Three wild technologies poised to change healthcare
February 3, 2023 – When I was a kid, I watched syndicated episodes of the original star trek. I was dazzled by space travel, yes, but also by medical technology.
A pocket computer”tricorder” detected diseases, while an intramuscular injector (“hyponebulization”) could handle them. Infirmary “organic bedscame with real-time health monitors that seemed futuristic then but feel primitive today.
Such visions have inspired many of us children to pursue scientific studies. Little was known about the real progress many of us would see in our lifetime.
Artificial intelligence helping to detect disease, robots performing surgery, even video calls between doctor and patient – it all once seemed fantastic but is now happening in clinical care.
Now, in the 23rd year of the 21st century, you might not believe what we will be capable of next. Three particularly wild examples come close to clinical reality.
Captain America, Han Solo and Star Trek villain Khan – all of them were kept at low temperature and then resurrected, waking up alive and well months, decades or centuries later. These are fictional examples, of course, but the science they are rooted in is real.
Rare cases of accidental hypothermia prove that full recovery is possible even after the heart has stopped beating. The drop in body temperature slows metabolism and reduces the need for oxygen, delaying brain damage for an hour or more. (In an extreme caseone climber survived after almost 9 hours of resuscitation.)
Useful for a space traveler? Maybe not. But that’s potentially huge for someone with life-threatening injuries from a car accident or a gunshot wound.
That’s the idea behind a breakthrough procedure that came about after decades of research in pigs and dogs, now in a clinical trial. The idea: A person with massive blood loss whose heart has stopped is injected with an ice-cold liquid, cooling them from the inside to about 50 F.
Doctors already induce more modest hypothermia to protect the brain and other organs after cardiac arrest and during surgery on the aortic arch (the main artery carrying blood from the heart).
But this experimental procedure – called emergency preservation and resuscitation (EPR) – goes way beyond that, “significantly shrinking the body‘s need for oxygen and blood flow,” explains Samuel Tisherman, MD, trauma surgeon at the University of Maryland Medical Center and the principal researcher of the trial. This puts the patient in a state of suspended animation that “could buy surgeons time to stop the bleeding and save more of these patients.”
The technique has been performed on at least six sick, although none survived. The trial is expected to include 20 people by the time it wraps up in December, according to the list on the US Clinical Trials Database. Although given the strict requirements for applicants (emergency trauma victims who are not likely to survive), one cannot exactly rely on a fixed schedule.
Still, the technology is promising. One day we might even use it to keep patients in suspended animation for months or years, experts predict, helping astronauts through decades of spaceflight or delaying the death of sick patients awaiting treatment. .
Another sci-fi classic: growing human babies out of the womb. Think of the fetal fields of The matrixor embryos frozen in Alien: Alliance.
In 1923 British biologist JBS Haldane coined a term for it – ectogenesis. He predicted that 70% of pregnancies would take place, from fertilization to birth, in artificial wombs by 2074. That seems unlikely, but the timeline is on track.
Developing an embryo outside the uterus is already common in in vitro fertilization. And technology allows premature babies to survive much of the second half of gestation. Normal human pregnancy is 40 weeks, and youhe youngest surviving premature baby was 21 weeks and 1 day old, just a few days younger than a handful of others who have lived.
The biggest hurdle for babies younger than this is lung viability. Mechanical ventilation can damage the lungs and lead to a chronic (sometimes fatal) lung disease known as bronchopulmonary dysplasia. Avoiding this would mean finding a way to maintain fetal circulation – the complex system that carries oxygenated blood from the placenta to the fetus via the umbilical cord. Researchers at the Children’s Hospital of Philadelphia (CHOP) did this using a lamb fetus.
The key to their invention is a surrogate placenta: an oxygenator connected to the lamb’s umbilical cord. Tubes inserted into the umbilical vein and arteries carry oxygenated blood from the “placenta” to the fetus, and the deoxygenated blood comes out. The lamb resides in an artificial fluid-filled amniotic sac until its lungs and other organs are developed.
Fertility treatment could also benefit. “An artificial uterus can substitute in situations where a gestational carrier – surrogate – is indicated,” says Paula Amato, MD, professor of obstetrics and gynecology at Oregon Health and Science University. (Amato is not involved in CHOP research.) For example: when the mother does not have a uterus or cannot carry a pregnancy safely.
No date has yet been set for clinical trials. But according to the research, the main difference between man and lamb can be summed up in size. A lamb’s umbilical vessels are larger, making tube feeding easier. With current advancements in the miniaturization of surgical methods, this seems like a challenge that scientists can overcome.
Messenger RNA therapy
Return to star trek. The contents of the hypospray injector could cure just about any disease, even a new discovery on a strange planet. It’s not unlike messenger RNA (mRNA) technology, a breakthrough that allowed scientists to rapidly develop some of the first COVID-19 vaccines.
But vaccines are just the beginning of what this technology can do.
A whole field of immunotherapy is emerging that uses mRNA to provide instructions for producing chimeric antigen receptor-modified immune cells (CAR-modified immune cells). These cells are designed to target diseased cells and tissues, such as cancer cells and harmful fibroblasts (scar tissue) that promote fibrosis, for example, heart and the lungs.
The field abounds in rodent research and clinical trials have begun to treat some late-stage malignancies.
Actual clinical use may take years, but if all goes well, these drugs could help treat or even cure major medical issues facing mankind. We’re talking about cancer, heart disease, neurodegenerative disease – turning one therapy into another simply by changing the “nucleotide sequence” of mRNA, the blueprint containing instructions telling it what to do and what disease to attack.
As this technology matures, we can start to feel like we’re really on star trekwhere Dr. Leonard “Bones” McCoy releases the same device to treat just about any illness or injury.