Cool Med­i­cal Break­throughs

The lat­est health­care tech­nol­ogy that could save your life

Singapore Women's Weekly (Singapore) - - CONTENTS -

Ground­break­ing med­i­cal in­no­va­tions this year will change our lives – and hope­fully even save them. Some an­tic­i­pated break­throughs seem to take us be­yond the realm of science and into science fic­tion ter­ri­tory (think 3D-printed pills or gene edit­ing), while oth­ers have less of a “wow” fac­tor, but will still of­fer much-needed re­lief.

Com­pil­ing a de­fin­i­tive list of fu­ture med­i­cal game-chang­ers is tricky. So,

The Weekly spoke to sci­en­tists, pol­icy mak­ers and phar­ma­ceu­ti­cal in­dus­try in­sid­ers to bring you some of the break­throughs just over the horizon, that may have a pro­found im­pact on your health in the year ahead.

Im­munother­apy for can­cer

This can­cer treat­ment uses the body’s own im­mune sys­tem to help fight the dis­ease. Yet sci­en­tists at the Gar­van In­sti­tute of Med­i­cal Re­search pre­dict this rev­o­lu­tion­ary treat­ment will be the med­i­cal story of 2017.

Ini­tially, im­munother­apy was used to tackle melanoma, then a type of lung can­cer. Now, it is be­ing used (or tested in clin­i­cal tri­als) to treat a broad range of ma­lig­nan­cies, such as bowel, pan­cre­atic and blad­der can­cers. Sci­en­tists hope that im­munother­a­pies may one day prove to be a “cure-all” for can­cer; in much the same way that peni­cillin is the panacea for in­fec­tions.

This year, the US Food and Drug Ad­min­is­tra­tion (FDA) is ex­pected to ap­prove the drug for the treat­ment of acute lym­phoblas­tic leukaemia, trig­ger­ing a wave of ap­provals for the treat­ment of other blood can­cers and lym­phomas. Sci­en­tists have long viewed im­munother­apy as the holy grail of can­cer treat­ments, but it’s proved in­cred­i­bly dif­fi­cult to make it work. Now, many on­col­o­gists be­lieve we may have cracked it. While still used in con­junc­tion with chemo­ther­apy, it’ll hope­fully sup­plant chemo, along with its hor­rific side ef­fects.

Tai­lor-made medicine

Four years ago, An­gelina Jolie an­nounced she’d had a dou­ble mas­tec­tomy to pre­vent the scourge of her fam­ily’s breast can­cer. In that coura­geous move, the film star splashed the sub­ject of ge­netic test­ing for dis­ease preven­tion across the front pages.

Sin­gle gene tests for dis­ease risk – such as the BRCA1 gene An­gelina car­ries – have been around for some years.Yet, in­creas­ingly, it is be­com­ing pos­si­ble to es­ti­mate peo­ple’s in­di­vid­ual risk of a whole range of dis­eases by look­ing at pat­terns across their genome se­quence (the six bil­lion base pairs of DNA they carry in ev­ery cell). Call it what you will – per­son­alised, ge­nomic or pre­ci­sion medicine – this ap­proach is aimed at both pre­vent­ing dis­ease and tai­lor­ing treat­ments. The Gar­van In­sti­tute pre­dicts that, this year we are likely to see clin­i­cal proof-of-prin­ci­ple stud­ies that show how “ge­nomic risk” can be used for early de­tec­tion and preven­tion pro­grammes, such as in can­cer.

Be­yond 2017, it will be­come more com­mon for doc­tors to use ge­nomic in­for­ma­tion as a first-line ap­proach to the di­ag­no­sis of dis­eases. Doc­tors should then be able to de­ter­mine how best to treat patients. By reading the clues in in­di­vid­ual genome se­quences, they will then be able to advise which drugs patients are most likely to re­spond to.

Choles­terol

There is noth­ing more ea­gerly awaited in car­dio­vas­cu­lar medicine than the re­sults from a large clin­i­cal trial of a new choles­terol-low­er­ing treat­ment.

Called PCSK9 in­hibitors, this class of drugs has been shown in ear­lier tri­als to si­lence the gene that cre­ates LDL (or “bad”) choles­terol. The out­come of the large Phase IIII trial should be known soon.

Choles­terol-low­er­ing stales, the cur­rent stan­dard-bearer in the fight against heart dis­ease, have had a bad rap in re­cent years. While still re­garded as safe and ef­fec­tive, their ad­verse side ef­fects (such as mus­cle pain and weak­ness) cause many patients to dis­con­tinue ther­apy or take less than the rec­om­mended dose.

Ex­perts say PCSK19 in­hibitors could be a vi­able op­tion for statin-in­tol­er­ant patients. The FDA last year ap­proved PCSK19 for high- risk patients, say­ing the drugs will likely be used more widely soon.

This is good news for Sin­ga­pore: Car­dio­vas­cu­lar dis­ease is the largest sin­gle cause of death in fe­males in Sin­ga­pore and world­wide, says Dr Derek Yong, Med­i­cal Direc­tor at Re­store Heart Cen­tre at Mount Alver­nia Hos­pi­tal. “It af­fects more women than men, and is more fa­tal than all can­cers com­bined, in­clud­ing breast can­cer. Women should un­dergo a full med­i­cal checkup at least an­nu­ally to check for car­dio­vas­cu­lar risk fac­tors such as di­a­betes mel­li­tus, hy­per­lipi­demia and hy­per­ten­sion.”

In­tra­venous iron

Up to one in three Sin­ga­pore­ans suffer from Iron De­fi­ciency (ID), and many don’t know it, says car­di­ol­o­gist Dr David Yeo, con­sul­tant car­di­ol­o­gist and direc­tor at Apex Heart Clinic at Gle­nea­gles Hos­pi­tal and med­i­cal direc­tor at The Iron Suites Med­i­cal Cen­tre. “Women of child­bear­ing age, be­tween 15 to 55, are es­pe­cially prone to iron de­fi­ciency and anaemia, es­pe­cially if they are preg­nant or have pro­longed men­strual bleed­ing.”

Iron de­fi­ciency causes short­ness of breath, headaches and fa­tigue. It’s es­pe­cially preva­lent in patients suf­fer­ing from heart fail­ure, but a new treat­ment is promis­ing sig­nif­i­cant im­prove­ments. Be­cause iron in foods like liver and oral sup­ple­ments aren’t ef­fi­ciently ab­sorbed by the body (only 10 per cent of oral iron in tablets is ab­sorbed, ac­cord­ing to Dr Yeo), in­tra­venous iron re­place­ments may be given to patients. Th­ese di­rect in­fu­sions of iron into the blood­stream are fully ab­sorbed by the body, but re­quire spe­cialised care at fa­cil­i­ties like The Iron Suites Med­i­cal Cen­tre, Sin­ga­pore’s first ID clinic.

Big Data per­spec­tives

The past decade has seen huge ad­vances in the amount of data we rou­tinely gen­er­ate, as well as our abil­ity to in­te­grate, cu­rate, an­a­lyse, un­der­stand, store and share it. The in­ter­sec­tion of th­ese trends is what we call “Big Data” and the health­care sec­tor (and so all of us) will ben­e­fit.

Until re­cently, the huge amount of data col­lected by the med­i­cal in­dus­try has been siloed in ar­chives con­trolled by dif­fer­ent hos­pi­tals, surg­eries, clin­ics and uni­ver­si­ties. Now, us­ing ad­vanced com­put­ing tech­niques, doc­tors can share all types of data – from symp­toms and med­i­ca­tions to test re­sults – to im­prove pa­tient care.

In Sin­ga­pore, the Na­tional Elec­tronic Health Record (NEHR) has been avail­able to all public health­care in­sti­tu­tions since 2013. It lets health­care pro­fes­sion­als ac­cess key med­i­cal records in a pa­tient’s his­tory from other clin­ics or hos­pi­tals, to get a more com­plete pic­ture of the pa­tient’s health. The NEHR is ex­pected to be ex­tended to the pri­vate sec­tor in com­ing years.

Big Data ap­proaches, such as com­puter al­go­rithms, can also de­tect pat­terns and trends to pre­dict epi­demics, im­prove qual­ity of life, avoid pre­ventable deaths and even cure dis­ease. By us­ing al­go­rithms to an­a­lyse ex­tremely large ge­netic and bi­o­log­i­cal data­bases in this way, we should be able to find fresh uses for known drugs, ac­cel­er­at­ing the devel­op­ment of new treat­ments. Ex­perts say it usu­ally takes a decade and about US$1.3 bil­lion to turn a lab­o­ra­tory find­ing into a suc­cess­ful drug treat­ment – Big Data break­throughs could cut this to two years and about US$130,000.

Ge­netic mi­cro­surgery

Five years ago, re­searchers proved that they could per­form mi­cro­surgery on genes, us­ing a pro­tein called Cas9 as a “scalper”. This gene edit­ing tech­nique, known as CRISPR, set off an ex­plo­sion of re­search, with sci­en­tists us­ing it to ma­nip­u­late specific genes in mice, rats, bac­te­ria, yeast, ze­bra fish, fruit flies and plants. Now, the first tri­als of gene edit­ing in hu­man em­bryos are un­der­way in China. Sci­en­tists there have re­ported ma­nip­u­lat­ing the genes of em­bryos to make them re­sis­tant to the HIV virus and also have edited genes linked to the sickle cell blood dis­or­der. Other tri­als have been ap­proved in the US and the Gar­van In­sti­tute in Aus­tralia ex­pects that th­ese tri­als will re­ally take off this year. This means that, in the fu­ture, we could be delet­ing – rather than treat­ing – dis­eases.

Blood tests for can­cer

Ex­perts say it’s only a matter of time be­fore di­ag­nos­ing and treat­ing can­cer will be as rou­tine as an an­nual check-up, thanks to so-called “liq­uid biop­sies”. Th­ese sim­ple blood tests look for cell-free cir­cu­lat­ing tu­mour DNA (aDNA), which is shed from a tu­mour into the blood­stream and is more than 100 times more abun­dant in the blood than tu­mour cells. Stud­ies are still be­ing con­ducted, but this tech­nol­ogy may do away with in­va­sive tis­sue biop­sies. Sev­eral med­i­cal com­pa­nies are de­vel­op­ing test kits to hit the mar­ket next year and an­a­lysts ex­pect huge de­mand, tip­ping an­nual sales of about US$13.1 bil­lion.

Di­a­betes drugs

Al­most a decade ago, a new wave of di­a­betes drugs hit phar­ma­cies, with prom­ises to lower blood-sugar lev­els.Yet they failed to al­le­vi­ate the scari­est statis­tic for Type 2 di­a­betes suf­fer­ers – half of them will die from car­dio­vas­cu­lar com­pli­ca­tions, with those odds ris­ing to 70 per cent by 65.

Last year, two new drugs showed signs of slash­ing those mor­tal­ity rates. Em­pagliflozin mod­i­fies the pro­gres­sion of heart dis­ease by work­ing with the kid­ney, while li­raglu­tide has a com­pre­hen­sive ef­fect on many or­gans.

In light of th­ese re­sults, a dis­tin­guished panel of doc­tors and re­searchers, as­sem­bled by the Cleve­land Clinic in the US, pre­dicts that, this year, there will be a to­tal shift in the line-up of drugs pre­scribed for di­a­betes, and as well as a wave of re­search into new av­enues tar­get­ing Type 2 di­a­betes and its re­lated dis­eases.

Hope for de­pres­sion

Ac­cord­ing to the Sin­ga­pore Men­tal Health Study con­ducted in 2010 by the In­sti­tute of Men­tal Health, as many as 1 in 17 Sin­ga­pore­ans have suf­fered from de­pres­sion and for some, tra­di­tional an­tide­pres­sants don’t re­ally work. Their only op­tion is in­ten­sive treat­ments, such as elec­tro­con­vul­sive ther­apy, where a light gen­eral anaes­thetic and an elec­tric cur­rent is passed through the brain for a few sec­onds. This treat­ment is only in­di­cated for those with se­vere de­pres­sion.

Di­ag­nos­ing and treat­ing can­cer will be as rou­tine as an an­nual check-up

In 2013, a study to see if ke­tamine – which is com­monly used for anaes­the­sia and, less com­monly, as a party drug – could al­le­vi­ate treat­ment-re­sis­tant de­pres­sion (TRD) pro­duced over­whelm­ingly pos­i­tive re­sults: 70 per cent of TRD patients re­ported im­proved symp­toms within 24 hours of be­ing in­jected with a low dose of ke­tamine. As a re­sult, the FDA ex­pe­dited the devel­op­ment of new med­i­ca­tions based on the ke­tamine pro­file and some, such as es­ke­tamine, are ex­pected to be avail­able to US patients shortly.

Self-ad­min­is­tered HPV test

In Sin­ga­pore, as in other de­vel­oped coun­tries, there have been huge strides in the treat­ment and preven­tion of the hu­man pa­pil­lo­mavirus (or HPV), the main cause of cer­vi­cal can­cer. Women here are urged to see their doc­tor for regular Pap smears, which can de­tect women’s can­cers and sex­u­ally trans­mit­ted dis­eases. Yet, ex­perts claim that the big­gest preven­tion ef­fort to date will soon take place, through large-scale de­ploy­ment of self-ad­min­is­tered HPV tests.

Th­ese tests – which in­clude a test tube, a swab and a mail-in box – would al­low you to ad­min­is­ter the test and process the re­sults in the pri­vacy of your own home, rather than the dis­com­fit­ing at­mos­phere of a doc­tor’s surgery. The con­ve­nience would al­low many more women to per­form the test, and seek med­i­cal as­sis­tance if nec­es­sary.

Bioab­sorbable stents

Many heart patients have metal stents in­serted into their chests to treat coro­nary artery block­age. More of­ten than not, the strut re­mains there for­ever, long af­ter its mis­sion has been ac­com­plished. The struts can make some scans and fu­ture surg­eries tricky, and lead to blood clots. Yet what if they could just van­ish?

The first bioab­sorbable strut was ap­proved in the US last July. Made of a nat­u­rally dis­solv­ing poly­mer, it widens the clogged artery for two years be­fore it’s ab­sorbed into the body in a man­ner sim­i­lar to dis­solv­able stitches. Ex­perts as­sem­bled by the Cleve­land Clinic are al­ready hail­ing th­ese stents as one of the top med­i­cal break­throughs of 2017.

“Stroke am­bu­lances”

Th­ese emer­gency ve­hi­cles, which are avail­able in the US and Aus­tralia, al­low stroke vic­tims to be treated quicker when time is of the essence. Equipped with a CR (Com­puted Ra­di­og­ra­phy) scanner the size of a wash­ing ma­chine, a stroke am­bu­lance will of­fer sus­pected stroke vic­tims a brain scan in their drive­way and ac­cess to time­crit­i­cal ther­apy up to an hour ear­lier. About 80 per cent of strokes are caused by a blocked blood ves­sel in the brain and may ben­e­fit from a clot-bust­ing drug, tPA.Yet the drug has to be taken within four hours of hav­ing a stroke, and un­for­tu­nately, it can be fa­tal in the 20 per cent of strokes that are caused by a haem­or­rhage.

Cur­rently, only 7 per cent of el­i­gi­ble patients re­ceive tPA as they don’t know ex­actly when the stroke oc­curred.The stroke am­bu­lance will di­ag­nose the type of stroke and de­liver treat­ment. On board to as­sist stroke vic­tims will be two paramedics, a ra­di­ol­o­gist, neu­rol­o­gist and nurse.

Mini pace­maker

It took Earl Bakken, founder of US med­i­cal de­vices com­pany Medtronic, just four weeks in 1957 to craft the first bat­tery-pow­ered pace­maker. His de­sign barely changed for 50 years, but last year, Medtronic’s new model, the Mi­cra, which is one-tenth the size and so small it can rest in­side the heart it­self, be­came the first of the next gen­er­a­tion of pace­mak­ers to be ap­proved by the FDA. Un­like tra­di­tional pace­mak­ers, which are im­planted un­der the skin us­ing an in­va­sive pro­ce­dure, the Mi­cra is slipped through the femoral artery via the groin, us­ing a catheter and docked in­side the heart’s right ven­tri­cle. It op­er­ates with­out elec­tri­cal wires that can break or get in­fected.

No more swal­low­ing pills

Many peo­ple need to take med­i­ca­tion daily, but find it dif­fi­cult to swal­low. Soon, this could be a thing of the past. In 2015, the FDA ap­proved a new type of pill that is 3D-printed and dis­solves into liq­uid when you take a sip of wa­ter. The pill, epilepsy drug Spri­tam, hit the US mar­ket last March. Its cre­ators are look­ing at other dis­ease ar­eas, so more rapidly dis­in­te­grat­ing drugs could be com­ing to a 3D printer near you.

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