Author: Nancy Fliesler

Health care wants YOU: 9 opportunities, 4 pearls for digital health startups

digital health startups - reverse pitches
A visual summary of reverse digital health pitches (illustration: CollectiveNext).

Boston’s digital health world is humming with tech talent, idealistic health care professionals and business-savvy accelerator organizations. The passion was palpable last week as 300-plus people gathered at MassChallenge’s latest Pulse@Check digital health meetup, hoping to turn their health care ideas into reality.

The event, hosted by Boston Children’s Hospital’s Innovation and Digital Health Accelerator (IDHA) and Cerner, a lead developer of health care IT systems, presented numerous opportunities and tips for digital health startups.

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Smart pad would provide biofeedback for Kegel incontinence exercises

biofeedback Kegel exercises urinary incontinence

If you’ve ever been given Kegel exercises to strengthen your pelvic floor, you may have wondered if you’re doing them right or if you’re getting better. Two physicians at Boston Children’s Hospital have developed a stick-on pad that could someday tell you.

Carlos Estrada, MD, director of the Spina Bifida Center and co-director of Urodynamics and Neurourology, and Jeanne (Mei Mei) Chow, MD, director of Uroradiology at Boston Children’s both work with children who have urinary incontinence. In the clinic, Estrada has equipment that provides biofeedback as kids practice squeezing their pelvic floor muscles. But parents had been asking for a home solution. “They say, ‘it’s hard to do it at home without getting any feedback,’” says Estrada.

Done right, Kegels can have an 85 percent success rate, he says. But lacking feedback, most people give up on them, including adults. “Adults can get monitoring, but it’s done in specialized clinics with intrarectal and intravaginal probes,” Estrada says.

Most people take a pass on that.

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Impaired recycling of mitochondria in autism?

mitochondria in autism tuberous sclerosis

A study of tuberous sclerosis, a syndrome associated with autism, suggests a new treatment approach that could extend to other forms of autism.

The genetic disorder tuberous sclerosis complex (TSC) causes autism in about half of the children affected. Because its genetics are well defined, TSC offers a window into the cellular and network-level perturbations in the brain that lead to autism. A study published today by Cell Reports cracks the window open further, in an intriguing new way. It documents a defect in a basic housekeeping system cells use to recycle and renew their mitochondria.

Mitochondria are the organelles responsible for energy production and metabolism in cells. As they age or get damaged, cells digest them through a process known as autophagy (“self-eating”), clearing the way for healthy replacements. (Just this month, research on autophagy earned the Nobel Prize in Physiology or Medicine.)

Mustafa Sahin, MD, PhD, Darius Ebrahimi-Fakhari, MD, PhD, and Afshin Saffari, in Boston Children’s Hospital’s F.M. Kirby Neurobiology Center now report that autophagy goes awry in brain cells affected by TSC. But they also found that two existing medications restored autophagy: the epilepsy drug carbamazepine and drugs known as mTOR inhibitors. The findings may hold relevance not just for TSC but possibly for other forms of autism and some other neurologic disorders.

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Harnessing MRI to steer drugs to hard-to-reach targets

drug delivery propelled by MRI

Once a drug is injected systemically, can you steer it to where you want it under MRI guidance? Pierre Dupont, PhD, and colleagues saw this as an engineering problem. Solving it could enable concentrated drug delivery to, say, a deep tumor in the lungs while simultaneously taking images.

Labeling drugs with magnetized particles is the first step, allowing the MRI scanner’s magnetic pulses to propel them. The next step is to be able to actively steer the particles through a series of branching vessels to a desired location. But getting a scanner to both image and propel particles forcefully enough to overcome the force of the blood flow is easier said than done.

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Entry door for deadly C. difficile toxin suggests new mode of protection

Clostridium difficile
C. difficile (Wikimedia Commons)

Clostridium difficile, also called “C. diff,” tops the CDC’s list of urgent drug-resistant threats. Marked by severe diarrhea and intestinal inflammation, C. diff has become a leading cause of death from gastrointestinal illness, causing half a million infections a year in the U.S. alone.

C. diff flourishes best in hospitals and long-term care facilities where people are on long-term antibiotic treatment. “Antibiotics clear out the normal intestinal bacteria and create a space for C. diff to colonize and grow in the colon,” says Min Dong, PhD, who researches bacterial toxins in the Department of Urology at Boston Children’s Hospital.

In today’s Nature, Dong and postdoctoral fellow Liang Tao, PhD, together with researchers at University of Massachusetts Medical School, reveal how C. diff’s most potent toxin gets into cells. The toxin’s entryway, a receptor called Frizzled, provides an important and interesting clue to fighting the hard-to-eradicate infection.

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Startup uses Uber to get patients to their medical appointments

Uber medical transportation Circulation

Getting to the doctor will soon get easier for some struggling patients. Boston Children’s Hospital has joined forces with the ride-hailing service Uber to pilot a non-emergency medical transportation platform.

The online, HIPAA-compliant tool, called Circulation, connects with health care information systems, enabling hospitals to schedule Uber rides for patients. The pilot will serve Boston Children’s, Mercy Health System in Pennsylvania and Nemours Children’s Health System in Wilmington, Delaware.

A 2005 study estimated that 3.6 million people miss medical appointments because they don’t have access to transportation. While Medicare and Medicaid and other payers provide non-emergency transportation benefits, such as taxi vouchers, patients may be unaware of the programs or have trouble navigating reimbursement rules for the rides. Frequently, the taxi or car service arrives late or doesn’t show up at all.

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Human brain evolution holds clues about autism… and vice versa

human brain evolution autism Human Accelerated Regions
Humans evolved to become more social and cognitively advanced, thanks to genetic changes in regions such as HARs — the child with autism spectrum disorder (ASD) being the exception. While mutations in protein-coding genes continue to be explored in ASD (indicated by the red ribbon of RNA), the scientists at far left are suggesting that mutations in regulatory elements (the histones , in green, and their modifications shown in yellow) may be important in both ASD and human evolution. (Illustration: Kenneth Xavier Probst)

Starting in 2006, comparative genomic studies have identified small regions of the human genome known as Human Accelerated Regions, or HARs, that diverged relatively rapidly from those of chimpanzees — our closest living relatives — during human evolution.

Our genomes contain about 2,700 HAR sequences. And as reported today in Cell, these sequences are often active in the brain and contain a variety of mutations implicated in autism and other neurodevelopmental disorders.

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I feel good! How mood influences time management

time management and mood

Most theorists boil human behavior down to a pursuit of pleasure. Yet all of us engage in mundane, even unpleasant activities. It’s called being an adult, right? Happy Monday!

But Maxime Taquet, PhD at the Computational Radiology Laboratory at Boston Children’s Hospital (who by day helps conduct advanced brain imaging in children with neurologic conditions) wondered why. If we’re such pleasure-seekers, how do we muster the will to do our taxes or vacuum the house?

Taquet, with Jordi Quoidbach, PhD, of the Department of Economics and Business at the University Pompeu Fabra in Barcelona, and other colleagues developed a smartphone app to track the activities and moods of more than 28,000 French-speaking people for an average of 27 days. At random times during the day, the app asked users to rate their current mood on a scale of 0 to 100 and indicate what they were doing at that moment from a list of options.

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Topical antibiotics for otitis media: A one-squirt cure?

otitis media transtympanic gel
A single-application gel could revolutionize treatment of ear infections, reducing side effects and drug resistance. (Click to play animation.) Credit:Kohane group

Otitis media, or middle-ear infection, affects 95 percent of children and is the number one reason for antibiotic prescriptions in pediatrics. Typically, antibiotic treatment involves 7 to 10 days of oral medication — several times a day — a formidable task for parents of little kids.

“Force-feeding antibiotics to a toddler by mouth is like a full-contact martial art,” says Daniel Kohane, MD, PhD, a pediatrician and director of the Laboratory for Biomaterials and Drug Delivery at Boston Children’s Hospital.

A single-application bioengineered gel could be the answer to parents’ and pediatricians’ prayers. Described in a paper published today in Science Translational Medicine, the gel would provide an entire course of therapy through a single squirt into the ear canal. It was developed by Kohane’s team in collaboration with investigators at Boston Medical Center and Massachusetts Eye and Ear.

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Keeping up with HIV mutations: Building a nimble vaccine test system

AIDS vaccine
A new technology speeds up natural antibody “evolution” to create a nimble HIV vaccine test system. (Images: Wikimedia/Pixabay)

An AIDS vaccine able to fight any HIV strain has thus far eluded science. HIV frequently mutates its coat protein, dodging vaccine makers’ efforts to elicit sufficiently broadly neutralizing antibodies.

Yet sometimes HIV-infected people can produce such antibodies on their own. This usually requires years of exposure to the virus, allowing the immune system to modify its antibodies over time to keep up with HIV mutations. But the goal is generally achieved too late in the game to prevent them from being infected.

“Only a small fraction of patients are able to develop broadly neutralizing antibodies, and by the time they do, the virus has already integrated into the genomes of their T-cells,” says Ming Tian, PhD, of Boston Children’s Hospital’s Program in Cellular and Molecular Medicine (PCMM).

Tian is part of a group led by PCCM director Frederick Alt, PhD, that developed a technology to greatly speed up HIV development. Described today in Cell, the group’s method generates mouse models with built-in human immune systems. The model recapitulates what the human immune system does, only much more rapidly, enabling researchers to continuously test and tweak potential HIV vaccines.

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