No Need to Learn Latin! Understanding In Vivo, In Vitro, and Ex Vivo Techniques

In vitro fertilization, ex vivo gene therapy, and in vivo clinical trials are exciting techniques in the medical field. The words that describe these methods (in vitro, in vivo, and ex vivo) are common adjectives used to describe research, treatments, or procedures. Although these words sound similar, they are distinct from each other and have unique uses and advantages. Let’s explore the meanings and uses of in vitro, in vivo, and ex vivo techniques.

In Vivo
In vivo describes when a study is done inside a living organism, such as a human or animal. In vivo is Latin for “within the living”. Clinical trials for medicines are often done in vivo because the conditions of a living organism cannot be replicated outside the body. Usually, in vivo treatments are tested on animals first, such as mice or rabbits, and if they produce the desired effects, clinical trials then open to humans. One advantage of in vivo clinical trials is that it shows the entire body’s response to a treatment or drug, including how the drug is metabolized by the body and the body’s response to the drug or treatment.

In Vitro
In vitro is Latin for “in glass”: it describes treatments that are done in a controlled environment such as a test tube or petri dish. The growth of cells, tissues, or bacteria that are in vitro is called a culture. Cultures are used extensively in the early stages of research because testing the responses of cells or tissues is much easier when they are isolated in a culture. Cultures can be easily replicated which is much cheaper than paying for living subjects to participate in an in vivo clinical trial! However, in vitro testing is mostly done in early stages of research because conditions in a petri dish or glass tube cannot show the effects of treatment on the entire body.

In vitro fertilization
In vitro fertilization (IVF) is a fertility treatment consists of extracting one or more eggs from a woman’s ovary and putting them into a petri dish with a man’s sperm. The dish is left in a controlled environment for three to five days, and then the fertilized egg is inserted into the woman’s uterus. She can then carry the embryo to full term within her body. IVF has helped women and men who struggle with fertility to have children with the assistance of a controlled environment outside the body, which is a great example of the advantages of in vitro treatments.

Ex Vivo
Ex vivo treatments combine elements of in vivo and in vitro to advance the boundaries of medical treatments and therapies. Ex vivo is Latin for “from life”: it involves cells or tissues taken from a living organism, such as a human or animal, and transports them into an artificial environment with very similar conditions. The new environment is as similar as possible to the body where the cells and tissues were extracted from so that they can later be implanted back into the body! An advantage of ex vivo treatments is that they provide conditions similar to in vivo experiments while benefiting from the isolation that in vitro methods have.

Ex vivo gene therapy
A revolutionary use of ex vivo methods is in the field of gene therapy, which prevents or treats disease by introducing new DNA into cells. Gene therapy is needed when the body has a defective gene and can’t produce necessary proteins. In ex vivo gene therapy, cells are taken from the body and exposed to a virus in an artificial environment. The virus inserts the gene into the cell’s DNA and the cell with the functioning gene is injected or transplanted back into the body. Ex vivo gene therapy has treated genetic conditions such as hemophilia and is being studied in clinical trials to determine whether it can be used to treat acquired diseases such as cancer.

In vivo, in vitro, and ex vivo describe the methods used for research and treatment and they differ in whether they take place inside the body or in a controlled environment such as a petri dish or test tube. The words may be in a different language but you don’t need to be an expert in Latin to understand how these methods are used to test new drugs and improve medical treatments!

References
https://www.healthline.com/health/in-vivo-vs-in-vitro
https://www.verywellhealth.com/what-does-in-vivo-and-in-vitro-mean-2249118

Technologies That Are Revolutionizing Baseball

With the 2020 World-Series around the corner, it’s important to reflect on baseball’s long history in this country. This will be the 116th edition of the World Series, which highlights just how long the sport has managed to stay relevant and loved by its fans. Despite being an old sport, there are several new advances and technologies introduced to the game that have modernized and changed the baseball experience.

One baseball technology that has impacted the overall player experience is Biotracking. Biotracking is where biomonitors record and measure different physical data. The wristband monitor tracks vital signs and physical stress during sleep, play, rest, and recovery. This data is useful for adjusting workouts, pitching motions, running style, and sleep cycles to the player’s individual needs.

Baseball technologies have also changed audience experience through VR systems. Virtual reality has expanded baseball’s audience by allowing fans to be in the game. Some teams like the San Francisco Giants have in-stadium VR, and the Chicago Cubs also had VR 360 viewing of the World Series celebration in 2016.

In addition to impacting the overall player and audience experience, there are also several technologies in use that focus on body mechanics and data gathering. Examples of technologies focused on body mechanics are:

  • The K Vest: a technology that places sensors on a batter’s upper torso, pelvis, and leading arm and hand. It captures motion and provides a detailed analysis of swing efficiency.  It is currently used by 21 different MLB teams, in addition to separate academies and individual players.

  • The SwingTracker is a technology used by 15 different MLB teams. It is a sensor that is attached to the knob of a bat and transmits data about angles, planes, and velocity. Using this data, a 3D model of a player’s swing can be created.

  • KinaTrax is a technological system consisting of 8 to 16 high-speed synchronized video cameras. These are installed along the first and third baselines, and they capture every movement of the pitcher and hitter. The system then provides 3D rotational and positional data for the movement.

  • The Edgertronic SC1 is a high-speed video camera capable of capturing up to 22,000 frames per second. Teams use the slow-motion visuals to see how a pitcher’s grip changes as he releases a ball, or how subtle adjustments in finger position affect ball rotation. Edgertronic is currently used by most MLB teams.

  • Rapsodo is a radar and camera combination that is situated on the ground between the mound and the home plate. The radar and camera combination results in data on ball speed, velocity, launch angle, and spin for pitchers and batters. This technology provides a ball-focused pitch analysis that can allow coaches and players to highlight areas for development.

  • Baseball has established itself as a timeless sport through its everlasting fanbase. Thanks to these technology advances, the sport will continue to modernize along with its audience.

Sources
https://www.fastcompany.com/90378232/5-technologies-that-are-changing-baseball
https://www.inverse.com/article/29968-10-baseball-technology-advances

What is Targeted Drug Delivery?

Targeted drug delivery is a method of delivering medication with the goal of maximizing its effects on specific parts of the body. This approach aims to minimize unwanted effects of the medication on non-diseased tissue, while at the same time prolonging the drug’s actions on its target.

Regular drug delivery utilizes blood circulation as a means to transfer the active substance to its target. The main disadvantage of that approach is that a very small percentage of the initial dose manages to reach the intended target, while the rest affects unintended cell populations. Targeted drug delivery aims to mitigate this exact issue by various ways.

Targeted drug delivery can be achieved by increasing the molecular specificity of the medication. An example of this approach is the use of monoclonal antibodies, which are commonly used in cancer treatment. Monoclonal antibodies are normally created by the immune system in response to a specific antigen, and they can only bind on cells that have that antigen on their surface. Thus, when creating monoclonal antibodies for different forms of cancer, scientists find protein targets that only exist on the surface of the cancer cells. This means that the treatment will only affect these cell populations, while having essentially no effect on any other cells they encounter through blood circulation.

When molecular specificity cannot be achieved, there is another effective way to increase drug concentration at the intended target site. Researchers have developed various delivery vehicles that can protect drugs from degradation and increase their amount in blood circulation, leading to higher concentrations and longer action time. Nanotechnology has played a significant role in the development of new delivery vehicles that can bypass the body’s immune response while being non-toxic.

Resources:

Drug Delivery: https://www.technologynetworks.com/drug-discovery/articles/drug-delivery-322035

Targeted Drug Delivery: https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/targeted-drug-delivery

What are the Main Functions of Blood?

From childhood cuts to Vampire films, everyone knows what blood looks like outside of the body: bright, red, and runny. But what exactly does blood do?

Blood is actually very hard at work within the body. The primary responsibility of blood is transportation: the blood delivers oxygen from the lungs to the cells of the body, transports carbon dioxide produced in the body back to the lungs for exhalation, transports critical nutrients and hormones to cells, and removes waste products. However, blood also works to maintain the overall function of the body via protection mechanisms and regulation functions. Learn more about the functions of blood below!

Protection: Blood plays a critical role in defending the body against external and internal threats to overall health and wellness. Some white blood cells within the blood work to protect the body from disease-causing bacteria entered into the bloodstream through an open wound, while others seek out and eradicate harmful body cells infected with viruses or cells with mutated DNA that could potentially cause cancer. Platelets in the blood also initiate clotting at the site of an injury to prevent harmful amounts of blood loss.

Regulation: Blood helps regulate and maintain the proper temperature within the body. When we are too hot, blood vessels become wider and allow more blood to flow through the skin, which causes more heat to be lost. Blood vessels leading to the skin capillaries become wider allowing more blood to flow through the skin and more heat to be lost to the environment. This is called vasodilation. When we are too cold, blood vessels constrict – which allows less blood to flow through the skin and conserves the core body temperature. This is called vasoconstriction. Blood also helps regulate proper pH and water levels within the body.

As you can see, blood plays a critical role in keeping your body safe, healthy, and functioning properly. Good thing you have around 1.5 gallons of blood inside of you!

Resources

Khan Academy: https://www.khanacademy.org/science/biology/human-biology/circulatory-pulmonary/a/components-of-the-blood

Medical News Today: https://www.medicalnewstoday.com/articles/196001

Texas Heart Institute: https://www.texasheart.org/heart-health/heart-information-center/topics/blood/

What’s the Difference Between Chemotherapy, Radiation Therapy, Immunotherapy?

The goal of cancer treatment is to cure, shrink, or stop the progression of a cancer. Depending on the particular situation, patients may receive one treatment or a combination of treatments. There are many different types of cancer treatments, which will be described in this post.

Doctors often recommend chemotherapy as a treatment for cancer. Chemotherapy uses drugs that kill dividing cancer cells and prevent them from growing. It is considered a systemic treatment, because it affects cancer cells throughout the body, which includes potential metastasized growths. Many chemotherapy drugs have adverse effects, some of which may be severe. Doctors recommend chemotherapy after assessing the risk for side effects, when they believe that the specific patient will have significant benefits from it.   A person will often have chemotherapy as part of an overall treatment plan, which may also include surgery and radiation therapy. These treatments are effective in many cases of cancer. However, their effectiveness will often depend on the stage of the cancer as well as its type. Overall, it is calculated that about 50% of cancer patients will receive chemotherapy as part of their treatment at some point.

This leads to the next cancer treatment of radiation therapy. Radiation therapy uses waves of energy, such as light or heat, to treat cancers and other tumors and conditions. Radiation inhibits tumor growth by destroying the genetic material responsible for cancer cell division, while at the same time having little effect on regular cells. Radiation therapy is a localized treatment, because the beams are targeted towards the affected region only. Doctors may recommend radiation for cancer at different stages. In the early stages, radiation therapy can help reduce the size of a tumor before surgery or kill remaining cancer cells afterward. In the later stages, it may help relieve pain as part of palliative care.

One of the more recent types of cancer treatment is immunotherapy, which utilizes our immune system to help us fight cancer cells. The immune system helps our bodies fight infections and other diseases. Drugs used in immunotherapy are boosting the ability of our immune system to detect cancer cells and have a stronger response against them. Examples include monoclonal antibodies, which bind onto cancer cells and mark them for destruction, as well as immune system modulators, that boost immune responses. Immunotherapy is also a systemic form of cancer treatment, and can provide a significant benefit in combination with other treatments.

Students: How to Effectively Communicate Science

When I first started working at Emory as a postdoctoral fellow, I was very excited to perform research at such a prestigious institution. Besides working in a lab, I was always passionate about science communication and soon started searching for opportunities to pursue my interest. Not too long after, I came across the Office of Technology Transfer (OTT) Marketing and Communications internship through word of mouth from previous interns. I quickly got in touch with the team to learn more and eventually applied and started.

Being a researcher, I was comfortable with scientific topics in my area of expertise, but I was eager to learn more about the breadth of research conducted at Emory. As a writer for the OTT blog and website, I had the opportunity to speak with Emory researchers across different disciplines – from immunology and oncology to plant research and beyond. I learned more about their work and goals, as well as the possible future impact of their discoveries on our lives. I also found out more about the licensing process, which was an entirely new field to me. I learned how the OTT helps researchers maximize the impact of their work and also protect their intellectual property.

During my time at the OTT, I had the unique opportunity to write about science in a way that is accessible to a broader audience. For most scientists, it becomes second nature to write complex scientific papers and speak in jargon and technical terms. However, it is important to also develop the ability to capture the main points of our work and explain it in a way that simplifies it, but still elevates its importance. Writing for the Simple Science blog series, I put myself in the reader’s shoes and practiced communicating science in a simple but engaging way.

This experience at the OTT solidified my decision to pursue science writing as a full-time job. I started applying for scientific writer positions and soon started interviewing. I can honestly say that my internship at the OTT was one of the most impactful lines on my resume and truly made me a better candidate. Not only did it give me important hands-on experience with writing, but it also helped me appreciate the impact of research in society and expand my horizons. I am now in a new role where I am writing about science full-time, and I see the benefits of my OTT experience every day in my work.

I am forever grateful to the OTT and the Marketing & Communications team in particular. Everyone was very helpful and easy to work with, making me feel at ease as a new intern. I truly believe this internship is a unique experience for students and trainees at all levels, whether in college, grad school or even during a postdoc. I wish all the best for the new cohort of interns and I am looking forward to all the amazing work that will come out of the OTT in the future!

— Vicky Kanta

Students: Learning to Write About Science

As a media studies major with an interest in writing and communications, I jumped at the chance to intern with the Office of Tech Transfer in the marketing department throughout my senior year.

From prior work experiences at magazines and web publications, I had quickly become familiar with the ins and outs of interviewing subjects, creating compelling social media content, and telling a good story. During my first few weeks at the Office of Technology transfer, I quickly realized that there was one critical function I was less familiar with: understanding and talking fluently about science.

My last, and only, academic exposure to the field of science was an astronomy class my freshman year, but suddenly I was thrust into the world of nanotechnology, medication adherence scales, liver disease, and more, introduced to me via PhD graduates and professors who are at the top of their respective fields.

Though I was intimidated at first, I soon realized that I had been given a really unique opportunity to learn more about the unmatched scientific innovation that occurs behind the scenes at Emory from the eyes of an outsider. Perhaps most importantly, I realized that I had a unique responsibility to share these ideas, inventions, and innovations in a way that someone like myself–with little to no background in science–could understand and engage with.

I took that responsibility seriously, and I enjoyed writing pieces on topics as varied as in-depth profiles of featured innovations at Emory to tongue-in-cheek social media posts about fun and unique patents to use at Christmas time.

While I never quite fully understood some of the more abstract scientific topics that I explored during my time at OTT, I left with a much stronger knowledge of scientific advancement and the licensing process as a whole. I have no doubt that my newfound background in science and tech writing will prove invaluable as I pursue a career that allows me to communicate widely with audiences across a range of subjects. (Though I think I’ll steer clear of nanotech–that never really clicked!) In all seriousness, my internship with OTT was one of my favorite experiences at Emory both because of the things it taught me, and for all of the things it didn’t.

— Presley West

The Future of Medical Records – FHIR

As medical care becomes increasingly sophisticated, the successful transfer and utilization of patient records is critical for providing the best outcomes. The Fast Healthcare Interoperability Resource (FHIR), developed by the nonprofit group Health Level 7 International (HL7), is the latest standard for such data. FHIR seeks to transform the way patient data is used by giving everyone from doctors to developers the opportunity to view and build on it in unprecedented ways.

Before FHIR, standards for sharing patient data could roughly be compared to PDFs. Health care providers receiving a report from another doctor could see the doctor’s notation, but generally not the underlying data that the doctor collected. Even if the provider was able to get access to that data, no protocol existed for filtering it or interacting with it. This informational gap severely hampered the ability of health care providers to collaborate in providing treatment.

FHIR, which was first released in 2011, uphanded this dynamic. Rather than providing static printouts, FHIR relies on data elements called “resources,” which are unique identifiers for medical information. Through combinations of these resources, FHIR expresses medical data, allowing health care providers to see and interact with the information. FHIR can be roughly compared to a URL, generating a dynamic form of patient records more akin to a webpage than a PDF.

The interoperability of FHIR leaves open many possibilities for future uses. The rise of wearable devices and Internet of Things technology means that there is more medical data floating around than ever before. Using FHIR, developers can create tools that allow health care providers and patients to utilize this data in innovative ways. For example, using the iOS app Apple Health, patients can now download their FHIR records. The app can keep those records up-to-date and organizes and presents them in a more user-friendly way, simplifying a previously confusing process. The resource-based nature of FHIR allows these records to be automatically updated every time new information is added. These discrete resources are then compiled for patient viewing on the Apple Health app, generating a readable report.

Doctors can also use Apple Health to view data from wearable devices such as the Apple Watch. With patient consent, doctors can incorporate heart rate data from such devices into medical records to help detect heart conditions and tailor treatment. In addition to Apple, Google, Microsoft, and Amazon are also working on applications that incorporate FHIR. FHIR apps are available on two primary marketplaces, run by software companies EPIC Systems and Cerner. Analogous to the iOS App Store or Google Play Store for smartphones, these two marketplaces allow developers to sell FHIR applications directly to consumers and healthcare professionals.

Doctors are also seeing other benefits from the integration that FHIR provides. A prime example is in the notation and documentation of medical records, which previously was a cumbersome process involving the use of dictation devices and apps to upload records to desktop-based records systems. Now, FHIR-based apps are beginning to emerge that can upload medical records quickly and seamlessly. The Nuance Surgical CAPD allows surgeons to create fully operative notes in less than 90 seconds. Doctors can dictate notes and capture images directly from their smartphones and upload them securely to a patient’s medical records.

One primary concern of FHIR developers is protecting patient privacy. While the open-source nature of FHIR allows increased collaboration and interoperability, it leaves open the possibility that third-party apps may not adequately protect sensitive medical data. In December 2018, EPIC instituted a three-month halt on applications by new developers to its FHIR “App Orchard.” EPIC later reopened enrollments with more stringent requirements for HIPAA compliance and security. With these concerns in mind, universities and medical providers have begun to give seals of approval to select FHIR applications that protect privacy. For example, Emory’s FHIR Advisory Committee gives formalized endorsements to apps that meet several criteria, one of which is protecting patient privacy.

Everyone who examines medical records, from hospital systems, to individual doctors, to insurance companies, will find FHIR helpful in creating a seamless patient experience and improving standards of care. FHIR apps are already serving innovate roles, from helping doctors manage medication dosage to streamlining directives for end of life care. FHIR will serve as a key building block of the medical records market for years to come, as the basis for innovative methods of sharing and analyzing medical data.

How Does Blood Clot?

The blood clot process begins whenever our skin or blood vessel wall breaks and blood starts coming into contact with the outside. That triggers a series of chemical reactions that result in the formation of a clot, which aims to stop the bleeding and help the vessel heal.

Initially, blood vessels in the area will constrict, to ensure that blood flow is decreased. During this process, small blood particles called platelets will start binding together in the damaged area, creating what is called a platelet plug. This leads to the next step of the process, in which several blood clotting factors are activated and create a chain of reactions that leads to the creation of fibrin, a fiber-like protein that helps increase the size of the clot and stabilize it.

If the clotting process does not stop when appropriate, dangerous clots can be formed in other parts of the body. This is why there is a rigorous control system ensuring that the clotting reaction stops when the vessel is sufficiently blocked to prevent bleeding. However, there are certain blood disorders that lead to increased clotting, such as thrombophilia.

High cholesterol concentrations can form plaques in arteries, making it difficult for blood to flow in the area. If these plaque breaks open, they will form a clot that travels in the blood stream. Most heart attacks and strokes happen when a plaque suddenly bursts.

Blood clots can also form when something obstructs the regular flow of blood in the body. If blood pools in the blood vessels or heart, the platelets are more likely to stick together. Atrial fibrillation and deep vein thrombosis (DVT) are two conditions where slowly moving blood can cause clotting problems. If undetected, these conditions can lead to serious heart problems or even death, which is why clotting factors are often included in blood analyses when the patient has a known risk for these diseases.

Wearables in Clinical Trials: Exciting Developments and Lingering Concerns

The use of wearable devices has skyrocketed over the past few years, with approximately 21% of Americans reporting regular use of a smart watch or wearable fitness tracker. Wearables are a great source of health-related data, which can even be streamed remotely in real time. Nowadays, smart wearable devices incorporate more sensors than ever – heart rate, oxygen saturation, even electrocardiograms, along with fitness and sleep information. Their potential advantages in clinical trial settings have not gone unnoticed. According to clinicaltrials.gov, there are approximately 950 trials that are using wearable devices, with over 300 of them successfully completed. However, this still only accounts for <2% of all trials, even though more studies could potentially benefit from their use.

One of the biggest issues in clinical trials is patient adherence to protocol, especially when there is extensive data collection required at home. This can be very demanding for participants and may discourage participation. Wearables can serve two roles in that domain, by delivering medication reminders and by collecting information in a continuous manner without the patient’s input. Importantly, since a large portion of the study can be conducted in the comfort of the participant’s home, this should lower participant dropout rates.

Wearable devices offer clear advantages in terms of data quantity and quality. Clinical trials are often conducted across different centers, sometimes spanning multiple continents. The use of the same wearable device type across sites will help with data consistency regardless of geographic location, especially if proper device usage training is provided. At-home data collection is also highly beneficial to researchers, since it results in real-life numbers that are consistent with the patients’ everyday activities. Furthermore, the increasing use of artificial intelligence (AI) in clinical trial data analysis will facilitate important pattern detection in large datasets collected from these devices.

Despite the large growth in wearable incorporation in clinical trials, there are still some legitimate concerns regarding regulations. The Clinical Trials Transformation Initiative has an extensive set of recommendations for the use of mobile technologies in clinical trials. They emphasize that devices themselves do not need to be approved by the Food and Drug Administration (FDA) to be used in clinical trials, but they do need to “verify and validate the appropriateness of the selected mobile technology.” The main problem here lies with the proprietary nature of the algorithms that these devices use, which may not allow researchers to thoroughly assess the accuracy of their sensors. In addition, many wearable manufacturers do not allow direct access to the raw data and give “black box” descriptions of the acquisition method and processing that takes place. The lack of data standards will likely slow the adoption of such devices in clinical trials.

Another issue regarding wearable use in clinical trials has to do with data ownership. All patient data collected during clinical trials fall under the Health Insurance Portability and Accountability Act (HIPAA), which regulates how protected health information can be used and shared. Consumer-grade devices are not regulated in the same way as medical devices, therefore many of the rules governing data protection are up to the manufacturers. Although many wearable manufacturing companies are working to support HIPAA compliance, there are still various privacy and data security concerns.

The innovation and potential that accompanies the use of wearables in clinical research is undeniable. However, there is still room for improvement to ensure a safe and reliable incorporation that benefits scientists, patients and society as a whole. Since this field is still fairly new, we can expect some drastic developments in the immediate future.

—  Vicky Kanta