From genomic-directed clinical trials and gene editing to personalized medicine and more, recent innovations in science and medicine are helping patients live longer, healthier and fuller lives.
Behind these advances are experts including genetic counselors, biomedical engineers, precision medicine champions, medical informaticians and others who will continue pushing their fields forward in service to patients.
In this three-part series, BWH Clinical & Research News caught up with several BWHers about these “careers of the future,” and what they will mean for clinical care and for those looking to join the health care workforce in the years ahead. Read part three of the series below, as well as the first and second parts of the series.
Biomedical Engineers: Ushering the shift from devices to systems
Michael Fraai, MS, CCE, executive director of Biomedical Engineering and Device Integration at BWH, defines a biomedical or clinical engineer as someone who applies engineering principles to the way technology is used to deliver safe and effective patient care.
“The field started off as device-driven, and it has evolved to now being very systems-driven, where a device is connected to another device which is connected to another device and so on,” said Fraai. “The profession requires both technical aptitude and collaboration with clinicians to know what the challenges are and how to resolve them. We’re now working with clinicians in a much more involved and collaborative way.”
Fraai’s team of 39 problem-solvers is responsible for more than 26,000 patient care devices at BWH, including electrocardiogram machines, infusion pumps, patient monitors, anesthesia machines, surgical equipment and others. Some of the devices continuously monitor patients’ vital signs from a central location and alert care team members to results that require action. The department serves BWH through collaboration with clinicians on technology selection, installation, inspection, maintenance, repair, upgrades and configuration, and over the years has improved patient care in the process.
If an anesthesiologist identifies a leak in an anesthesia machine while delivering anesthesia to a patient, for example, he or she calls Fraai’s team. They in turn collaborate with the anesthesiologist and the rest of the care team to figure out a solution to the problem, which could be an issue with the machine or the patient. The team works in this way with nearly every discipline and clinical team across the hospital. In addition, Biomedical Engineering was responsible for getting all of BWH’s patient care devices ready for seamless, reliable integration into Epic.
Fraai says that the future of biomedical engineering will continue to become more systems-based, with all devices communicating with each other, as well as much more data-driven to provide evidence-based care.
“With all of the patient data that comes out of these devices, we want to be able to make evidence-based decisions to provide better care,” he said. “We’ll be looking at how the data integrate into Epic and providing data to clinician-experts for research.”
As a way to inspire and train the next generation of biomedical engineers, Fraai’s team regularly hosts two engineering interns from the University of Connecticut for a two-year internship.
“If you have the aptitude to apply your technical skills in a meaningful way, this is the profession, the hospital and the department to be in,” said Fraai. “We work with the best clinicians in the world; they continually challenge us to provide the most innovative solutions.”
Bioengineers: Breathing imagination and inspiration into human health
When BWH bioengineer Sangeeta Bhatia, MD, PhD, was in high school in the late 1980s – around the time the field of bioengineering was just getting started – her father took her to a mechanical engineering lab at MIT.
“The lab focused on using ultrasound for hyperthermia, and it really captured my imagination that you could build instruments to impact human health,” said Bhatia, who runs the Laboratory for Multiscale Regenerative Technologies at MIT, which conducts research at the intersection of engineering, medicine and biology to develop novel platforms for understanding, diagnosing and treating human disease.
Inspired by what she saw, Bhatia went on to study biomedical engineering in college, graduate from medical school and earn her doctorate in biomedical engineering as well. She says she always thought she would work in industry, but she found that she missed interacting with trainees and the early-stage innovation of the academic setting.
Microlivers and nanoparticles
Among her many inventions and achievements, Bhatia created an artificial “microliver” that allows liver cells – which lose function quickly when removed from the human body – to maintain their function for weeks when cultured in the lab. To do this, Bhatia used her knowledge of microfabrication – a computer chip manufacturing method – to create a microenvironment that could stabilize liver cells after being removed from a donor liver. These microlivers model human drug metabolism, drug-induced liver disease and interaction with human pathogens, and are being used for drug testing, discovery and tissue engineering.
After this discovery, Bhatia launched a start-up that provides microlivers to pharmaceutical companies to help them predict the safety of new drugs that they develop. She is also working with a Boston University bioengineer, Christopher Chen, MD, PhD, who creates blood vessels using a variety of techniques, including 3-D printing. Together, they are making vascularized microlivers and testing them in mouse models.
“Beyond building livers, we found that the interest in speeding computation led to a miniaturization of microfabrication methods to the nanoscale,” said Bhatia. “This created a portfolio of methods to leverage for use in medical innovation, ranging from manipulation of a single protein to groups of cells.”
This recognition led Bhatia to initiate a program in cancer research. She and her team have developed synthetic biomarkers to help diagnose oncologic diseases through non-invasive tests, including using a paper-based urine assay. The team created nanoparticles that interact with tumor proteins, which then release biomarkers that can be detected in urine. The nanoparticles have been tested in mouse models and may one day be used to diagnose cancer, and other diseases, in humans.
“Exploring the physics and biology of the nansocale is quite powerful because the lengths of the biological building blocks of DNA, RNA and proteins are all nano-sized,” said Bhatia, who won the prestigious Lemelson-MIT prize in 2014 for her groundbreaking inventions to improve patient care and human health globally. “The miniaturization of technology to approach the nanoscale has opened up a whole new world of nanomedicine. Recognizing that materials can now be synthesized to be administered into the body, find their way into a diseased tissue and make a measurement or deliver a therapy is what got us excited about applications in cancer.”
Solving problems in the clinic
Bioengineer Oren Levy, PhD, MSc, part of the Karp Lab in BWH’s Division of Engineering in Medicine, says that bioengineers today can impact the world of patient care just as much as clinicians.
“Bioengineers are developing novel biomaterials, which may solve many of the problems surgeons and others see in the clinic every day,” said Levy. “We have the incredible possibility of touching the lives of millions of patients by developing a tool, instrument, approach or therapy that could help them.”
Levy focuses on improving stem cell therapies by engineering cells that can home in on sites of disease and damage. Over the years, he’s seen the field of bioengineering come closer and closer to accurately replicating human living systems in the lab and using those systems to screen for drugs. He says he is especially excited by the promise of organ engineering – the creation of artificial lab-cultured organs that might eventually be transplanted into patients in need.
“As we understand more and more about cell biology and the processes of cell expansion and differentiation, we will get to the point where we understand how to effectively combine biomaterials and cells to grow organs in the lab,” he said. “There are a limited number of organ donors and donor organs. Imagine someone who needs a cornea transplant, or a cystic fibrosis patient who needs a lung, being able to get one over the shelf. It could vastly improve quality of life.”
Bhatia is similarly invigorated by the field’s promising future. She says that transformative ideas and innovations in advanced technology, such as 3-D printing and DNA sequencing, have, by now, been able to incubate and mature.
“It’s an exciting time to be a bioengineer because many technologies have matured to a stage where they can be translated to the clinic,” she said. “At the same time, new technologies like 3-D printing and nanomaterials are constantly emerging to add even more possibilities for the future.”