A drug for sleep apnea, an “artificial pancreas” for people with diabetes, innovative therapies for breast cancer … Medical news in 2018

During conferences held at the Cleveland Clinic’s Medical Innovation Summit, clinicians and scientists discussed technologies and innovative therapies that will be implemented this year. Considering the period of creating new drugs, therapies based on them and medical technologies, this year’s implementations are the result of several years, and sometimes even a decade of research. Often, these studies were preceded by discoveries that completely changed the perception of a given disease or knowledge about its causes. There are also many milestones in the study of diseases – milestones often caused by sudden phenomena such as epidemics or outbreaks of new diseases.

The first and already implemented new medical technology this year is the so-called hybrid closed-loop insulin delivery system (HCLID). Touted as an “artificial pancreas”, the system is quite complex. It consists of a device that measures blood glucose directly and an insulin pump that stabilizes the glucose level with very high accuracy. This time, there is no need for the intervention of the patient, who had to read the test results and decide what dose of insulin he needs – the system works automatically and automatically doses the right amount of hormone.

The second leading technology to be introduced in the next six months is a cure for persistent obstructive sleep apnea. In the USA, this disease affects 21 million people, the number of patients in European countries is similar. Sleep apnea, a disease that affects men more often and is considered a derivative of lifestyle, is now also defined in various studies as possibly having a genetic cause. This condition leads to high blood pressure, strokes, strokes and heart attacks. Until now, sleep apnea was most often treated with a change in lifestyle or in the case of abnormal structure of the upper respiratory tract, the so-called CPAP mask, i.e. a mask with a pump that maintains mild hypertension, which allowed to keep the upper respiratory tract open to air flow at night during sleep. However, due to the inconvenience of use, 40 percent. patients could not use it. Currently, a bioimplant designed three years ago is being implemented, which stimulates the opening of the upper respiratory tract. This system is already after clinical trials, where its high effectiveness was found.

In 2018, experts predict, the FDA will approve a treatment for two conditions that cause blindness – Leber’s congenital blindness and retinitis pigmentosa. The first innovative therapy for these diseases consists in the delivery by the viral vector – the mutant virus serves as a transport carrier – of the correct copy of the gene and thus replacement of the defective gene in the retinal cells. The second is to deliver a copy of the gene using the CRISPR / Cas9 method, which allows the defective gene to be turned off and “swapped” with the correct one. Both have been brought together into one innovative therapy that is likely to be approved by the FDA, as it was already awarded “drug” status in 2017. Importantly, this first genetic therapy, successful in testing, opened the way to other genetic therapies for the diseases that cause blindness; it is very likely that in the next decade those who have never seen or have been blinded will regain their vision.

Another new biomedical technology is the rapid reduction of the level of low-density lipoproteins, i.e. the harmful LDL cholesterol. LDL cholesterol is responsible for the so-called cholesterol deposits, narrowing the lumen of the arteries, and possibly too rapid development of dementia at the age of 65+. A new type of therapy may reduce its level by 75%, but it is not necessary, as in the case of ordinary statins, to constantly take the drug. According to research, the new method of therapy allows for 20 percent. reducing the risk of death caused by a heart attack, circulatory block or heart attack. The new therapy involves the use of a combination of an innovative drug – a PCSK9 inhibitor and a new type of statin. This allows you to reduce the level of LDL by 75 percent.

There is another technology that clinicians expect to expand this year. Today, often referred to as “telehealth”, it focuses not so much on the treatment of diseases as on preventive care and counseling in the case of minor illnesses. The second area is the introduction of “telehealth” programs for inpatients – so as to prevent complications and facilitate their quick recovery after surgery or treatment. In addition, the market of health applications in smartphones and external devices, associated with them, measuring more and more complex health parameters, such as glucose level, respiratory rhythm, tendency to sleep apnea. The first simple cardiology recorder with a smartphone application will probably be on the market this year, providing data 24/7.

The Zika and Ebola virus outbreaks have made researchers and clinicians aware that the process of making vaccines must be rapidly accelerated, as well as their distribution. The creation of a new platform for innovative vaccines begins precisely from her side: this year, vaccines fixed in the dry-freeze technology will appear, which will allow, while maintaining all properties, to be delivered to virtually every region of the world. The process of developing influenza vaccines will be significantly accelerated to accommodate recent virus strains emerging; the cultivation will take place on tobacco leaves, with the use of insects and with the help of nanoparticles and extracted proteins. The method of administration will also change: vaccines will be administered intranasally, orally, edible for young children, and implanted chips that biodegrade and release the vaccine gradually, eliminating the need for repeated doses. The first such vaccine is to be this year’s flu vaccine in the form of a patch with hundreds of tiny needles so that the dose can penetrate the skin.

This technology is related to another – telemedicine and concerns areas where a doctor cannot be expected to reach quickly. In 2016, a startup company used drones to deliver drugs to remote Rwanda provinces. This practice became routine in 2017 and methods were developed during this process that allow the supply of drugs also to other regions. In 2017, the first attempts to deliver drugs by drones to housing estates in Lapland, completely inaccessible in winter, began in Finland.

Breast cancer is one of the most dangerous and difficult to treat cancer in women. Currently, it is detected too late, and it may recur immediately to the advanced form, with metastasis. As a result, all new therapies for this cancer are urgently needed. In the current year, it is planned to implement therapies based on PARP inhibitors for people with specific mutations in the BRCA1 and BRCA2 genes. These pharmacological drugs turn off the DNA repair mechanism by inhibiting PARP activity. It is especially toxic for cells deficient in BRCA1 / 2 activity, i.e. proton-neoplastic cells. The new CDK 4/6 inhibitors for ER-Positive / HER-2 Negative breast cancer, which is one of the most malignant types of this cancer, have a similar effect. Scientists are also working on new inhibitors that target the epithelial growth factor receptor, HER2; effects should be expected even this year.

Recent discoveries from 2017, made simultaneously by several separate international research teams, allow to conclude that a technology will be developed that will enable communication with the environment of patients completely paralyzed due to amyotrophic lateral sclerosis (ALS), a neurodegenerative disease leading to a gradual paralysis of peripheral and central nerve fibers and brain neurons and paralysis. The same system can also be introduced for patients after stroke, traffic accidents and other, and massive strokes.

Pre- and postoperative procedures have been standardized for quite a long time: no eating before surgery, painkillers and anesthetics to increase the patient’s quality of life, and staying in bed, which accelerated the recovery process. Several medical teams have now independently developed new postoperative strategies that will be implemented, as a trial this year, in France, UK. Britain and the USA. The ERAS (Enhanced Recovery After Surgery) protocol will be implemented as soon as possible – allowing for a light meal before surgery, except for surgery directly on the gastrointestinal tract, postoperative nutrition with high-protein liquid food, limited opioids in favor of other types of drugs, and regular walks shortly after surgery, starting from a few steps to the obligatory half-hour walk. This protocol reduces the risk of blood clots, infections, muscle atrophy and post-operative infections, again resulting in a healthier patient leaving hospital faster.

Misfolded proteins like beta-amyloids, which are responsible for neurodegenerative diseases like Alzheimer’s and Parkinson’s disease, are tested for substances that can neutralize them or prevent their deposition. This research requires multivariate analyzes that can only be handled by specialized computer systems. This year, he is starting work on Alzheimer’s disease and some types of cancer in a research laboratory jointly established by Microsoft and the University of Cambridge. In turn, the problem of folding proteins and abnormal proteins, in terms of their neutralization, will be dealt with by the Google artificial intelligence program – AlphaGo Zero. The first results of research on supercomputing medical centers are to be available at the end of 2018

This effect, especially for women, is very traumatic and may even be a depressant factor, which is a very detrimental factor in anti-cancer therapy. An innovative solution that prevents this from happening is the rapid cooling of the scalp before, during and several minutes after the chemotherapy treatment. It is about lowering the temperature of the scalp by a few degrees. During trial tests performed on women treated with chemotherapy in the early stages of breast cancer, this method was able to reduce hair loss by an average of 74%. In May 2017, this method was granted the status of a “drug” by the FDA, and is currently being researched by French, American and Swedish centers. It will be implemented as a therapy this year, initially in the USA and France.