Deep dive into tomorrow’s healthcare — 2019 trends
Welcome to Hello Tomorrow long-form series. More in-depth pieces that allow you to sink your teeth into specific topics and discover the upcoming trends before everyone else.
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Over the last decades, there’s no denying that medical care has tremendously advanced. Worldwide, we now employ high tech imaging technologies to diagnose diseases in a minimally invasive fashion. Instead of relying only on natural products as cures, we have developed synthetic molecules against many complex diseases dramatically reducing early mortality.
Surgical instruments from 50 years ago look more like medieval torture instruments to us and thanks to Sci-Fi movies, we dream of hand-held scanning devices diagnosing a patient in a few seconds and sick bays that allow non-invasive therapies for any given disease. And rightly so, as the latest advances in tissue engineering and gene editing on the biotech end and AI in the digital field promise unprecedented health care quality.
However, it will probably take decades until these technologies fully become part of the medical care routine and their efficacy remains speculative at this point.
In addition, while it’s true that infectious diseases are no longer the primary cause of premature death, patients are still suffering from non-communicable diseases such as cardiovascular diseases, cancer or diabetes fill the hospital beds instead.
For this reason, the focus of this article will be on more immediate developments. Hello Tomorrow is in a unique position to preview the near-term future as we see a lot of startups coming through our Global Startup Challenge with over 4,500 applications worldwide this year alone.
Analysing the data provided by our applicants, let’s open a window into the future in Healthcare.
What we foresee — core trends
If you only read the following, you will have a pretty good overview of the major trends currently dominating Healthcare.
Heard about antibiotic resistance? Well, new antimicrobial solutions are less likely to give rise to resistant bacteria
The widespread use of antimicrobial agents led to a significantly decreased mortality rate among patients suffering from bacterial infections around the globe. However, it came at a price. Infectious organisms have adapted and are becoming increasingly resistant to the currently available drugs, creating what we now call “antibiotic resistance”. This resistance is a massive source of concern as it renders some widely used drugs ineffective.
Consequently, Oppilotech’s efforts focus on the development of fast-acting antimicrobial agents targeting complex key structures of bacteria such as the assembly of the cellular membrane or wall. This should make the adaptation for bacteria more difficult and thus slow down the development of antibiotic resistance. To achieve this, scientists at Bioharmony Therapeutics and Omnix Medical take advantage of mechanism already available in nature such as enzymes from viruses killing bacteria and small peptides coming from the innate immune system of insects destroying the cell wall.
Another mechanism which won’t give rise to new resistance is the cleansing of chronic wounds through focused laser impulses that thermally ablate bacteria without damaging the human cells. Also not utilizing antibiotics is the approach followed by Gedea Biotech which cures bacterial vaginal infections by lowering the pH of the environment instead of targeting directly the bacteria.
We’re finding non-invasive ways to manage and fight diabetes
Besides the rise of antibiotic resistance, the second major risk factor for our health is our own lifestyle. The lack of physical activity in combination with an unbalanced, calorie-rich diet results in obesity, a major risk factor for non-communicable diseases such as diabetes.
The good news is that we are closing in on a non-invasive glucose measuring method which would relieve diabetic patients from finger pricking each day. In spite of Verily pausing its program on glucose monitoring contact lenses, PKvitality succeeded in measuring glucose chemically in the interstitial fluid, using microneedles embedded in a smart watch at your wrist while DiaMonTech detects glucose via a photothermal method. The latter approach requires you to put a finger on a small device which screens your finger veins for glucose signals using near-infrared light.
In addition to the improvement of daily diabetes management, new therapeutics could relieve diabetes type one patients from constantly carrying and self-injecting insulin. The approaches are ranging thereby from an artificial pancreas introduced by MedicSen to a drug discovered by Abarceo repairing dysfunctional pancreatic cells.
Our diagnostics will be low-cost and patient-centred
In contrast to diabetes management which moves away from finger pricking, numerous companies are working towards the dream of testing many parameters from a small amount of blood trying to deliver on some of the promises Theranos never kept. While the principal aim to obtain physiologically relevant parameters from a minimum amount of blood in a low-cost, patient-centered way remains identical, the prize per test and the number of simultaneous measurements set out by Theranos will not be reached in the near future.
However, there is still hope for low-cost diagnostic solutions from body fluids. Continuously decreasing prices in DNA sequencing and improved detection sensitivity allows SAGA Diagnostics to sequence tumour DNA from blood samples and a company named Elypta measures up to 19 cancer biomarkers from a urine or blood sample. Similarly, advancements in the field of acoustics enable Tambua Health to diagnose the respiratory system in minimal invasive fashion system based on the sound pattern of a cough. Cardiawave uses soundwaves to diagnose and treat clogged aortic blood vessels, the main risk factor for a heart attack, making medical diagnosis and treatments less painful and more patient-centred.
Under the radar — picking up on new trends emerging
Now that you’re up to date on the core trends, stay onboard to explore our analysis of the more niche topics and shine with this under-the-radar knowledge.
Exosomes are extracellular nanovesicles which mediate communication between both neighbouring and distant cells by transporting proteins, lipids and nucleic acids between cells.
Here is how they work normally, in their “natural state” if you will. The molecules transported by the nanovesicle maintain their biological activity inside, thus being capable of modulating and reprogramming the recipient cells. Depending on the parent tissue they are derived from, exosomes have regenerative effects which Exogenus Therapeutics uses to treat skin or autoimmune diseases.
Taking advantage of these capacities, we are engineering exosomes as a novel therapeutic delivery system. Their small size, lack of toxicity and target specificity, in combination with their ability to overcome the blood-brain barrier as well as to spread deep into tumour tissue, makes them a promising drug delivery platform. The delivery content, as well as the composition of exosomes, can be customized to yield an increased target specificity and enhanced therapeutic effect, like Ciloa is doing.
In addition to being a new super-efficient delivery service, exosomes are systemically detectable in blood and accurately represent the molecular makeup of the parent tissue. Let’s say your medical condition requires a biopsy of your liver. Instead of doing it with the classic highly invasive method, Clara Diagnostics simply uses a small amount of blood to screen for exosomes stemming from your liver and analyse them, thus creating a less invasive “liquid biopsy”. For these reasons, more than 35 clinical trials are underway to confirm that the analysis of exosomes circulating in the blood is indeed a suitable method to diagnose and characterize tumours.
About 15 years ago, a monkey was enabled to mind-control a cursor on a computer screen. The field has rapidly evolved since then with scientists from GTX medical, Hello Tomorrow’s Grand prize winner in 2014, being able to firstly restore the walking ability of paralyzed monkeys and very recently also of paralyzed humans. This progress is possible in part due to advancements in Brain-Computer Interfaces (BCIs) made by scientists at companies such as Neuroloom who have developed a system to improve the wiring between a computer system and the neurons in the brain.
The most recent generation of BCIs from ni2o is equipped with state-of-the-art algorithms which allow the reading of brain signals while simultaneously performing electrical stimulation counteracting pathologic neuronal signals as in Parkinson’s disease. Other BCIs restore motor control over specially-enabled prosthetic limbs developed by Esper Bionics. This should tremendously ease the daily life of these patients who otherwise suffer from severe sensory and motoric limitations.
One step further is a company called SensArs which relays the information from sensors in a prosthetics back to the brain. This enables a feedback loop so the patient receives sensations from the missing limb which is the last step to a fully functionally replacement.
Mental health solutions for a world of urban dwellers
While urban living continues to offer many opportunities, jobs and services, the urban environment and lifestyle also impose new health risks. Besides the well-known factors such as physical inactivity and air pollution which result in an increased number of cardiovascular and respiratory diseases, the deprivation of restorative sleep is a major health risk.
It is scientifically proven that people suffering from lack of sleep are more prone to developing mental health issues such as depression and anxiety and neurodegenerative diseases such as Parkinson’s. The quality of sleep is adversely affected by noise, pollution and stress.
But don’t despair. The good news is that we see solutions addressing these issues. A company called Denoize Ltd. builds noise cancelling windows, others such as Neurobit Technologies develop clinical-grade sensors to monitor sleep and will warn the user in case sleep anomalies are detected. Similarly, Myndblue’s AI-backed solution identifies predictive markers for depression and PTSD.
Once depression is diagnosed, a new consumer product promises relief for certain patients. Flow Neuroscience has developed a medical-grade headset that performs transcranial direct current stimulation (tDCS) on the brain and an app that further targets the behavioural elements of a major depressive disorder. In contrast to currently available drug-based treatments which modulate the biochemistry of the brain, electric stimulation of the brain is considered less specific. However, electric brain stimulation is a clinically proven and more affordable method, that overcomes the often occurring adverse side effects associated with current chemical treatments.
A glimpse in the far future
Now that you know pretty much everything about core trends and niche topics, we are also able to build a longer-term view of what the future holds in healthcare. Let’s go deep into the lab.
Quantum computing for drug discovery
Today, pharmaceutical companies take on average more than 10 years and often billions of dollars to develop a new drug. Quantum computing holds the great promise to increase the number of discovered drugs as well as to cut costs and time to market. While there are many drug classes, one principle remains the same: to exert a desired therapeutic effect, a drug needs to physically bind to a cellular component such as a protein to modulate its function. A direct consequence of this principle is that the better the fit between drug and protein is, the stronger the inhibition or alteration of the protein function is.
Right now, the only way to do so is through a cost and time intensive wet lab approach. Thus it is a long-standing dream to find the best fit between protein and drug based on computer models.
However, at this point, the currently routine available computing power is not sufficient to simulate all the physical forces that apply when a protein folds into its three-dimensional structure. Without the correct structure of the protein and the degree of flexibility intrinsic to each structure, a computer-based simulation of a drug-protein interaction remains too approximative.
Enter quantum computers. Quantum computing and startups such as ProteinQure and GTN LTD, are believed to solve the problem. They could provide enough computing power to accurately simulate protein folding and to screen the theoretically existing number of 1060 drug-like molecules for their binding characteristics to the protein of interest.
By the end of 2018, Dr He announced the alteration of the DNA of two newborn babies using CRISPR/Cas9, causing an international uproar. To protect the babies from a potential HIV infection, Dr. He disabled the CCR5 gene in the fertilized eggs from which the babies developed. He received massive critics from the science community and the public for not having sufficiently addressed the legal and ethical implications.
In addition to these implications, genome editing is not yet considered safe on a biological level. It is known that the molecular machinery is not only modifying the gene of interest but also alters other parts of the DNA sequence. Those off-target DNA alterations may impose a serious health risk. Both scientists in academia and startups are working on improving the specificity of CRISPR/Cas and its delivery methods. Currently, the administration routes still restrict the use to research lab and a limited number of cells.
There is another powerful application of CRISPR/Cas to watch out for — the autonomous drive of a gene through a population. Instead of individually modifying each genome in-vitro as in the previous example, so-called gene-drives would allow passing on a CRISPR/Cas-modified gene to the next generation, without further intervention and independently from the genome of the mating partner. One good example is mosquitos that carry a disease. Despite controversial discussions about this application, a consortium is reflecting upon the use of it to eradicate Malaria.
Lastly, the next revolutionary CRISPR/Cas application is in sight. Scientists have discovered variants that can be programmed to modify RNA. This could pave the way for a new drug class targeting RNA-based viruses such as Ebola.
Acknowledging the hype
These topics have now been around for awhile and despite their potential to bring significant changes, it’s always rewarding to take a hard look at reality.
No article dealing with emerging trends in healthcare can circumvent to touch upon the buzzword of 2018 — blockchain. After its successful debut in the finance industries, the blockchain technology received also great attention from other industries such as the healthcare sector. While the blockchain won’t advance medicine itself, its potential to address the problem of counterfeit drugs is undenied. By securing the supply chain against tempering attempts, Meditect offers a solution that guarantees the quality of a drug until it is handed over to the patient. The second field of application in healthcare is linking and securing sensitive medical data which is stored in different locations. A blockchain-based link between distributed personal medical data ledgers could result in complete personal medical records which will ease the medical diagnosis and follow-up consultations. If adequately engineered as done by AzaadHealth, such a solution also gives back the ownership over the medical data to the patient who can permit access to medical staff, researchers or insurance representatives upon request.
AI & Co
Other digital technologies often associated with revolutionizing the healthcare industry are artificial intelligence and telemedicine applications. Indeed, the latter can save lives where network reach and speed increases faster than medical expertise. However, telemedicine and medical chatbot applications are not yet able to adequately substitute a visit at a doctor’s office. Until further, it will remain only an option in case no medical staff is available in person.
In striking contrast, artificial intelligence has recently been proven to exceed the abilities of senior medical doctors in certain well-defined cases. For example, the AI-based based analysis of medical images developed by NeuroPsyAI or the classification of cardiac and pulmonary noises into the pathologic and non-pathologic state performed by Steth IO’s smart stethoscope have been proven successful and may be soon incorporated in routine care. However, AI applications will not immediately start spreading through all domains of medicine because of the following reasons. Firstly, physiological parameters significantly vary already between healthy persons. Secondly, a key indicator for the diagnosis of a disease by a clinician is the location, level and kind of pain a patient suffers, a parameter that can hardly be transformed into structured data.
Both facts lead to a high variance in any medical data set which makes the application of the majority of machine learning algorithms impossible. More complex, neuronal networks like algorithms are sufficient when analysing only a few parameters such as the cardiac sound pattern mentioned above. For these reasons, we see artificial intelligence applications in healthcare supporting medical doctors in routine care rather than replacing them.
– Nicolas Goeldel, PhD, Deeptech Lead at Hello Tomorrow –