FutureMed Takeaway Points: Day 5, February 10, 2012
Regenerative Medicine, Neuromedicine, IBM Watson, Wearable Elecrtonics
Daniel Kraft MD - Stem Cells & Regenerative Medicine
-Stem cells are: unspecialized; pluripotent or multipotent; self renewing, give rise to mature and specialized cells
-Usage of hematopoeitic stem cells expanding: traditionally in bone marrow transplant (BMT) for leukemia, lymphoma, myeloma, now to autoimmune, anemia, genetic disorders, -Cardiovascular disease Rx with adult stem cells (MI and CHF: injection of bone marrow stem cells into heart to improved ejection fraction, Peripheral vascular disease induce angiogenesis)
-Advancements: Instead of using radiation to knock out bone marrow use antibody to stem cell (could be used in sickle cell disease, thalassemias), Anti-aging or HIV treatment
-Tissue engineering – Decelleralized organs, infused with stem cells can reconstitute a beating heart, or potentially upon a 3D generated scaffold
-Getting stem cells – Bone Marrow (MarrowMiner), peripheral blood, cord blood
-Getting embryonic stem cells - from embryos, skin cells (put nucleus in healthy donor egg), re-program cells (4 factors can take any cell and create pluripotent stem cells), cellular alchemy (go directly from skin cell to target tissue) – will allow patients to maintain tissue banks
Gabor Forgacs PhD - Building Tissues and Organs
-The embryo is the ultimate tissue engineer …if you cut limb in embryo it can re-grow
-Printing organs – Organovo method: placing scaffold (agarose – inside of tube), stem cells (bio-ink), remove scaffold, place in bioreactor (e.g. perfusion) which causes cell sorting and fusion
-Current use of printing for vessels and nerves, later create animal products (edible meat)
-Current natural organ structure may not be the best, we can create better ones
Ajay Verma MD PhD – Neurodegeneration Therapeutics, Biogen Idec
-Neuro-degeneration will affect many people, part of aging process – Nature invested more in reproduction than maintenance (the ‘Soma theory’)
-All neurodegenerative disease shares common pathways: metabolic (mitochondrial) and oxidative (free radicals), macromolecular (DNA-RNA-protein intracellularly must be turned over or else toxic proteins build up), structural (protein interference) integrity
-Neurons don’t replicate and under constant metabolic stress – damaged proteins may spread to other cells causing further damage
-Proteinopathy (amyloid, synuclein, tau, TDP-43, SOD-1 ) most have no normal known functions, and are common to many neurodegenerative diseases
-Can we learn from successful agers? Study their brain – one observation is their immune defenses (auto-antibodies against proteins); can make antibodies from their B-cells
-Drug developments – we need to use new technology to improve discovery as CNS drug development slowest and expensive
-We have no biomarkers for neuro-degenerative disease (eg cholesterol in heart disease)
-We need better medical imaging, EEG (as biomarker – we have unique signatures)
-MEG, EEG changes in Alzheimer’s and mild cognitive impairment (can track progress/drug response, or even used as therapy with brain computer interfaces)
-Cognition – IT and mobile technology can improve assessment; cognitive games where your score in the game can be a treatment marker
Christopher deCharms PhD CEO of Omneuron
-We can use technology to go beyond our individual abilities using the nervous system
-Technologies already exist to interface with the brain (cochlear implant), and retinal implants are coming
-Brain stimulation – placing pacing wire into brain with stereotactic technique; can make significant impact on movement disorders; new Non-invasive means of controlling brain coming (transcranial magnetic stimulation of cortex, Focused US to stimulate, Optogenetics)
-Brain reading – downloading consciousness: we can read out activity via fMRI in the visual cortex when shown a letter in a fMRI.
-No diagnostic testing for chronic pain/anxiety – finding brain correlates with subjective experience; there are likely signatures to existence and extent of pain; we can teach people how to control pain
-New trends: Neuro-plasticity, Lie detector, personality typing, whole brain emulation
-We will pioneer the exploration of the inner space (brain) – Kids will master and train their brains
Philip Low PhD, CEO NeuroVigil (see recent NYTimes coverage of NeuroVigil)
- iBrain: A platform for hacking into the Brain: Data driven neurodiagnostics
-iBrain – a platform to access the brain at home involving algorithm to measure cortical biomarkers with improved resolution
-Biomarkers – unique EEG signatures of sleep, in addiction, Alzheimer’s, Parkinson’s Disease
-Pharma – can evaluate drug impact on the brain for multiple pathologies
-Electric biomaps of brain activities for different areas of the brain possible
-Looking at brain while imagining movements produce different patterns
Tan Le, Emotive Lifesciences - Global Neurological Health
-Mental health diseases based on abnormal neural networks
-Internet and mobile technology have revolutionize the ability for democratization of data.
-To make something democratized it needs to be 1) easy to use 2) inexpensive 3) able to collect and share data easily. e.g. wireless light weight EEG head sets
-A cloud of medical information gathered can be mined using machine learning algorithms to provide breakthroughs in medicine and early warning biomarkers.
-Focused on detecting long term (averaged out) changes in your brain that are brain abnormalities.
Russ Altman MD PhD - Stanford (Pharmacogenomics DataBase)
on Pharacogenomics Pharma
-Pharmacogenomics research network- to understand how genomic variation affects drug response e.g. Codeine has different metabolizers liked to CYP2D6
-Predictive drug interactions through statistical analysis of large data sets.
-Combining data mines increases the power of this analysis: Crowd sourcing for data. -Analyzing Internet sources by looking at words that were associated in searches helps to reveal patients symptoms and possible drug interactions.
-Pharmacogenomics 1.0 will arrive: using DNA sequence/genotypes as sources of information in prescribing (100s of drugs TODAY)
-Pharmacogenomics 2.0 will begin: use of DNA sequence/genotypes to design drugs, drug cocktails…chosen specifically for you.
-First wind of effective pharmogenomics to the general public will cause the public to demand it from providers.
Dale Bredeson MD Buck Institute of Agingon on Systems Therapeutics for Alzheimer’s disease.
-Imbalance in normal physiological processes that balance the synaptic maintenance vs the synaptic reorganization.
Alzheimer’s is a complex disease (prion like, physiological imbalance in function)…will likely need a cocktail of many drugs (like in HIV or cancer…to synergize Rx)
-Systems therapeutics involves looking at all elements of physiological balance (vitamin D, homocysteine) and bringing them to normal before adding drugs, along with memory training, better sleep, exercise (increases brain derived neurotopic factor (BDNF)), diet
Paul Grundy MD – IBM. Global Director of IBM Healthcare Transformation on The Medical Home Social transformation and social entrepreneurship
-Old model is episodic care all going through physician; need to move to parallel, population approach
-Today care is uncoordinated, 5 specialists working on a body without communication
-As a doctor you should be managing a population (preventative health)
-What people want: long-term comprehensive relationship with physician – want access, healing relationship, efficiency, 24hr access, email connection (move to synchronous communication)
-Large health insurers are shifting to preventative care payment
-We need information, accessible, and actionable at point of care – it will open up medicine
-Medical home – place where data goes and is accountable – 10% reduction in total costs
-Chronic – have ambulatory chronic care clinic to coordinate care
Marty Kohn MD Chief Medical Scientist, Care Delivery Systems, IBM Research-
IBM Watson & Applying Artificial Intelligence in Medicine
-Watson’s goals: improve quality of care, reduce errors, engage patients, improve audit trials, improve efficiency, better utilize skills, advance evidence based care, foster a health care analytics ecosystem, capture value.
-Right content, right time. Best practices to point of care.
-Strengths in Watson: Interprets and understands natural language questions. Analyzes large volumes of unstructured data, Quantifies degrees of confidence in potential answers. Supports iterative dialogue to refine results, adapts.
-Self-reinforcing perception bias- leads physicians to select possible diagnoses early in data collection and is then biased to reaffirm these beliefs through selective listening
-Watson is Stateless- it does not retain protected health information.
-Watson makes electronic medical health record useful -access to the important data and alerts the doctor as to what is missing.
-Watson as an enabler, not a solution – it can help primary care physicians with treatment and referrals
Computer History Museum
Eythor Bender – CEO of Ekso Bionics “Meet the real bionic man…”
-Spinal cord prosthetics haven’t changed in 40 years – The future is exoskeletons and wearable robotics
-Invented HULC for military to carry heavy loads easily, now ‘Ekso’ for the disabled
-Robots can change people’s lives – Exoskeletons will be the eyeglasses of the 21st century
Hans Keirstead PhD - Stem cells for spinal cord injuries and beyond
-Acute spinal cord injury – inflammation causes significant damage; by blocking the immune response you improve recovery; Same antibody used for MS and RA now being examined for use in treating spinal cord injury.
-Subacute spinal injury involves missing cells – fill gap with (oligodendrocytes- derived from embryonic stem cells)
-Chronic spinal injury involves scar tissue – replace with neurons derived from stem cells
-Recent large breakthrough in drug development is testing drugs on tissues derived from stem cells first, sometimes cells derived from the actual patient.
David Icke, CEO of mc10 - Blackbox for the body – The future of body computing
-Reshaping electronics to make them flexible (wearable and implantable)
-Thin silicon with accordion design makes them flexible e.g. Epidermal electronics moves with skin and can measures strain, temperature, EEG, ECG, etc. 7 microns, lasts 1 week
-Future: design small sensors to combine with wireless connection and analytics for intervention and implantation