Health care has come a long way since whole - body bloodletting. But medicine of the future will make even today's broad - based therapies obsolete. Breakthroughs such as cancer - hunting nanoparticles, virus busting lasers and featherweight heart monitors have begun to usher in a new era of targeted treatment, one in which drugs go directly where they're needed, leaving healthy body tissues intact, and the slightest sign of illness is detected in real time. Here are a few of the new innovations that will help doctors sharpen their focus in the years to come.
MAGNETIC BRAIN STIMULATION. For the 20 percent of depressed patients who do not respond to drugs such as Prozac, the traditional last ditch treatment option has been electroshock therapy. Recently, researchers worldwide began investigating a promising new alternative: transcranial magnetic stimulation. In TMS, magnetic pulses created by a metal coil attached to the scalp generate small electrical currents in the brain, these stimulate nerve cells in areas involved in depression, without harming surrounding gray matter. The treatment gained more momentum this spring when the Israeli firm Brainsway announced successful trials of its newest incarntion: Deep TMS.
The magnetic fields of standard TMS devices extend only about half an inch into the brain's cortex, But the coils of Deep TMS can stimulate neurons farther inside the brain by projecting magnetic fields into the skull from several points around its periphery. This means that, for the first time, clinicians can target the brain's deep seated limbic system, which plays an important role in mood regulation. So far, the device has lived up to its promise, 40 percent of the 64 depressed patients who recieved Deep TMS achieved a clinically significant degree of recovery. As Brainsway lobbies for FDA approval of the device, Sofer is also evaluating Deep TMS's suitability for Parkinson's and other neurological conditions that affect brain areas far below the surface.
STEM - CELL SCAFFOLD. To pinch hit for missing tissue at an injury site, stem cells need a scaffold to grow on, but artificial materials such as plastic won't do, since the body flags and rejects them as foreign substances. Ravi Kane, a biological engineer at the Rensselaer Polytechnic Institute in Troy, N.Y., has circumvented the problem with his biodegradable stem - cell framework made from alginate, a complex carbohydrate found naturally in brown seaweed.
Time - release microscale beads called microspheres are embedded in the scaffold with a carb eating enzyme called alginate lyase. As a result, the scaffold degrades at a tuneable rate once inside the body. Kane hopes the algal frameworks will allow doctors to implant stem cells directly into injured tissue, healthy bone stem cells at a fracture site, for instance, or neural stem cells in brain areas ravaged by Alzheimer's. Future versions of the scaffold could pack a one - two punch, delivering stem cells and drug compounds at the same time. This is a modular system, there's still room in the scaffold to put other types of microspheres inside.
PRE - EMPTIVE STRIKE AGAINST CANCER. Scientists around the world are working overtime on new cancer treatments, including more effective chemotherapy and better bone - marrow transplant procedures. Johns Hopkins biochemist Thomas Kensler aims to make all their efforts moot. Along with colleagues at Dartmouth College, Kensler is uncovering surprising ways to prevent malignancies from forming in the first place, like an earthquake or avalanche, cancer is the end result of a whole sequence of unstable conditions, abnormal cells must cluster in the wrong place at the wrong time, and cell to cell communications must break down, allowing cell proliferation and differentiation to proceed unchecked. Kensler has disrupted this sequuence in the lab by treating healthy tissue with a chemical compound called CDDO-Im.
Derived from acids in plants, CDDO-Im activates natural enzymes that remove toxic compounds from cells, compounds that might otherwise create DNA mutations that lead to cancer. CDDO-Im won't be available to patients for several years, but when it is, Kensler says, " I can see doctors recommending healthy people for this procedure based on their genetic susceptibility and the environment conditions they've been exposed to. Our goal is to prevent that very first cancerous cell from tipping over the edge."
SUPERBUG ZAPPER. Antivirals and antibiotics have long been the first line of defense against superbugs like HIV and staph, but they have some serious drawbacks. Antivirals can wreak havoc on the pancreas and liver, and antibiotics don't work against mounting drug resistant strains. In response, Arizona State physicist K T. Tsen has developed the ultimate multipurpose treatment tool, a superfast infrared laser that zaps bacteria and viruses without harming surrounding tissue. What makes Tsen's approach so novel is that his laser bumps off pathogens by mechanical means, not chemical or biological ones.
" We use the laser to create large vibrations on the protein coat of the bacteria or virus, exciting it to such a high energy state that the weak links on the capsid, or outer shell, break off," he says. Since mammalian cells don't have such a shell, this method destroys unwanted bugs while leaving patients bodies unscathed. Large scale clinical trials are still pending, Tsen says, but preliminary in vitro experiments indicate the laser effectively destroys the HIV virus. The laser might be in hospitals within a couple of years.
BLOODSTREAM BOT. Nowadays, procedures like removing tumors or Roto-Rooting plaque filled arteries can require long hospital stays. But a mosquito size robot developed by Oded Salomon, an engineer at Israel's Technion Institute, may be able to pull off these surgical feats without making large incisions, so recuperation is much faster. Taking a cue from 1980's PC games like " Laser Surgeon, The Microscopic Mission," Salomon's 1-mm diameter bot, dubbed "ViRob", uses its barblike metal arms to grip the insides of veins and arteries and excise small amounts of tissue with built in slicers. To operate most surgical probes, Surgeons must grasp an external that protrudes from the body, but ViRob has no such limitations. After the bot is injected into a vein, operators can mqnipulate its speed and direction by turning an external magnetic field to a variety of frequencies.
You don't need to control ViRob manually from outside, so you can access areas that otherwise can't be reached, and doctors might even be able to perform operations remotely while a patient is at home. Salomon predicts specialists will begin using the robot for procedures such as biopsies and blood vessel repairs within five years.
TARGETED DELIVERY. Pills may treat symptomes of the illness they're designed to fight, but when absorbed into the bloodstream indiscriminately they can also trigger debilitating side effects. Chemotherapy agents, for instance, cause nausea and hair loss, while antibiotics can trigger fatigue and shortness of breath. To help patients avoid side-effect doldrums, researchers at Philips's pharmaceutical division are developing the medical equivalent of a targeted missile-delivery system.
Philips scientists place particles of drugs inside microscopic bubbles of fluorocarbon gas and then inject them into a patient's blood stream. After the bubbles have reached the area flagged for treatment, a technician administers a high-energy ultrasound pulse. When you hit a certain ultrasound resonance, the bubbles break, and that disperses the particles of drugs. Researchers hope doctors will someday be to use bubble encased drugs to treat prostate, breast and brain cancers, eliminating the grueling physical toll usually associated with such therapies. Microbubbles let you give a dose in a more rational way. You can deliver a high concentration of the right drug to the spot where you want it.
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