The last two years have been brutal for Americans. With approximately one million deaths in just over two years, this worldwide pandemic upended our lives in many ways.
But hope remains. We’ve assembled a list of 10 medical innovations that reveal the pandemic did not stop scientists from improving our lives. From the ability to deliver organs for transplant by drone, to improved cardiac aortic surgery and double lung transplants, to CAR T-cell therapy which experts say provides a cure for some blood cancers, the list is staggering.
CAR T-cell Therapy
This is a new cancer treatment successfully used to treat blood cancers. The therapy is customized for each patient and approved by the FDA. T cells are immune cells that have the ability to kill cancer and do other things like fight infection.
When someone has cancer, their own immune cells, or T-cells are not killing their own cancer.
This therapy takes out the patient’s T-cells, and genetically modifies them so the T-cells will activate and begin growing, dividing and start killing the cancer. A version of the HIV virus is used — the part that is good at attacking the T-cells without the parts that make one sick.
“Imagine the cancer cell has a piece of velcro on the outside, but the patient does not have the immune cell with that other piece of velcro to stick to it,” said Dr. David Porter, medical oncologist at Penn Medicine. ”We take out the immune cells and genetically change them so they now have the other piece of velcro on it — so when they float by that cancer cell, the two pieces of velcro stick together and the T-cell can now kill the cancer cells.”
Pioneered by University of Pennsylvania immunologist Carl June, the initial successes in blood cancers have been stunning, said Porter.
“Patients who have multi relapsed ALL leukemia have almost no probability of cure,” said Porter. “The vast majority will die and die quickly. With CAR T-cells (treatment), up to 90% will achieve complete remission. There is no precedent for that… and over half will have long term remission and I believe will be cured of leukemia. It is absolutely groundbreaking.”
Porter said there are many trials for solid tumors and autoimmune diseases. He noted that 10 years ago people said it wasn’t going to work for blood cancers.
“This is the most satisfying and humbling experience of my career — it has been successful beyond my wildest dreams. Curing previously incurable cancers has been the most rewarding and exciting thing I have been involved with.”
Porter recommends watching Fire with Fire, a three-minute video that depicts the journey of Emily Whitehead — the first ALL leukemia pediatric patient who was dying but was then cured after CAR T-cell therapy.
TAVI (Transcatheter Aortic Valve Implantation)
TAVI is a less-invasive procedure to repair damaged aortic valves.
The surgery, called transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI) is a less-invasive procedure to repair damaged aortic and often referred to as a game changer. According to the American Heart Association, it is similar to placing a stent in an artery. TAVI delivers a fully collapsible valve to the valve site through a catheter.
Dr. Mark Ricciardi, Director Interventional Cardiology and Structural Heart Disease at NorthShore Cardiovascular. Institute said the first human TAVI was performed 20 years ago for a patient with severe aortic stenosis who was unable to withstand conventional valve replacement. At the time, Riccardi said it was a “startling thing to see such a procedure performed when few had even imagined it could be done. It was especially exciting for those like us at NorthShore with high patient volumes and an acute awareness of the fact that too many of our patients were not good candidates for open heart surgical valve replacement.”
While TAVI is now established as the best option for most patients with aortic stenosis, there are still some patients who have anatomical barriers to safe implantation of the valve. Little by little, Ricciardi said they are studying and learning how to apply TAVI and related technologies to those with such technical challenges. They are also heavily investing in the study of transcatheter valve treatments for other heart valves, in particular the mitral and tricuspid valves.
A Blood Test for Depression
Mark Rasenick — a Distinguished Professor of Physiology & Biophysics and Psychiatry at UIC — and fellow researchers have developed a biomarker that can confirm the diagnosis of depression, or specifically, the symptoms of depression. Their findings were published in Molecular Psychiatry in January of this year.
“If you are not having symptoms and are better, the blood test will indicate that you are better,” Rasenick said. Of the people who are on antidepressants who did not get better, the biomarkers showed that even with the same amount of drug, they did not get better.
Rasenick said they can now say to people who might argue there is no treatment because “it’s just in my head” they can convince them that no, the depression is real and biological. Best of all, because blood platelets live only one week, results are available as soon as a week or two after starting medication.
Rasenick is hopeful that this technology will help more people seek help for depression. He said more than half of those who are depressed do not seek treatment.
Rasenick s Pax Neuroscience Inc., a life-science company with a mission to transform patient outcomes by bringing the cellular biology of depression into its diagnosis and treatment Dr. Rasenick’s research funded by the NIH, the Veterans Administration, as well as by other government, philanthropic and industry sources.
Minimally Invasive Double Lung Transplant
In September 2021 Cedars Sinai performed their first minimally invasive double lung transplant.
Traditionally, bilateral lung transplants, surgeons open the chest and break the sternum. The patient is placed on a heart-lung machine during the surgery which averages six hours. During a minimally invasive bilateral lung transplant, the surgery accesses the lung via 3-inch, or less, incision under the nipple. The patient’s lung is deflated before removal, and the donor’s lung is deflated before insertion. “The bottom line is that recovery from minimally invasive lung transplant takes days rather than weeks. Reducing recovery time produces additional benefits for patients: shorter hospital stays, reduced risk for post-op infection and reduced need for medication, including opioids,” the report stated.
Dr. Pedro Catarino, Director of Aortic Surgery in the Smidt Heart Institute at Cedars-Sinai was part of the pioneering team utilizing the minimally invasive lung transplant in England. Later he served as director of transplantation at Royal Papworth Hospital in Cambridge where he taught the method to surgeons, including members of Cedars-Sinai team.
Catarino said the pivotal moment was when their Intensive Care Unit was extremely stretched by patients with Covid-19 and they were seeking ways to help lung transplant patients get out of the hospital sooner.
“We switched overnight to our minimally invasive ‘keyhole’ approach,” he said.
Dr. Catarino believes his team has a responsibility to share this technique and so they are reporting results and teaching at medical and other conferences internationally.
“Within our unit we are looking for even more ways to enhance the technique, like adding robotic assistance,” he said. “The patient experience of undergoing a lung transplant is vastly improved with this new technique, and it allows us to happily offer a lung transplant to patients who would have otherwise had a longer recovery, like older adults.”
Drones and Healthcare Delivery
In 2019 an unmanned aircraft delivered a kidney needed for transplant at the University of Maryland Medical Center in Baltimore. The flight was a collaboration between aviation and engineering and engineering experts at the University of Maryland’s Department of Aerospace Engineering and Unmanned Aircraft Systems (UAS) Test Site; transplant physicians and researchers at the University of Maryland School of Medicine (UMSOM) in Baltimore; and collaborators at the Living Legacy Foundation of Maryland.
“The initial cold call from the transplant surgeon, Dr. Joe Scalea from UMMC, was both intriguing and a call to action. His explanation of the antiquated approach to organ transportation was the real reason we felt compelled to take this on – it would make an immediate difference in people’s lives,” said Matthew Scassero, Director University of Maryland, UAS Test Site.
Since 2019, the initial ideas have been commercialized. MissionGo was founded by those who worked in both aviation and the medical field. Dr. Scalea and UMD served as a catalyst for the foundation of MissionGO.
“The doctors who partnered with MissionGO understood that every second counts when working with donations, specimen testing and transplantation and the pilots at MissionGO understood that safety is the top priority for unmanned aircraft systems. Together, we could revolutionize the donation process and, potentially, save more lives than ever before, “said Megan Crout, marketing manager for MissionGo.
Crout said the successful use of drones has been extremely humbling.
“When you look at the numbers, there are currently about 3,000 Marylanders and more than 100,000 people nationwide waiting for a life-saving transplant. One donor can save up to eight people through organ donation and enhance more than 75 lives through tissue donation. The mere fact that we can help facilitate these transplants and expedite the delivery process. In one of our flight tests, there was an approximate 292% time improvement over ground transportation – showing that not only is this a time-saving innovation, but also a more sustainable one with much less carbon impact than current transplant transportation logistics.”
Scasserri said this will be the primary way that organs are moved in the future.
“Regulations from the FAA will need to be pushed, but the technology is ready now, and it makes a huge difference. From intra-city to international, moving organs by autonomous vehicles of all kinds, especially air, will be the method we all use.”
Diabetes: Continuous Glucose Monitoring (CGM) Device
While Continuous Glucose monitoring (CGM) first appeared in the 1990’s as the Glucowatch, it was inaccurate and irritated the skin and never caught on, says Dr. David Oyer, Clinical Associate Professor of Medicine (Endocrinology) at Northwestern Feinberg School of Medicine. Neither did the Medtronic device in 2000.
The current Medtronic Guardian sensor communicates with their insulin pump, allowing automatic basal adjustment, or “closed loop system” of insulin delivery. This requires calibration against a fingerstick blood sugar. Dexcom has developed good sensing devices utilizing a sensor inserted under the skin with a cradle for the transmitter that beams to the reading device or to a smartphone. Their sensor was an advance because it offered alerts for high or low glucose.
The breakthrough in CGM was the introduction by Abbott labs of the Freestyle Libre sensor which was approved by the FDA in 2016. The sensor was applied at a healthcare office and read by a reader that could be downloaded when returned to the doctor’s office.
In September 2017 the device was approved for patient use with the patient able to see the results at home. The Freestyle Libre was applied to the back of the arm, read by a device, and lasted 10 days. This was a breakthrough event because of the ease of application and use and comparatively low cost, about 140 dollars a month. Upgrades have allowed it to be read by a phone.
Today all sensor data from Libre, Dexcom and Guardian can be shared via internet access with the healthcare provider’s office. When the covid pandemic made office visits difficult, the ability to see and analyze data remotely became very valuable and more and more patients availed of the new technology. Insurance coverage gradually was expanded as the value became apparent, led by Medicare. Today more and more diabetic patients are being followed and managed by CGM. Advantages include the feedback of seeing the glucose changes after eating and having alerts for high and low glucose and the ability to share with family members.
One example, Oyer said, is a patient with impaired vision on the Libre 2 with alerts. She was visiting her daughter out of town, and during the night the alarm went off. The daughter found her in a coma and was able to treat the low glucose and wake her up.
CGM is now available to large numbers of patients with diabetes and is improving their care in many ways.
Drug for Postpartum Depression: Brexanolone, Currently Approved by the FDA
Postpartum depression affects up to 15% of mothers. Historically, many women have not been successfully treated with antidepressants which typically take many weeks to take effect.
In 2019, the antidepressant brexanolone became the first treatment approved by the FDA.
The University of North Carolina at Chapel Hill established the first perinatal psychiatry inpatient unit for women who are pregnant or postpartum and in need of psychiatric admission for serious mental illness in 2011, said Riah Patterson, director of UNC’s Clinical Brexanolone Program. They participated in the clinical trial brexanolone, the first drug approved by the FDA to treat postpartum depression in 2019.
“PPD (Postpartum depression) is the most common complication of childbirth and that it has been very difficult to treat to remission. A large part of the problem has been that historically women’s health has been overlooked after birth and their depression may go unrecognized. Another part of the problem is that PPD had been treated like a major depressive episode (MDE) and did not have any specifically tailored medication treatments until now,” Patterson said.
Brexanolone has been a life saving medication for those who have access to it. And yet many women with PPD go untreated or undertreated.
“This medication requires a 60 hour medical admission for the infusion and many mothers can’t get away from their childcare or outside-of-home work responsibilities. We hope that there will be an approved oral version of this medication soon so that more women have access,” Patterson said. “Watching women feel dramatically improved over 60 hours is a total honor. These women want to return home to establish bonds with their infant, to re engage in their lives. It is rare in psychiatry to see such a dramatic change in affective state over such a short time period.”
GLP-1 Agonists for Weight Loss
“Although we consider obesity [excess body fat that impairs health] to be a disease, we have limited treatments available that result in significant and sustained weight loss. High dose semaglutide, a medication that mimics a naturally occurring gut hormone in the body that suppresses appetite, presents a new way of thinking about treating obesity. Participating as the lead physician in this global study offered an opportunity to help develop and test this new medical innovation. Said Dr. Robert Kushner, Medical Director of the Center for Lifestyle Medicine at Northwestern Medicine in Chicago.
High dose Semaglutide, a medication that mimics GLP-1, a naturally occurring gut hormone in the body, represents a paradigm shift in the treatment of obesity.
Kushner, the lead investigator for a global study that involved nearly 2000 subjects in 16 countries said the results were impressive with ⅓ subjects losing more than 20% of their body weight. That result is nearly double what is achievable with current medications, Kushner said. Based on these results Semaglutide 2.4 mg was approved by the FDA for chronic weight management in June 2021.
“Using hormonally based treatment represents a paradigm shift in the treatment of obesity. I view semaglutide as the first of a new generation of therapeutics. There are multiple hormones in our body that signal us to both start or to stop eating. That is called appetite regulation. By harnessing these hormones, we can develop a suite of medications that will help people follow a calorie controlled, healthy diet more consistently and without deprivation.” Kushner said.
Artificial Intelligence Revolutionizing Healthcare
The use of Artificial intelligence has impacted healthcare extensively. Among the many areas affected: diagnosis, communication between physician and patient, transcribing medical information, prescriptions and the remote treatment of patients. It is, according to the study below “changing the landscape of medical science and will separate hype from reality:
“Artificially intelligent computer systems are used extensively in medical sciences. Common applications include diagnosing patients, end-to-end drug discovery and development, improving communication between physician and patient, transcribing medical documents, such as prescriptions, and remotely treating patients. While computer systems often execute tasks more efficiently than humans, more recently, state-of-the-art computer algorithms have achieved accuracies which are at par with human experts in the field of medical sciences. Some speculate that it is only a matter of time before humans are completely replaced in certain roles within the medical sciences. The motivation of this article is to discuss the ways in which artificial intelligence is changing the landscape of medical science and to separate hype from reality,” the article read.
Arterys, a company out of San Francisco is building a world where clinical care is data driven, intelligent and patient-focused according to their website.
“The Arterys mission is to transform healthcare by reducing subjectivity and variability in clinical diagnosis. Our dream is to bring data-driven medicine to every patient, regardless of where they live. As long as you have access to the web, you have access to Arterys.”
NorthShore University HealthSystem invested substantially in 2014 and in 2020 invested again in AI.
“AI / analytics is not a silver bullet. It is an enabler,” said Chad Konchak, MBA, Assistant Vice President, Clinical Analytics for NorthShore University HealthSystem.“ What makes our AI initiatives successful is how we integrate these tools and technologies in to team-based care. It is the partnerships we have with our clinical and operational leaders that make AI actionable. Otherwise we would simply have expensive tools and technology that at best are admiring problems.”
Konchak said he sees natural language processing (NLP) engine expanding as well as the scale of their AI capabilities increasing a sthey become more advanced with building and deploying models.
“I think the biggest reason people work in healthcare is to make an impact on the communities we serve. There is nothing more rewarding than seeing our analytics work enable better outcomes, healthier populations, or provider satisfaction / experience. For example, our eCART predictive model that identifies patients at risk of a cardiac arrest saves approximately 1 life a week. There is little more rewarding than helping to support that kind of outcome.”
Corbevax Vaccine
Corbevax Vaccine is a low-cost version of a COVID-19 vaccine which received Emergency Use Authorization in India in December. Dr. Peter Hotez, Professor, Departments of Pediatrics, Molecular Virology & Microbiology, Baylor College of Medicine and co- director Texas Children’s Hospital Center for Vaccine Development.
Dr. Peter Hotez and Dr. Maria Elena Bottazzi were nominated for the 2022 Nobel Peace Prize for their efforts to develop and distribute the COVID-19 vaccine worldwide.
Dr. Peter Hotez, is the founder of the Corbevax Covid Vaccine. This vaccine is durable, produced at low cost with a very good safety profile, is patent free and is delivered at low cost. It is being produced in partnership with Biological E and received emergency approval for use in India. Biological E plans to produce one billion doses for distribution in Inda in 2022. Dr. Hotez will not profit by it’s development.
“It’s India’s gift to the world” he said in a YouTube video in January, 2022.
Hotez said they are working to transfer this technology to multiple low-and-middle-income country vaccine producers in the hope they can make not only
their own Covid-19 vaccine, but also universal coronavirus vaccines.
A pivotal moment in the development of the Covid-19 vaccine was when the Covid-19 virus sequence came online in Biorvix — the preprint server for biology — in January 2020.
Hotez said it was then they recognized it was similar to Sars and since they had previously developed a Sars vaccine, knew developing a Covid-19 vaccine using a similar technology was feasible.
He also said this approach is used as well for neglected tropical disease vaccines that they sometime call “the antipoverty vaccines.”
“It is extremely gratifying using science in the pursuit of an important, humanitarian goal, “ Hotez said.
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Susan Berger is a freelance journalist in Chicago and has written for the Washington Post, New York Times and Chicago Tribune. She was a 2021 CDC Fellow through the Association of Health Journalists, a National Press Foundation Fellow in 2019 to study vaccines and dementia. She also has written for Health Magazine, National Post, Agence France-Presse, and CBC and Better Magazine. Ms. Berger has appeared on the Today Show, NBC Nightly News, BBC World News, CNN, WGN-TV, WTTW-TV and on CBC Radio. Her work can be viewed at www.bergerreport.com and you can follow her on Twitter @Msjournalist
