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Collaborate Innovate, Features, Health, Highlight, Innovation

Digital Health: Better for you

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Sarah Keenihan discovers how digital health, improved data integration and innovative manufacturing are making Australians healthier.

COVID-19 has accelerated Australia’s demand for digital health delivery. But even before this change, Professor Tim Shaw was pressing for greater integration of everyday technologies into healthcare. 

“It’s crazy we don’t use simple technologies for better health management,” says Shaw, who is Director of Research and Workforce Capacity at the Digital Health CRC. “There are simple technologies we can apply, and most of these already exist .”

The Digital Health CRC is working with industry partners — such as healthcare solutions company HMS — to deliver personalised healthcare messages for patients with chronic heart conditions. They are developing interactive voice response systems for this purpose and also plan on utilising text messages and emails.

More broadly, the CRC aims to improve the use of data for informed decision-making by doctors, and refine services and models of care in general practice and hospitals.

“Data can empower teams on the floor,” says Shaw. “We want to equip clinicians with access to useful information.”

The Digital Health CRC has 80 industry partners, including 16 universities.

“You can’t do digital health without industry,” says Shaw. “Working in the CRC environment helps us to be more nimble, more agile, and to focus on innovation without being bogged down. But we’re still powered by academic expertise.”

Aged care, and health at a distance

Assisted aged care is a health area ready for innovation through technology. With partners Aged and Community Services Australia and the Aged Care Guild, the Digital Health CRC recently created the Living Better Lab to trial technologies to improve delivery of aged care services. 

Enhancing the health of Australians living outside our main cities is another key focus for the CRC. 

“It’s a question of equity”, says Professor Suzanne Robinson, Flagship Director for the Rural and Remote team. Relatively low access to health services partially explains why Australians living in rural and remote areas have shorter lives and higher levels of disease and injury. 

“We’re working to apply digital technology to help all Australians access health services,” says Robinson. “The CRC provides the right environment to pilot ideas for managing health outside urban centres.” 

The Digital Health CRC is working with the WA Country Health Service to expand technology application through their telehealth platforms.  

Long-distance sharing of digital images and patient records between urban and rural doctors, and expanded use of artificial intelligence, may bridge health gaps between city and country dwellers. 

New materials for knee repair

It’s not just data that can transform Australia’s health; new materials are also being developed. Orthopaedic care is a good example, where clinicians seek effective solutions to fix faulty bones and joints. 

Torn or ruptured ligaments are a big part of this problem. Orthopaedic surgeon Nick Hartnell estimates a global annual market of around $14 billion for replacement parts, taking into account procedures to knees, shoulders and ankles. 

Hartnell devised a uniquely Australian solution: kangaroo tendons. 

As head of startup Bone Ligament Tendon Pty Ltd, he’s working as part of a $6.9 million Innovative Manufacturing CRC (IMCRC) project to explore the viability of roo tendons to form donor ligaments in human patients. Allegra Orthopaedics and the University of Sydney are also partners. 

“It could be as fast as two to three years to get to market,” says Hartnell. “We’re making really good progress already.” 

In Australia, rates of surgical reconstruction of the anterior cruciate ligament (ACL) — a fibrous band that stabilises the knee joint — have increased during the past decade. 

“There’s no question the numbers of operations are going up and more of them are in young patients and women,” says Hartnell. 

He says the standard approach for ACL repair is to take a piece of tendon from another part of the human body — usually the hamstring — and replace the faulty one within the knee. But ligament failure is quite common using this method. 

Kangaroo tendons are strong, long and easily available

Enter kangaroo tendon, which is strong, long and easily available. “We collect tendons from animals that have already been culled for the human and pet meat markets,” says Hartnell. The tendons are then treated in the lab to prepare for insertion. 

To counter the risk of detachment from the bone, replacement roo ligaments are secured within recipient knees using 3D-printed ceramic biodegradable screws. 

“The patient’s own bone grows into innovative screws and the original materials dissolve away over time,” explains David Chuter, CEO and Managing Director at IMCRC. 

“There’s lots of interest in the commercialisation of these screws for other orthopaedic uses as well.”  

It’s a good example of how an innovation can have benefits beyond what it was originally designed for. 

“Patients, the healthcare system, state governments and even insurance companies may all see the benefits of this innovation in the long run,” says Chuter. 

“Manufacturing like this is rapidly moving towards being an enabler for many industries.”  

You never know where technology will take you.

Digitalhealthcrc.com

imcrc.org

Features, Health, Innovation, News, Technology

Game on – assistive tech for Parkinson’s disease

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A gaming system called ‘OrbIT’ is being trialled to improve health outcomes for individuals with Parkinson’s disease, thanks to a collaboration between Flinders University, the University of Adelaide and Parkinson’s South Australia.

The three-year study, funded by the Estate of the late Olga Mabel Woolger, will trial the assistive technology as a cognitive training device to improve outcomes and delay the onset of dementia for people with Parkinson’s disease. The research project is led by Flinders University Rehabilitation Engineer David Hobbs and University of Adelaide neuroscientist Dr Lyndsey Collins-Praino, in partnership with Parkinson’s South Australia.

The OrbIT system is a fun and easy to use computer gaming system designed to engage the player in targeted, cognitively challenging activities. It features a novel controller which does not require a strong grip or fine motor control. This makes it highly suitable for individuals with Parkinson’s disease, who may otherwise struggle to use traditional gaming consoles.

There are over 82, 000 Australians living with Parkinson’s today, making it the most common major movement disorder and second most prevalent neurodegenerative condition. There is currently no cure.

“Within 15 to 20 years, 80% of people with Parkinson’s will go on to develop dementia”, explains Dr Collins-Praino. “Using the OrbIT system as a cognitive training device may help to slow down and prevent this.”

OrbIT was originally developed for children with cerebral palsy and has also been trialled for people undergoing stroke rehabilitation. The current collaboration came about through a chance meeting when Dr Collins-Praino attended a presentation by OrbIT lead developer Mr Hobbs and suggested the potential for OrbIT to help people with Parkinson’s.  

“Sometimes the best collaborations come about by chance”, says Dr Collins-Praino, who is looking forward to using OrbIT in a clinical setting. “It’s really exciting to have a potential tool that can make cognitive training accessible.”

The trials will take place through Parkinson’s SA’s new Brain x Body Fitness Studio, a studio which focuses on movement and flexibility, whilst also being a social hub for over 50’s. As well as traditional gym facilities, Brain x Body provides programs and assistive technologies which have been clinically proven to improve neuroplasticity,

Chief Executive Officer of Parkinson’s SA, Olivia Nassaris, has always been on the lookout for assistive technologies and was highly impressed by OrbIT when she first visited Mr Hobbs’ Flinders University laboratory last year. She describes OrbIT as the perfect project. “It happened completely organically. Dr Collins-Praino saw the potential for the benefits of OrbIT to be translated to Parkinson’s research and the collaboration has worked out perfectly between the three groups.”

“Assistive technology such as OrbIT improve quality of life by maximising independence and self-management”, says Ms Nassaris. This research trial will be an important step in improving the health outcomes for individuals with Parkinson’s disease.  

Source: University of Adelaide, Parkinson’s SA

Image: Lyn Paunovic (centre), who has Parkinson’s disease, holds the OrbIT game controller. Left to right: Lyn’s husband Tolley Paunovic, Dr Lyndsey Collins-Praino, Lyn Paunovic, Olivia Nassaris and David Hobbs.

Health

From cell to accessible therapy: the future of regenerative medicine

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The cell and gene therapy industry is the fastest growing sector of regenerative medicine. Commercial cell therapies are being developed to treat several major diseases, including cardiovascular disease, cancer and autoimmune conditions. However, developing and manufacturing cell therapies is lengthy, labour intensive and expensive.

The CRC for Cell Therapy Manufacturing (CTM CRC) began in 2013, operating at the interface of cell biology and materials science. The CRC aims to help the cost-effective manufacture of cell therapies and assist their rapid translation into clinical practice.

CTM CRC’s research programs are driven by commercial imperatives and initially brought together 15 participant organisations across four states, including two international companies. That approach has led to the development of new immunotherapies and novel materials and surfaces to optimise cell and gene therapy manufacture.

From the outset, CTM CRC has focused on developing strategies to ensure its work continues beyond the funding period. “With two CTM CRC legacy vehicles to continue the excellent work carried out to date, the strategy to transition towards self-sufficiency has paid off,” says CTM CRC CEO

Dr Sherry Kothari. The CRC has incorporated its first spin-out company, Carina Biotech, and a second company, TekCyte, will also soon be incorporated. Both Carina and TekCyte will further develop and commercialise CTM CRC technologies, and are poised to continue the CRC’s work of making cell therapies more affordable and accessible.

Carina Biotech — A promising future for cancer treatment

In the last five years, researchers have achieved promising results in clinical trials of a revolutionary new treatment for blood cancers called Chimeric Antigen Receptor (CAR)-T cell therapy. CAR-T cell therapy is an immunotherapy that harnesses the patient’s own immune system to fight their cancer.

Since 2012, CAR-T cell therapy trials in adult and paediatric patients have recorded complete remission rates of up to 93%, offering huge potential for leukaemia and lymphoma treatment. The replication of this success in the treatment of solid cancers is a new focus of this approach, and it’s also the basis on which the CRC for Cell Therapy Manufacturing (CTM CRC) company, Carina Biotech, was founded.

“To effectively translate the unprecedented cancer-killing activity of CAR-T cells in blood cancers into solid cancers would represent the Holy Grail in the cellular immunotherapy industry,” says Dr Justin Coombs, CEO of Carina Biotech.

T-cells, the backbone of CAR-T cell therapy, are the ‘warriors’ of the immune system and they attack undesirable cells in the body. CAR-T cell therapy involves isolating a patient’s T-cells from a sample of blood and engineering them so they recognise and attack specific markers on cancer cells. These new CAR-T cells are then infused back into the patient to seek and destroy the cancer.

Carina Biotech’s first lead technology in cell and gene therapy research is a CAR-T cell that attacks a cancer-specific marker on solid cancers, but not on healthy cells. Early data indicates these CAR-T cells can kill a diverse range of solid cancer cells in vitro, including breast, ovarian and brain cancers and melanoma. Pending positive results from in vitro pre-clinical studies, slated to begin in 2018, the first-in-human clinical trials could follow within two years.

It is clear there is great potential for CAR-T cell therapy to play a leading role in the race to cure cancer, but as Dr Coombs cautions, “Solid cancers are shaped by evolution to defend themselves from attack. Carina is aiming to develop weapons for immune cells to destroy all solid cancers.”

TekCyte — Moving rapidly from lab to commercial scale

TekCyte, the translational facility of CTM CRC, was set up to respond to manufacturing challenges in the evolving cell and gene therapy industry. TekCyte’s focus is to translate technologies from the lab to pilot scale.

“Pilot-scale manufacturing is where many technologies stall because they cannot be replicated in commercial settings,” says Dr Tony Simula, who leads TekCyte with Dr Andrew Milligan. “There are unique challenges in scaling up processes involving living cells and TekCyte addresses these as an important step towards commercial manufacture of cell therapy products.”

TekCyte is currently validating two CTM CRC technologies for the commercial market: the delivery of stem cells for the treatment of chronic wounds, and an antithrombotic coating for vascular stents to reduce thrombosis and restenosis. With positive preclinical data to date, it is imperative that TekCyte is able to consistently produce both products in large volumes, as well as meeting stringent regulatory requirements and demonstrating reliable performance. TekCyte’s infrastructure and expertise enables it to fulfil this critical translational role so it can bridge the gap between the laboratory and commercial development.

“TekCyte is unique because it combines materials surface and cell biology expertise, with the know-how and infrastructure required to manufacture at pilot scale,” says Dr Milligan.

“This capability has given TekCyte a competitive advantage and enables it to expand its offering to include product development for companies.”

TekCyte aims to establish itself as an important player in the global supply chain for the regenerative medicine industry. It is evolving into a world-class translational facility, able to develop and supply specialised coatings and processes for cell and gene therapy manufacture and other biomedical applications.

 

Health, Highlight, Innovation, News

Wearable diabetes patch

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Featured image above: type-1 diabetes patch, which consists of wearable sensors (Humidity, Glucose, pH, Strain, and Temperature sensors) and a co-integrated feedback drug delivery system. Credit: Hui Won Yun, Seoul National University

Recent technological advances in painless, wearable electronic devices could help make life easier for diabetics and their carers.

To keep their blood sugar levels in check, diabetics need to draw blood from their fingertips to measure glucose concentration, and then calculate the amount of insulin they need to inject, several times a day. This is painful and tedious, and often leads to poor management, with dangerous consequences.

Type-1 diabetes is a lifelong disease, one of the most common in children, and the incidence is increasing in Australia.

Now, Korean scientists have created a skin patch to measure glucose in sweat, and published the results in March 2016 in Nature Nanotechnology. They demonstrate that glucose concentrations in sweat closely followed changes in blood glucose. When the skin patch senses elevated glucose levels (or hyperglycemia), the microneedles embedded in the patch then deliver a glucose-lowering drug – metformin – under the skin.

The patch contains an array of sensors also detecting humidity, pH and temperature – parameters used to calibrate the glucose reading in sweat. When hyperglycemia is detected, a built-in heater dissolves the protective coating on the microneedles to infuse metformin.

Biomedical engineers in the USA described a similar device last year called Smart Insulin Patch. In this skin patch, the insulin-loaded microneedles themselves are sensitive to hyperglycemia, which triggers their dissolution, delivering insulin into the body when needed.

Glucose monitoring and management

The GlucoWatch was the first non-invasive real-time glucometer on the market, over a decade ago. “The technology was brilliant. The new skin patch sensors are more sophisticated versions of this,” says Professor Justin Gooding, co-director of the Australia Centre for Nanomedicine at UNSW Australia, and Editor-in-Chief of the journal, ACS Sensors.

The problem with continuous glucose monitors, which are implanted under the skin, is that they can’t be worn for more than a week or two before they need to be replaced, says Gooding.

Other continuous monitors available measure glucose via a fine needle under the skin, and have been reported to irritate the skin with prolonged wear. Non-invasive sweat sensors could eliminate this problem.

Wearable devices that monitor and manage blood glucose levels automatically, build on ideas for an artificial pancreas (also called closed-loop system) from the 80’s, says Gooding. This is a network of devices that together mimic the function of a healthy pancreas.

Gooding explains that it’s challenging to create a skin patch device that can deliver different doses of insulin at different times, like an insulin pump can. Most systems deliver a constant dose, or they just dump.

“Closing the loop is the Holy Grail for diabetes management,” says , a clinical endocrinologist at Prince of Wales Hospital, Randwick and researcher at the Centre for Diabetes, Obesity and Endocrinology, Westmead.

“It’s still a bit of an art to work out how much insulin someone needs,” she says. The biggest hurdle to closing the loop is the right algorithm to calculate the correct dose of insulin to be injected at the right time.

The skin patch devices could be useful to maintain steady blood sugars between meals, but a large dose of insulin still needs to be injected for glucose spikes after a meal, says Lau. “Often you need to anticipate the spike and inject before a meal to effectively control blood sugars”, she explains.

Clinical trials of an artificial pancreas using existing constant glucose monitors and insulin pumps teamed with new advanced algorithms – to calculate insulin doses – have been scheduled to begin in 2016 by the creators from Harvard University and University of Virginia, USA.

Advances in different research areas take us closer to the possibility of a minimally invasive artificial pancreas that can be worn as a skin patch.

“Research into closed-loop systems is really important because they help us understand how technology can be used to control diabetes,” says Lau.

– Sue Min Liu