By Olivia R. Weidner, DHIT Global Intern | June 30, 2020
On Friday, June 26th, 2020, the Digital Health Institute for Transformation (DHIT) hosted the seventh installment of its digital web series in collaboration with the ASSIST Center at North Carolina State University.
The DHIT Frequency Webinar Series, which takes place biweekly, is a way to keep our community connected while many work from home. Each segment will be co-hosted by DHIT’s President, Michael Levy, and Adam Curry, ASSIST Innovation Ecosystem Director. The series will spotlight distinguished guests from across the ecosystem to discuss the state of digital health in the time of COVID-19.
Amidst widespread fear and uncertainty, DHIT explores the role of digital health in the global response to COVID-19, gaining insight into the ways this crisis has catalyzed the usage and acceptance of telehealth and other digital health technologies. Last week’s panelists included:
- Dr. Stanko Skrtic, Senior Science and Innovation Medical Director at AstraZeneca
- Murat Yokus, BioInterface Lab Researcher, North Carolina State University
- Dr. Karen Leitner, Medical Director of Transgender Virtual Medical Home at Teladoc
Over the past few weeks, DHIT’s web series COVID Unites Us All has focused on remote monitoring in the current moment and beyond. In recent episodes, panelists have provided insight into monitoring technologies for specific organ systems, shedding light on the benefits of tracking pulmonary and cardiac health measures. This past Friday, the webinar took a broader look at biochemical sensing, with three distinguished guests representing the research, commercial, and clinical domains, respectively. Murat Yokus, BioInterface Lab researcher at the ASSIST Center, offered viewers a look at his work with electrochemical sensors. Dr. Stanko Skrtic, Senior Science and Innovation Medical Director at AstraZeneca, shared an industry perspective on the biochemical sensing marketplace. Finally, Dr. Karen Leitner discussed her clinical experience as Medical Director of the Transgender Virtual Medical Home at Teledoc.
Most of us are familiar with wearable technologies; wearables have been a key focus of the COVID web series, and many of us own smart watches or fitness trackers that collect personal health data. Biochemical sensing seeks to utilize forms that are similar to that of popular commercial wearables while enabling more complicated and diverse data collection. Yokus provides a helpful framework for understanding this concept:
“Biochemical sensors are essentially sensors used for converting chemical information into measurable signals. Different from physical sensors, biochemical sensors utilize biorecognition elements such as enzymes, antibodies, or nucleic acids. Then, an electrochemical signal or current can be measured with a wearable electronic system.”
“One thing that’s very important, which you’re always trying to do, is identifying the patients who are most at risk. This is critical for making sure you’re giving the right care to the right patient at the right time. This is especially important for COVID, since there is such a wide and disparate clinical presentation in patients. It would be really helpful to have a biomarker that would alert you to the people that are most at risk for becoming severely ill.”
Dr. Karen Leitner
Biochemical sensors can track levels of electrolytes, metabolites, hormones, and even some drugs. A familiar example of a broadly-used biochemical sensing technology is the continuous glucose monitor (CGM), a device used to track blood sugar levels in individuals with diabetes. In the case of CGMs, market demand drove development, resulting in significant research into staple enzymes used for glucose detection. Despite advances in the realm of diabetes management, biochemical sensing technologies have yet to be deployed for other chronic conditions. Thus far, continuous glucose monitors stand alone in terms of proven efficacy and validation; similar devices for other applications lag behind.
Although biochemical sensors have yet to reach their full impact, these technologies have the potential to drastically alter the clinical experience for both patients and providers. Dr. Leitner shed light on this potential, giving our audience a glimpse at additional use cases. According to Leitner, biochemical sensing could be useful in the management of a number of chronic conditions, especially those that require frequent blood work to track disease markers. For example, in patients with a history of prostate cancer, levels of PSA (prostate-specific androgen) are checked about every 3 months in the lab. However, PSA levels can fluctuate frequently, so it is often difficult to accurately identify trends with these brief, 3-month snapshots. Wearable biometric sensing devices could enable long-term or continuous tracking of these levels, which would obviate the need for routine blood work while improving the quality of data collected. Prostate cancer is but one example; Leitner also sees promise in utilizing similar technologies for managing postoperative hypoparathyroidism and renal disease. Biochemical sensing allows clinicians and patients to view a more continuous disease trajectory, enabling more cost-effective and controlled intervention. By doing so, acute cases of dangerous, emergent, and resource-intensive disease progression may be avoided.
Given the possibilities and potential advantages of biochemical sensing, it’s no surprise that researchers seek to apply these technologies to the COVID-19 pandemic. One potentially relevant biomarker is cytokine, an inflammatory molecule of the immune system. When an individual’s immune system reacts to infection with COVID-19, a “cytokine storm” can be triggered, leading to high fevers and respiratory distress. Essentially, this “cytokine storm” represents an overreaction of the immune system, which can worsen disease trajectory. For this reason, the cytokine is a biomarker of interest for COVID-19. Moreover, the ratio of cytokines in blood and in sweat is 1:1, meaning that a wearable device could potentially measure levels in sweat to preclude lab visits.
In the case of COVID-19, disease presentation is highly variable. Some patients experience few or no symptoms, while others may require hospitalization and mechanical ventilation. In some patients, cytokines may play an important role in determining disease outcome. If biochemical sensors could track levels of this relevant biomarker, health professionals could potentially predict and proactively manage cases that are likely to become severe.
As new technologies for biochemical sensing develop, there are some key considerations that will guide the process. Skrtic tells viewers:
“It’s important to choose and work on biomarkers that have already been validated and are used for clinical decision-making. It’s a very long journey to establish and validate a biomarker in terms of clinical use. You have to think: ‘what’s the easiest, quickest, most clinically robust biomarker for making decisions?’ There won’t be one technical platform that we use for everyone; there won’t be one fix for all. We’re going to have many niche offerings to serve the diversity of patients. Otherwise, we won’t be able to make something that is truly patient-centric and user-friendly.”
In short, identifying and validating novel biomarkers and fluids to measure is a process requiring extensive research. The development of continuous glucose monitors was driven by demand and a clear clinical use case, and this will likely become a pattern for other conditions as well. Nonetheless, Skrtic emphasizes the fact that we’ll see diversity in form factors and applications across different disease categories; thus, biochemical sensing promises to expand the scope of personalized medicine. As the field continues to advance, researchers seek to improve the quality of the clinical experience for all by keeping the patient in mind at each stage of development.
DHIT thanks its guests for serving on the panel, and everyone who tuned in! If you were not able to catch last week’s webinar, check out DHIT’s Media page to see what you missed. DHIT and ASSIST would also like to give a special shoutout to our Program and Innovation Champions: Pfizer Digital, RIoT, Excelerate Health Ventures, Device Solutions, Medallia, Charlotte AHEC, Elsevier, Cone Health Ventures, Hangar6, SotoIP, and Duke MEDx.
We are excited to announce DHIT’s partnership with the ASSIST Center to launch a Virtual Incubator using Crowdicity to collect crowdsourced ideas from the digital health community focusing on remote care. This innovation engine will serve as a catalyst to advance remote care by sourcing ideas from the ecosystem and nurturing them from inception to implementation. For more information, see our landing page for the Incubator and mark your calendar for Friday, July 10th for the next installment of the DHIT Frequency Webinar Series, which will focus on big data and the determinants of health. Until then, stay safe, everyone!
- To learn more about the ASSIST Center, visit assistcenter.org
- To learn more about the Virtual Incubator, visit dhitglobal.org/incubator
- To view previous recordings, visit DHIT’s Media page here: https://www.dhitglobal.org/media/
The Digital Health Institute for Transformation (DHIT) is a 501(c)(3) non-profit education and research institute supporting communities through the process of digital health transformation. We collaborate with leading academic institutions, associations, and industry to cultivate talent and ecosystems with our immersive learning platform, harnessing real-world experiences that drive the adoption of next generation skills, emerging technologies, and mindsets needed to foster the digital health leaders and innovators of the future, today. For more information, visit dhitglobal.org.
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