Losing one’s memories, and therefore one’s identity, must be a terrifying experience. With a global estimate of almost 50 million people living with dementia, predicted to rise to more than 130 million by 2050, the burden of Alzheimer’s and dementia are indisputable. While there are still no approved drugs for the treatment of Alzheimer’s, there is an urgency for developing diagnostic tests and the identification of biomarkers that enable the early detection of the disease. In light of this need, diagnostic technology company IQuity (pronounced I-Q-witty) has recently received a grant from the National Institutes of Health (NIH) to build a platform around the early detection of Alzheimer’s. We sat down with IQuity’s Founder and CEO, Dr. Chase Spurlock, to talk about this effort and the company’s progress with other diseases they have tackled.
Mohammad Saleh, Medgadget: Tell us about yourself and how you came to be a part of this work.
Chase Spurlock, IQuity: I’m the CEO of IQuity, a tech company based in Nashville using data science to detect and monitor disease. At IQuity, we can use a variety of data sources – ranging from blood samples to large, population-level healthcare datasets including insurance claims or electronic health records to identify disease and help optimize patient journeys. A large portion of my work has focused on autoimmune diseases through research initiated at IQuity and through my faculty position at Vanderbilt. Autoimmune diseases affect you and someone you know – these are conditions like multiple sclerosis, rheumatoid arthritis, Crohn’s disease and others where the immune system harms the body’s tissues and organs. We can’t cure these diseases, but we can treat them. If we can detect the disease early, we have the best chance for optimal long-term outcomes including reduced disability and longer life expectancy.
The first demonstration of our use of data science to build tools to help providers diagnose and treat these illnesses was to create blood-based tools that doctors can use to make fast, accurate diagnoses. We created a platform that looks at RNA data, a real-time snapshot of what’s taking place inside the patient’s blood cells, and then builds computer models to allow us to examine new patient samples and ask if they look like patients with specific diseases we may have seen before. To date, we have commercialized three tests leveraging our technology for multiple sclerosis, IBS (irritable bowel syndrome) and IBD (Crohn’s disease and ulcerative colitis), and fibromyalgia syndrome.
Apart from our blood-based studies, we began using our disease knowledge and data science expertise to look at large, population-level datasets to see if we could craft similar insights that enable early disease detection and patient monitoring. Layering claims data with datasets that help us understand the social determinants of health, we have been able to mirror our blood testing work and create a technology that enables faster disease detection, correction of misdiagnosis and the ability to monitor patient disease at scale. Monitoring is critical to ensure that treatment plans remain effective and prevent adverse events. Our approach makes it possible to alert care teams so that interventions can occur faster than is conventionally possible today.
As we look to the future and the broad applicability of our technology, we began exploring whether we could use our blood-based approach or population analytics platform to tackle new disease indications. Alzheimer’s disease quickly rose to the top of the list because this fatal neurodegenerative disease affects over five million Americans and often goes unnoticed until symptoms manifest 15-20 years after the damage to the brain starts. We feel that our approach using blood-based technology for population-level analytics holds extraordinary potential to make an indelible mark on how clinicians can approach Alzheimer’s care in the years ahead.
Medgadget: Can you give our readers a quick overview of what the current status of Alzheimer’s early detection and drug research is?
Spurlock: We need tools that can accelerate the diagnosis of Alzheimer’s disease – whether these innovations come in the form of biomarker development, digital technologies, or a combination of the two. Both approaches will allow us to understand how the disease develops and progresses, the patient populations affected by Alzheimer’s and provide opportunities to refine future clinical trials by enhancing patient recruitment efforts. There are no approved treatments that can slow the progression of Alzheimer’s disease – they are primarily used to treat symptoms and are useful for only a short window of time. In the future, approved drugs for Alzheimer’s will be most effective when administered early. The diagnostic tools we have proposed to develop through our NIH-funded studies seek to identify patients at the earliest stages of the disease and could potentially be used in clinical trials to assess treatment responses. If we can identify patients early and include them in clinical trials, we will have a better chance of finding therapeutics that can alter the trajectory for this devastating condition.
Medgadget: What makes IQuity uniquely adept at tackling this problem?
Spurlock: At IQuity, we have successfully commercialized tools that can be used to identify disease. Using multiple sclerosis (MS) as an example, we have shown that we can identify patterns in blood at the time of a clinically isolated syndrome, which is the major clinical precursor to MS. In MS and fibromyalgia, have shown us that these long non-coding RNAs (lncRNAs) exhibit high levels of disease-type specificity meaning that lncRNA patterns measured in blood are often specific for one disease and can be used to differentiate among similar conditions and healthy individuals. The preliminary studies that we outlined in our recent Alzheimer’s grant highlight the utility of these biomarkers to distinguish Alzheimer’s disease from other neurological illnesses.
As an expansion of our work in genomics, we are eager to explore the use of the longitudinal health records in our population datasets (insurance claims data or electronic health records) to assess whether our existing data science approaches could be applied to identify early patterns for Alzheimer’s. These efforts will help us understand environmental, racial or other social factors that can explain how this disease may arise and could lead to opportunities for early intervention.
Across both areas of our business, I believe IQuity is uniquely poised to make discoveries that can improve diagnostic tools, inform pharmaceutical development and enhance the quality of life for patients living with many diseases. While autoimmune conditions have traditionally been our focus, the opportunities to help patients with a variety of medical conditions, including Alzheimer’s, are possible with the infrastructure we have put in place.
Medgadget: Can you tell us about the technology driving the Alzheimer’s detection efforts? How does it work and where does machine learning factor in?
Spurlock: The funding we recently received will support our work to identify and measure lncRNA found in blood and build software capable of detecting specific RNA patterns for Alzheimer’s disease. RNA-sequencing will allow us to identify candidate RNAs we will then validate in a larger cohort of Alzheimer’s patients, disease controls and age-matched healthy controls. Data derived from this expanded cohort will then be used to train machine learning models to determine if these biomarkers can be used to construct a specific blood-based pattern for Alzheimer’s. Independent blood samples not included in the training will be used to test if the model can accurately and reproducibly distinguish among these groups. This work will consist of patients from across the United States, allowing us also to examine if geography can influence the expression of the RNAs we identify.
What’s interesting about this approach is that machine learning helps us identify the RNAs present in a blood sample that hold the highest level of ‘predictive power’ and determine among those we select which RNAs are more or less important in determining the presence of Alzheimer’s or any other disease we choose to study. While we are explicitly using our approach to build diagnostic strategies to identify presence or absence of disease, use of these methods could uncover novel targets for therapeutic intervention if these biomarkers are found to change as a consequence of intervention.
Medgadget: Can you maybe share some specific success stories? How accurate has the platform been so far?
Spurlock: Pilot funding from the NIH will be used to launch our Alzheimer’s work. It will allow us to expand our focus beyond the company’s traditional emphasis on autoimmune disease to test if our approach can be used to detect Alzheimer’s accurately. What we have documented thus far is that our blood tests are more than 90 percent accurate for the autoimmune and related conditions that we’ve examined.
Medgadget: Do you think work like IQuity’s early detection efforts for Alzheimer’s can lead to a renewed interest in searching for therapeutics for Alzheimer’s?
Spurlock: Absolutely. If we can identify these diseases early using genomics or population-level analytics, we will have a series of useful tools that can help determine the right patients for clinical trials. Identifying these patients at the earliest moment means they can take an investigational drug and have the best chance to reap the benefit of these new therapeutics. As Bill Gates and the Alzheimer’s Drug Discovery Foundation have correctly stated many times, the new drugs currently under development will be most successful in slowing early Alzheimer’s. All too often, patients who develop Alzheimer’s are caught many years after the disease has already caused damage to the brain.
If we can identify diagnostic biomarkers, we can better understand the genetics of how these diseases manifest and begin to understand, at a molecular level, the mechanistic underpinnings of the disease and create targeted assays that can look for these changes. Using population-level analytics to ask these same types of questions, we can begin pinpointing the social determinants of disease and from these studies further refine the inclusion and exclusion criteria for clinical trials. The combination of molecular and population analytics, I believe, will enable us to understand better the types of patients who ultimately arrive at an Alzheimer’s diagnosis and create a window for early intervention.
Medgadget: Where do you see IQuity in the next 5-10 years with your work in Alzheimer’s and other areas?
Spurlock: IQuity’s future is very bright. We’re at a significant inflection point in healthcare where we are starting to see artificial intelligence/machine learning tools implemented more often for clinical use. At IQuity, we are creating a series of platform technologies that we can apply to many areas of human health and disease. While we have focused on autoimmunity and related disorders, we have found that our blood-based and population-level analytics can affect many conditions. The work we’ve done has shown that we can predict oncoming diagnoses, spotlight misdiagnoses, and stratify severity of disease. A unique aspect of our approach is the ability to trigger not only an alert, but embed a context or reasoning into each alert that helps those receiving this information understand how our tools arrived at a result. I think this level of insight is going to be at the heart of how we can positively shape healthcare to make the patient experience better, improve outcomes and lower healthcare costs.
Medgadget: When should we expect to be hearing more data about IQuity’s Alzheimer’s efforts?
Spurlock: The focus of this project hits close to home for many on our team. My own family has witnessed firsthand the negative consequences of early Alzheimer’s and dementia. We often wondered if we could have done something differently to recognize or treat the underlying causes of the disease – but it just wasn’t possible. There remains so much work to be done to make this a reality. At IQuity, the second we received funding we immediately began work. Our laboratory efforts are underway to refine the biomarkers we have already identified, and I would expect data to emerge in the next several months that we intend to share at conferences or in peer-reviewed journals.
For more information, check out IQuity’s website or read our previous interview.
Researchers at the National Eye Institute in the U.S. have developed a retinal imaging technique that reveals live neurons, blood vessels, and epithelial cells within the retina. The method involves combining adaptive optics and angiography, and allows the researchers to view complex units of cells that interact in the outer edge of the retina. As this retinal region is involved in a range of diseases, including atherosclerosis, age-related macular degeneration (AMD), and Alzheimer’s disease, the researchers hope that the technique could help with diagnosis and disease monitoring.
“For studying diseases, there’s no substitute for watching live cells interact,” said Johnny Tam, a researcher involved in the study. “However, conventional technologies are limited in their ability to show such detail.”
Post-mortem tissue samples and tissue biopsies are frequently used to study cellular characteristics in disease. However, such samples provide only a rough approximation of living tissue and make it difficult to monitor disease progression over time. A non-invasive method to accurately monitor living cells in the retina has not been available, partly because light becomes distorted as it passes through the eye.
To help overcome this issue, the researchers employed adaptive optics, a technique which is used in space telescopes, and which involves deformable mirrors and computer algorithms to correct for light distortion. The researchers combined this optical technique with angiography, which involves injecting a dye into the blood, and then using a camera to image the blood vessels within the retina.
The new technique resulted in high-resolution images of the retina that allowed the researchers to observe features in real time that had never been seen before in living retinal tissue, including complex units of epithelial cells, photoreceptors, and capillaries.
The approach has potential in helping to diagnose and understand a variety of diseases. The research team tested the imaging technique in a patient with retinitis pigmentosa, and discovered that the photoreceptors had died in specific regions of the retina, but that retinal pigment epithelial cells (RPE cells) and capillaries were still intact in these regions.
“In the past, we have not been able to reliably assess the status of photoreceptors alongside RPE cells and choriocapillaris in the eye,” said Tam. “Revealing which tissue layers are affected in different stages of diseases – neurons, epithelial cells, or blood vessels – is a critical first step for developing and evaluating targeted treatments for disease.”
A look at the smallest blood vessels in the eye - YouTube
Top image: Photoreceptors (left), retinal pigment epithelial cells (center), and choriocapillaris in the living human eye.
EyeQue, a company based in Newark, California, is releasing a vision testing system that you can use at home to test your eyes with the help of a smartphone.
The EyeQue VisionCheck personal vision tracker snaps onto the screen of a smartphone and the user simply places it against the eye to perform the testing. The accompanying app displays various images on the screen and while the user looks at those, an internal motor rotates a series of lenses that work together to measure the eye’s focus and astigmatism, and so the refractive error. A special tool built into the app also helps to measure the distance between the pupils. Using the results, the patient can obtain prescription glasses as the system is as accurate as necessary for that application. It provides the spherical, cylindrical, and axis figures that are needed to make the glasses.
The VisionCheck device relies on the Inverse Shack Hartmann optical method and the eye measurement technology was patented originally at MIT.
EyeQue hopes that its device, which is currently available for preorder for $60, will help people to save on prescription glasses, particularly those whose eyesight keeps changing on a regular basis.
L’Oréal, the big skin care company, has just released a tiny device for monitoring skin’s exposure to the sun. Offered through Apple’s online shop and at some of its physical stores, the La Roche-Posay My Skin Track UV device doesn’t use any batteries while being able to upload its readings to a paired smartphone.
The energy of the sun is used to store the data within the device, while near-field communication (NFC) is used to download the readings to the smartphone. Downloads are activated by simply tapping the device against the paired smartphone and the user can then use the app to review how much time was spent exposed to dangerous UV light. In addition to this personalized data, the app includes pollen, humidity, and pollution levels that it gathers from online sources.
“Our research has long indicated the need for better consumer understanding of personal UV exposure,” in a statement said Guive Balooch, Global Vice President and Head of L’Oréal’s Technology Incubator. “We created this battery-free sensor to seamlessly integrate into the lives, and daily routines, of those using it. We hope the launch of this problem-solving technology makes it easier for people to make smart, sun-safe choices.”
The device is only 12 mm X 6 mm, is waterproof, and has a clip so that it can be attached to hats, shirts, and bracelets.
Here’s a promo video for the La Roche-Posay My Skin Track UV:
Birds and many other animals are able to perceive the Earth’s magnetic field, an ability that allows them to navigate around the world with magical ease. Scientists at Helmholtz-Zentrum Dresden-Rossendorf (HZDR), a research center in Dresden, Germany, have developed an electronic skin that can give humans the same capability. The new technology may end up being used to help blind people move around their environment, and to assist those with vertigo and other orientation issues. Moreover, it may prove useful as a basis for an intuitive way to interact with computers, virtual and augmented environments, and to control robotic equipment.
The e-skin consists of a a polymer foil with magnetic field sensors sensitive enough to detect the Earth’s magnetic field. This is an impressive achievement, since a typical fridge magnet generates a magnetic field roughly 1,000 times stronger in its vicinity. The e-skin is very flexible, and so can be attached to the hand or other parts of the body. It was tried as a joystick, of sorts, to control the movements of an avatar within a virtual world, and it worked remarkably well.
Next steps will involve integrating the new sensing capability with other technologies in order to make practical use of the new sensor. Thanks to this and other technologies, we may soon see blind people walking around on their own with remarkable ease and independence that is still not fully possible.
More from Helmholtz-Zentrum Dresden-Rossendorf:
The sensors, which are ultrathin strips of the magnetic material permalloy, work on the principle of the so-called anisotropic magneto-resistive effect, as Cañón Bermúdez explains: “It means that the electric resistance of these layers changes depending on their orientation in relation to an outer magnetic field. In order to align them specifically with the Earth’s magnetic field, we decorated these ferromagnetic strips with slabs of conductive material, in this case gold, arranged at a 45-degree angle. Thus, the electric current can only flow at this angle, which changes the response of the sensor to render it most sensitive around very small fields. The voltage is strongest when the sensors point north and weakest when they point south.” The researchers conducted outdoor experiments to demonstrate that their idea works in practical settings.
Researchers at Washington University in St. Louis have developed a diagnostic method involving photoacoustic imaging, a technique that combines ultrasound and laser light. The development may allow clinicians to diagnose ovarian cancer earlier, helping to save lives.
“When ovarian cancer is detected at an early, localized stage – stage 1 or 2 – the five-year survival rate after surgery and chemotherapy is 70 to 90 percent, compared with 20 percent or less when it is diagnosed at later stages, 3 or 4,” said Quing Zhu, a researcher involved in the study. “Clearly, early detection is critical, yet due the lack of effective screening tools only 20–25 percent of ovarian cancers are diagnosed early.”
Transvaginal ultrasound allows clinicians to see ovarian masses, but doesn’t allow them to tell if what they are viewing is a neoplastic tissue. The new technique, however, combines ultrasound with photoacoustic imaging, where laser light penetrates the vaginal wall to illuminate the vascular bed in the ovaries.
This allows clinicians to investigate the vasculature of the structures, and assess clinically relevant parameters such as tumor angiogenesis and blood oxygen saturation. Typically, ovaries bearing tumors will have extensive blood vessels and lower blood oxygen saturation compared with healthy ovaries. Aside from helping clinicians to identify a tumor, these parameters also relate to tumor metabolism, growth, and the potential of a tumor to respond to treatment.
The Washington University research team designed a specialized vaginal probe with a sheath containing laser-connected optical fibers that wrap around an ultrasound probe. Using the probe in a pilot study involving 16 patients, the researchers found hallmark increases in angiogenic markers and reductions in blood oxygen saturation in a common type of ovarian tumor, including early stage tumors.
“Physicians are very excited about this because it might bring significant change into current clinical practice,” said Zhu. “It is very valuable to detect and diagnose ovarian cancers at early stages. This technology can also be valuable to monitor high-risk patients who have increased risk of ovarian and breast cancers due to their genetic mutations.”
Based on these initial promising results, the researchers are applying for funding to conduct a large clinical trial, and hope to validate the technology in a larger group of patients.
See a video about the project below.
‘Hopeful technology’ could change detection, diagnosis of deadly ovarian cancer - YouTube
Diabetic foot ulcers are common maladies that are difficult to heal. In many cases, a total-contact cast is put on the leg with the ulcer to take the pressure off of the bottom of the foot, helping it to heal. While this is effective, supplying oxygen to the ulcer also helps it to heal. This is difficult to do when a patient wears a cast, but researchers at Purdue University have come up with a solution that just might work.
The research team has developed special insoles that contain pockets of oxygen near the site of the ulcer. These reservoirs slowly release the oxygen gas onto the insole, and are designed to be used along with a cast.
In order to personalize each insole and to control the release of the oxygen, the silicone-based rubber material of which they’re made of can laser machined individually. This allows the oxygen pockets to be placed exactly where they’ll come in contact with an ulcer, and the permeability of the silicone can also be adjusted to control the flow of oxygen.
Here’s a video that gives a glance at how the new insoles are created:
Shoe insole could help heal diabetic ulcers on-the-go - YouTube
At the just concluded American Heart Association’s Scientific Sessions 2018 in Chicago, Eko, the makers of popular digital stethoscopes, showed off a neural network AI algorithm that is able to detect murmurs better than a group of cardiologists. The study, titled “Artificial Intelligence Detects Pediatric Heart Murmurs With Cardiologist-Level Accuracy,” involved teaching a computer to spot suspicious murmurs by first giving it thousands of previously diagnosed sound recordings. The computer analyzed these for unique audio signatures and found enough nuances to be able to identify murmurs in a sample auscultation.
This important, as general practice and internal family physicians routinely misdiagnose murmurs at an incredible rate. Access to cardiologists is limited, so an automated system that can help during regular screenings can go a long way. Moreover, this is an excellent sign that machine learning and other AI techniques can really help with daily medical care by bringing virtual experts in different fields to the doctor’s office.
The software can be coupled with Eko’s Core and Duo digital stethoscopes, so it only takes a regulatory approval to introduce the technology into clinical practice.
It’s that time of the year when we call on technological visionaries, medical futurists, and creative people of all kinds to submit medical science fiction stories to our annual Medgadget Sci-Fi Writing Contest. At Medgadget, we keep a record of the progress of medical technologies and hope to inspire you to imagine a future where medicine is able to do things that are currently deemed impossible or, even better, have not yet been imagined.
Medicine, and the people that work within this field, can be influenced by new ideas and technologies, and we hope participants in our writing contest will investigate how that happens and what it can lead to, both in good or not so good ways. Science fiction can entertain, certainly, but it can also help us face important issues and prepare for changes before they suddenly arrive. We hope our contest can help do that.
Many science fiction writers of the past have focused on space travel, surveillance, robotization, artificial intelligence, and how societies will change in the distant future. We encourage our contest’s participants to look into the future of medicine with the same excitement, skepticism, and hope as sci-fi writers did.
Here are the rules:
Your original fictional essay has to be 250-2500 words of English language emailed to firstname.lastname@example.org and marked as “Sci-Fi Writing Contest” entry.
Top entries will be printed here and, therefore, must be safe for work and families. Please keep the language clean.
Judges will be blinded. Blinded by your dazzling prose, yes, but also to your identity. We are assembling an all-star judging panel, including Medgadget editors, so you can be assured your work will be reviewed by accomplished writers, physicians, and a few fans of the Blade Runner.
Submissions from anonymous writers are accepted, but we will need an address or PO Box to send you your prize!
Canon Medical won FDA clearance to bring to the U.S. market its brand new Vantage Orian 1.5 Tesla MRI scanner. It features a wide 71 centimeter bore and quiet operation thanks to its Pianissimo and Pianissimo Zen technologies. Pianissimo makes all scanning sequences quieter, while Pianissimo Zen allows certain scans to be performed at near ambient noise levels. To help young patients and those uncomfortable inside a scanner, Canon offers an immersive virtual experience called MR theater that combines audio and video to keep the person’s attention on something other than the scan.
The scanner was developed to maximize productivity and lower operating costs. Rapid Scan, an offering built into the scanner, allows many scans to be performed faster than before. The ForeSee View planning tool helps to prepare for scans to make sure rescans are not necessary. Additional technologies allow for cardiac and perfusion scans without the patient having to hold the breath.
“We are committed to offering our customers the premium diagnostic imaging tools they need to deliver accurate, confident and effective patient care,” said Dominic Smith, senior director, CT, PET/CT and MR Business Units, Canon Medical Systems USA, Inc. “The Vantage Orian was designed to increase productivity while ensuring patient comfort and delivering uncompromised clinical confidence.”
Here’s a Canon video of the new device when it was unveiled at the European Society of Radiology annual gathering earlier this year:
Introducing the Vantage Orian 1.5T at ECR 2018 - YouTube