotherapy drug, which is released when they are heated, to target the tumor and its surrounding cells.

Finally, gold nanospheres that do not heat up in response to the near-infrared radiation are used to deliver RNA, or gene therapy to the site, in order to silence an important oncogene in colorectal cancer. Oncogenes are genes that can cause healthy cells to transform into tumor cells.

The researchers envision that a clinician could remove the tumor, and then apply the patch to the inner surface of the colon, to ensure that no cells that are likely to cause cancer recurrence remain at the site. As the patch degrades, it will gradually release the various therapies.

The patch can also serve as a neoadjuvant, a therapy designed to shrink tumors prior to their resection, Artzi says.

When the researchers tested the treatment in mice, they found that in 40 percent of cases where the patch was not applied after tumor removal, the cancer returned.

But when the patch was applied after surgery, the treatment resulted in complete remission.

Indeed, even when the tumor was not removed, the triple-combination therapy alone was enough to destroy it.

The technology is an extraordinary and unprecedented synergy of three concurrent modalities of treatment, according to Mauro Ferrari, president and CEO of the Houston Methodist Research Institute, who was not involved in the research.

“What is particularly intriguing is that by delivering the treatment locally, multimodal therapy may be better than systemic therapy, at least in certain clinical situations,” Ferrari says.

Unlike existing colorectal cancer surgery, this treatment can also be applied in a minimally invasive manner. In the next phase of their work, the researchers hope to move to experiments in larger models, in order to use colonoscopy equipment not only for cancer diagnosis but also to inject the patch to the site of a tumor, when detected.

More information can be found from MIT website.

Smartphone app helps patients prepare for and recover from surgery

A new smartphone app is helping University of Virginia Health System surgery patients follow a treatment program to better prepare them for surgery and speed their recovery.

Since 2013, colorectal surgery patients at UVA have used the Enhanced Recovery After Surgery (ERAS) program. ERAS aims to educate patients, improve their outcomes and help to make them more comfortable before and after their surgery. In the first six months after ERAS was implemented for elective colorectal surgery, the overall median length of stay for patients decreased from five days to three days, overall complication rates were reduced by around 50 percent, and patient satisfaction scores improved across the board.

The ERAS program includes:
- Having patients drink sports drinks two hours before surgery to reduce the need for IV fluids
- Providing non-narcotic medications to minimize use of opioid pain medications
- Getting patients out of bed and walking soon after surgery
- Having patients eat as soon as possible after surgery

The key to making ERAS work, UVA care providers said, is extensive patient education both before and after surgery. Patients already receive an educational handbook and a paper checklist to ensure they complete needed tasks.

“We are bringing patient education into the digital age with an ERAS website and a mobile app to complement the handbook. This ensures patients have the information they need to understand their care and be better prepared for surgery,” said Bethany M. Sarosiek, RN, the ERAS development coordinator at UVA. “The app puts the information directly at their fingertips.”

Full story can be found from University of Virginia website.

Bionic vision system for people with vision loss from outer retinal degeneration CE approved

Pixium Vision announced that it has been awarded CE mark for its IRIS®II bionic vision system. This 150-electrode epi-retinal implant features a design intended to be explantable and upgradeable. The IRIS®II system is now CE mark approved for people with vision loss from outer retinal degeneration.



Christina Fasser, President of Retina International, an umbrella association of 33 national societies, said: “The progress in research with vision restoration of some visual perception is a reality, particularly with retinal prostheses. This research is addressing the growing patients’ expectations and their hope to regain some sight. On behalf of our member organisations, we are delighted to welcome the new bionic vision system IRIS®II that may offer people suffering from retinitis pigmentosa a new treatment option with a design that is intended to be explantable and upgradeable.”

The IRIS®II system is only available by medical prescription. Several leading ophthalmology centers in Europe are continuing to evaluate the system’s long-term performance based on a pre-defined protocol. The company is now able to file for national reimbursements.

Khalid Ishaque, CEO of Pixium Vision said: “The CE mark certification is a major step forward for Pixium Vision and for retinal dystrophy patients who have lost their sight. This recognition, by an independent expert body, validates the long-term multidisciplinary work that has resulted in market approval of the IRIS®II system. We will continue to develop our bionic vision systems with the aim to deliver improved visual perception and help retinal dystrophy patients lead more independent lives.”

In parallel, Pixium Vision is developing a tiny, wireless, sub-retinal photovoltaic implant for patients with AMD (age-related macular degeneration).

Product details can be found from Pixium Vision website.

Diagnosing gout could be easier and cost-effective with new portable device

UCLA researchers have designed a portable imaging system that can diagnose gout, a condition that affects more than 8 million adults in the U.S. alone.

The new system is compact and cost-effective, and it could allow many more primary care doctors to screen for the disease, which is the most common type of inflammatory arthritis.



The research, which was published in the journal Scientific Reports, was led by Aydogan Ozcan, UCLA’s Chancellor’s Professor of Electrical Engineering and Bioengineering and associate director of the California NanoSystems Institute, and John FitzGerald, a UCLA clinical professor of rheumatology.

According to the CDC, the incidence of gout in the United States is nearly three times more prevalent today than it was 50 years ago — likely because of the changing Western diet, and growing rates of obesity and hypertension. The condition occurs when uric acid levels in the blood increase to the point that the uric acid crystallizes. This leaves needle-like crystal deposits in the joints, tendons and ligaments, which triggers severe inflammation. It is caused by a combination of factors including diet, medication and genetics, and it occurs more commonly in those who consume red meat, drink large amounts of beer and are overweight.

The definitive test for gout calls for a doctor to draw joint fluid from a patient and then use a device called a compensated polarized light microscope to identify uric acid crystals in the sample. But recent studies have shown that primary care doctors usually opt to make their diagnoses without performing the procedure.

In addition, polarized light microscopes are bulky, heavy (weighing more than 20 pounds) and expensive ($10,000 to $20,000 or more). They also have a relatively small field of view, which can make it time-consuming to examine a large sample, and can produce unreliable test results. The examiners’ ability to detect crystals can also vary widely depending on their level of training.

The UCLA-designed platform, based on a technology called lens-free on-chip microscopy, can perform wide-field imaging without the need for lenses. It uses holographic imaging to produce high-resolution images of the crystal-like objects — the telltale signs of gout — in the patient’s fluid sample.

The technology works by sending a stream of light through a polarizer, through a sample of the fluid on a microscope slide, and then through another polarizer before it reaches an image sensor microchip, a component also found in mobile phone cameras and webcams. The image sensor captures the holographic diffraction pattern produced by the sample and feeds it to a computer with software that can quickly generate an image of the sample. The platform can use the entire active area of the image sensor chip — about 20 to 30 square millimeters, or approximately 100 times larger than standard optical microscopes can analyze at a similar resolution level — allowing for rapid analysis of larger volume of samples.

“With its wide sample area, cost-effectiveness and portability, our microscope can significantly improve the efficiency and accuracy of gout diagnoses, and it can be deployed even at the point of care and in clinical settings with limited resources,” Ozcan said.

The UCLA technology could ultimately be used to diagnose other conditions that are caused by crystals forming in bodily fluids and that are currently diagnosed using conventional polarized light microscopes — kidney stones, for example.

More information can be found from UCLA website.

Robot therapist hits the spot with athletes

If you see a physiotherapist or a Chinese physician for a sprained back, do not be surprised if your therapist turns out to be a robot.

Meet Emma, unveiled today by a start-up incubated by Nanyang Technological University (NTU Singapore), which has been treating Singapore’s national athletes, such as national basketballer and Mediacorp actor Chase Tan.

Short for Expert Manipulative Massage Automation, Emma is now treating patients at the Singapore Sports Hub, using acupoint therapy to relieve muscle strains and injuries.

Developed by AiTreat, a start-up company founded by NTU graduate Albert Zhang, Emma is undergoing user trials at Kin Teck Tong’s Sports Science and Chinese Medicine Clinic at the Kallang Wave Mall.

Mr Zhang, the creator of Emma, said his creation, a robotic arm with a 3D-printed massage tip that runs on proprietary software, can resolve some of the challenges faced by sports therapy clinics, such as a shortage of trained therapists and a need to deliver high quality therapy consistently.



“We have designed Emma as a clinically precise tool that can automatically carry out treatment for patients as prescribed by a physiotherapist or Chinese physician,” said Mr Zhang, who graduated in 2010 from NTU’s Double Degree programme in Biomedical Sciences and Chinese Medicine.

“This is probably the first such robot in the world developed specifically for use by Traditional Chinese Medicine (TCM) physicians and sports therapists. Our aim is not to replace the therapists who are skilled in sports massage and acupoint therapy, but to improve productivity by enabling one therapist to treat multiple patients with the help of our robots.”

Emma, which has a user-friendly interface and recommended guidelines for various sports injuries, was designed by Mr Zhang based on his experience as a licensed TCM physician in Singapore for the past five years.

The robot consists of a single, 6-axis robotic arm capable of highly articulated movements, a 3D-stereoscopic camera for vision, and a customised, fully rotatable 3D-printed massage tip. Several safety features which work in tandem with advanced pressure sensors are also in-built, to ensure the comfort and the safety of its patients.

Since patient trials started last week at Kin Teck Tong, Emma has treated 50 patients with different conditions, such as tennis elbows, stiff neck and shoulders, lower back pain, as well as muscle pulls.

Integrating advanced sports science and traditional Chinese medicine, Kin Teck Tong is a modern medical institution with a chain of clinics that offer sports injury rehabilitation and pain management.

Executive Director of Kin Teck Tong, Ms Coco Zhang, said the new physiotherapy robot has the potential to be a disruptive innovation, especially in the TCM and sports science industry.

“Like many developed countries, Singapore has the problem of an aging population. Over the next decade, more people are going to suffer from physical ailments such as arthritis and will be seeking treatment,” Ms Zhang said.

“However, as the younger generation prefer knowledge-based jobs rather than physically intensive jobs such as massage therapists, there will likely be a shortage of trained therapists in future. In our trials with the robot, the experience has been very good, as it can perform most treatments as well as our therapists.”

Since Kin Teck Tong is the exclusive TCM Partner of the Singapore Athletic Association and Basketball Association of Singapore, delivering high quality therapy is extremely important for the athletes’ recovery, Ms Zhang added.

Physiotherapy meets the Cloud

To ensure a consistent quality of therapy, Emma has sensors and diagnostic functions that will measure the progress of the patient and the exact stiffness of a particular muscle or tendon.

These detailed diagnostics are uploaded to the cloud where the progress of each patient can be analysed and generated into a performance report. For the first time in TCM treatment, patients can accurately measure their recovery progress using precise empirical data.

This is extremely valuable for athletes, as their injuries, treatment and recovery can now be measured and monitored by their physician and therapists. In addition, the treatment programmes can be adjusted according to the progress of the patients’ recovery.

AiTreat’s propriety cloud intelligence is supported by Microsoft, after Mr Zhang and his teammates won the Microsoft Developer Day Start-up Challenge earlier this year.

Incubated at NTUitive, NTU’s innovation and enterprise arm, the one-year-old start-up spent six months developing their first prototype after receiving a grant from SPRING Singapore’s Ace Start-up grant.

After the clinical trials are completed, AiTreat will focus on developing its second-generation robot that is more compact and mobile.

“What we have demonstrated, is the possibility of having a tireless clinical massage therapist that always delivers high quality treatment,” added Mr Zhang.

Chief Executive Officer of NTU Innovation and NTUitive Dr Lim Jui said disruptive innovations like Emma are what the university hopes to achieve by nurturing an entrepreneurial and innovative culture amongst NTU students, graduates and professors.

“We are happy to support one of NTU’s promising graduates to turn his dream into reality that will benefit society,” Dr Lim said. “We hope to encourage more of our students to follow Albert’s footsteps, daring to dream and willing to plunge into uncharted waters to develop future solutions to benefit Singapore and the world.”

Full story can be found from NTU website by following this link.