UK surgeon named world’s first astronaut with a disability

The European Space Agency on Wednesday selected the world’s first astronaut with a disability. John McFall, whose right leg was amputated at age 19, is the first recruit for a new program investigating accommodations for astronauts with disabilities.

The agency called for applications in March 2021, seeking people with disabilities who could pass stringent physical and psychological testing but were limited by a lack of hardware accommodations. The program will investigate the changes and costs required to send astronauts with disabilities into space. The ESA chose McFall out of 257 entrants, and describes him as the world’s first “parastronaut.” And next spring, he will enter the 12-month training program at the European Astronaut Centre in Cologne, Germany.

“I’ve always been hugely interested in science generally, and space exploration has always been on my radar,” said the 41-year-old McFall on Wednesday. “But having had a motorcycle accident when I was 19, like wanting to join the armed forces, having a disability was always a contraindication to doing that.”

After McFall’s accident and amputation, he learned to run again and won a bronze medal in the 100-meter dash at the 2008 Paralympic Games. In addition, he earned several medical degrees and was a Foundation Doctor in the British National Health Service from 2014 to 2016. McFall currently works as a trauma and orthopedic specialist in South England.

“In early 2021 when the advert for an astronaut with a physical disability came out,” said McFall, “I read the person specifications and what it entailed, and I thought, ‘Wow, this is such a huge and interesting opportunity.’ And I thought that I would be a very good candidate to help ESA answer the question they were asking: ‘Can we get someone with a physical disability into space?’ And I felt compelled to apply.”

The best fitness gifts for your friends who work out

Fitness fanatics can be pretty intense. You’ll probably identify us from miles away, decked out in workout gear, obsessing over the food we eat, or discussing our gains nonstop. A fitness lover has probably invested a lot of time and money into tools that can help improve performance, which can make us tough to shop for — we probably already have everything we need! But we’re also very likely to be super excited by any new toy that could boost our workouts. Plus, the most dedicated of us probably wear out our favorite gear quickly enough that we could always use new stuff.

What to get a fitness lover

It’s natural to assume that gifts for fitness lovers must be used during workouts, but recovery is an equally important (and frequently overlooked) part of anyone’s fitness journey. And presents for fitness lovers don’t have to be tech-infused, either. Gift cards to their favorite athleisure or fashion brands would probably be well-received, while compression braces or socks can provide them physical support. A pair of gloves would also help your weightlifting pal avoid getting more calluses, and special insoles can turn decent running shoes into great running shoes.

A versatile gift for anyone trying to keep active would be a resistance band, which suits a variety of strength levels and is very travel friendly. And, as my sports chiropractor constantly reminds me, a foam roller is the best thing for my sore muscles.

Tech gifts for fitness fans

Of course there are plenty of gadgets targeting exercisers and our muscles. From traditional machines like treadmills to smart skipping ropes and VR boxing simulators – the land of fitness tech gets stranger by the day.

As someone who’s recently become somewhat of a workout fiend, I would enthusiastically welcome anything that’s related to improving my performance. I’ve tested all manner of devices — whether it’s Gatorade’s sweat patch and hydration-tracking bottle or smart mirrors and form-checking cameras. From my experience, single-purpose devices are the most likely to sit around unused. Things like the Gatorade bottle and Fiture mirror, for example, which actually serve a purpose even if they’re deactivated, are more likely to withstand the test of time. Here are our favorite tech products for fitness lovers.

Garmin Forerunner 745

Garmin Forerunner 745
Engadget

Serious runners swear by Garmin’s Forerunner series. They’re the gold standard for running watches, thanks to their accuracy and comprehensive suite of features. You can track your cadence, stride length, ground contact time, balance and more, but Garmin also helps monitor your recovery time and training load.

It’ll analyze your performance and workouts, using your aerobic and anaerobic data to see what effect your exercise is having on your endurance, speed and power. The Forerunner 745 will also tell you if you’re training productively, at your peak or if you’re overreaching. Like most other smartwatches, this will also track your sleep, control your music playback and alert you to incoming notifications from your phone. It may have a more basic-looking operating system than the Apple Watch or Galaxy Watch, but the Forerunner 745’s best trait is that it will last up to a week on a charge. — Cherlynn Low, Deputy Editor

Buy Forerunner 745 at Garmin - $500

Apple Watch Series 8

Apple Watch Series 8
Will Lipman Photography for Engadget

For iPhone users, there is no better smartwatch than the Apple Watch. Whether you opt for the maxed out Ultra or the basic SE, you’ll be getting your loved one a well-rounded and competent wearable. The Series 8 sits between those two models and offers a great balance of features and comfort. It’s not as chunky as the Ultra and has an onboard skin temperature sensor that the SE doesn’t.

Your giftee will receive reminders to stay active, have their walks automatically detected and be prompted to take mindfulness breaks throughout the day. Apple’s workout tracking also does a great job of logging time elapsed, calories burned, distance traveled and other key metrics. Plus, with watchOS 9, the workout pages now show what heart rate zone the wearer is in, so they can better understand when to push themselves harder or take it easy.

If the person you’re shopping for is more of an endurance athlete or outdoor adventurer, the Ultra’s enhanced GPS and special features might make it a better gift, but at $800, it’s wildly expensive and you might want to split the cost with others. — C.L.

Buy Apple Watch Series 8 at Amazon - $399

Fitbit Inspire 3

Fitbit Inspire 3
Will Lipman Photography for Engadget

Compared to older Inspire models, the third generation comes with a color touchscreen that’s easier to navigate. While Fitbit OS remains pretty basic, it will at least deliver smartphone notifications to your wrist. Plus, the lowkey software translates to 10-day battery life, even in that small, lightweight frame. If the person you’re shopping for prefers to leave their phone at home when they go on a run, the Inspire 3 lacks the onboard GPS necessary to route their journey, so you’ll need to look for something else. But for almost everyone else, the Inspire 3 is a great, low-profile way to keep track of your activity. — C.L.

Buy Inspire 3 at Amazon - $100

Samsung Galaxy Watch 5

Samsung Galaxy Watch 5
Samsung

Samsung’s line of smartwatches remains the best on the market for Android users. Though the Galaxy Watch 5 runs the relatively basic Wear OS, the company has managed to bake in its capable health and fitness-tracking system to help the user stay active. Its auto-detection is among the most accurate in the industry, and it tracks an impressively long list of workouts, including swims. And if your loved one already uses Samsung phones and appliances, they’ll find some useful integrations like smart home controls from their wrist.

The Watch 5 is also a capable sleep tracker, and though it doesn’t offer as many mindfulness-related features as Apple and Fitbit, Samsung does have some meditation guides in its Health app. It’s also the only smartwatch on this list with a round face, which fans of traditional watches may prefer. — C.L.

Buy Galaxy Watch 5 at Amazon - $280

Apple Fitness+

Apple Fitness+
Apple

If you’re shopping for someone that wants to get more active but is intimidated by gyms, a Fitness+ subscription is a great way to help them get started. Apple’s library of video workouts caters to all levels, but it’s especially friendly to beginners. Fitness+ contains comprehensive guides, as well as collections designed for pregnant people or new parents, giving plenty of options for those who may find themselves in different life situations.

Starting in October, Apple opened up Fitness+ so you no longer have to own an Apple Watch. Now, your giftee just needs to have an iPhone, and they can follow along the routines through their TVs, iPads or, yes, iPhones. If they also own an Apple Watch, they can pause and resume the classes from their wrist, as well as see their heart rate and Move ring progress on the screen.

Since the videos can be viewed on iPads, Fitness+ is suitable for people who travel a lot. They can take the classes in hotel rooms, RVs, cruises and more. It’s also a great last-minute gift. Just know that for anyone that has a specific favorite sport and doesn’t want to explore new types of activity, Fitness+ might feel too easy. — C.L.

Subscribe to Apple Fitness+

Withings Body+ smart scale

Withings Body+ smart scale
Engadget

The right weighing scale can deliver more readings than just weight alone. Case in point: Withings’ Body+ smart scale. It’ll tell you how heavy you are, sure, but it also uses multi-frequency bio-electrical impedance analysis (BIA) to get your muscle mass, fat mass, bone mass, water percentage and visceral fat level. And like all good connected scales, it’ll send all that information to an app on your phone so you can track your progress over time.

The Body+ scale also offers Pulse Wave Velocity (PWV) tracking, which measures the speed at which your blood travels to see your vascular and nerve health. At $100, it’s not the cheapest, but it does produce a wide range of data that regular weighing scales don’t. You can also consider less premium devices from Withings that also offer body composition measurements, like the Body Scan or Body+, which will serve your friend perfectly well. — C.L.

Buy Withings Body+ scale at Amazon - $100

Theragun Mini

Theragun Mini
Therabody

It’s important to take care of your body even after you’ve completed a tough workout. The Theragun Mini can take your recovery routine to the next level by helping you massage out tension points in your muscles with more force than you could even provide on your own. It has three different speeds, all of which work better on different muscle groups, and its ergonomic design makes it pretty easy and comfortable to hold while using it. Sure, you can get more speed options, smartphone connectivity and more with the high-end models, but the Mini is great not only for its relatively affordable price, but for its compact design as well. Weighing only three pounds, it could easily live in your gym bag for daily muscle maintenance but you could also throw it on your carry-on before a trip so you can work out those cramps and knots you’ll inevitably get after sitting in an airplane seat for a few hours. — Valentina Palladino, Senior Commerce Editor

Buy Theragun Mini at Amazon - $199

Shokz OpenRun Pro

Shokz OpenRun Pro
Shokz

The Shokz OpenRun Pro Bluetooth headphones provide a unique way of blending music with an active lifestyle that’s ideal for runners, cyclists and more. They use bone conduction to deliver sound to your inner ear through your cheekbones, leaving your ears open so you can remain aware of your surroundings.

The OpenRun Pro model is the company’s premium offering and provides one of the richest bass experiences available for this style of headphones. They’re IP55 water-resistant, offer a useful 5-minute quick charge for 1.5 hours of listening and last up to 10 hours on a full charge. You should keep in mind that the open-ear design is a tradeoff, since they’re not great for noisy environments.

This is an interesting gift for fitness enthusiasts because they’re probably not the first style of headphones that they’d consider. But once they’ve taken them for a run or a bike ride, the benefits of having music while also keeping track of nearby traffic or pedestrians is game changing. — Jon Turi, Homepage Editor

Buy OpenRun Pro at Amazon - $180

Withings ScanWatch Horizon

Withings ScanWatch Horizon
Will Lipman Photography for Engadget

There are smartwatches, there are fitness watches, and then there is Withings’ ScanWatch Horizon. It’s the French company’s gussied-up version of its class-leading hybrid that remains my only pick for people who want something smart, but classy, on their wrist. Horizon comes with activity, fitness, sleep and heart-rate tracking as well as a built-in ECG to monitor your heart health. But it’s been styled like a diver’s watch, with the OLED subdial the only clue that it’s a lot smarter than it looks at first glance.

Maybe it’s the fact that what makes Horizon so good is how well-hidden its smarts really are, and how good it looks on your wrist. And that’s before you get to the practical stuff – it’s $500, so it’s cheaper than a Submariner and does plenty more. The battery will last for a month at a time, reducing the need for you to keep your charger close by at all times. And Withings’ Health Mate app remains one of the best on the market for giving you insights about your body you might not have noticed yourself. — Daniel Cooper, Senior Reporter

Buy ScanWatch Horizon at Amazon - $500

Amazon Clinic is a virtual healthcare service over text chat

Amazon has launched a new virtual health service that gives you a way to consult healthcare professionals for common conditions and get prescriptions for them without heaving to make a video call. This new product is called Amazon Clinic, and it offers a text-based solution that connects you with third-party virtual care options. You can choose among Amazon's partner telehealth providers, but the purpose of your consultation has to be in the service's list of accepted conditions, which include acne, hair loss, acid reflux, pink eye, sinusitis and UTI. You can also use the service to get prescription renewals for conditions like asthma, high blood pressure and migraine. 

This is but the latest product Amazon has introduced in its bid to delve deeper into the healthcare sector. The e-commerce giant launched Amazon Pharmacy to deliver discounted prescription medicine to Prime members in 2020, and it entered a deal to purchase primary healthcare company One Medical for $3.9 billion in July. Amazon offers an app-based telehealth service called Amazon Care to its employees and other companies across the US, but it will end all operations after December 31st. According to a previous Washington Post report, Amazon Health Services SVP Neil Lindsay told employees that while "enrolled members have loved many aspects of Amazon Care, it is not a complete enough offering for the large enterprise customers [the company has] been targeting, and wasn’t going to work long-term."

Unlike Care, Clinic wasn't designed to be an enterprise offering. At the beginning of your consultation on the service, you'll have to select your condition and choose your preferred provider from the list of partners before answering a short questionnaire. You'll then be connected to a secure messaging portal where you can chat with a healthcare professional, who'll send you a personalized treatment plan. They can also send your preferred pharmacy — one of the options, of course, is Amazon Pharmacy — any necessary prescriptions. You'll remain connected to your healthcare professional for up to two weeks after your initial chat, and you can send them follow-up messages within that time. 

While the service doesn't accept insurance right now, you can pay with an FSA or HSA debit card or get your receipt reimbursed when possible. You do have to pay a flat fee upfront, which is dependent upon your condition. Amazon says that the cost of care is equivalent or less than the average copay in many cases. As for medication, coverage varies, but you can use insurance to pay for it. Amazon Clinic is only available in 32 states at the moment, though the company is hoping to expand its reach to additional states over the coming months. 

Update 11/15/22 10AM ET: Clarified that Amazon Care is still around, but that it will end all operations after December 31st this year. 

Soft robotic device stimulates muscles, sparks hope for ALS and MS patients

Today, muscle atrophy is often unavoidable when you can't move due to severe injury, old age or diseases like amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS). However, Harvard researchers see hope in soft robotics that could someday stretch and contract the muscles of patients unable to do so themselves.

The Harvard engineers tested a new mechanostimulation system on mice, successfully preventing or assisting in their recovery from muscle atrophy. The team implanted the "soft robotic device" on a mouse's hind limb, which they immobilized in a cast-like enclosure for around two weeks. While the control group's untreated muscles wasted away as expected, the actively stimulated muscles showed reduced degradation. The researchers believe their system can eventually lead to implants helping humans with atrophy.

Its promise stems from its ability to induce a small mechanical muscle strain that mirrors natural stimulation during exercise. Moreover, while keeping atrophy at bay, the device didn't lead to any severe tissue inflammation or damage.

"There is a good chance that distinct soft robotic approaches with their unique effects on muscle tissue could open up disease or injury-specific mechano-therapeutic avenues," said David Mooney, Ph.D., the paper's senior author and Harvard's Wyss Institute engineering faculty member.

Illustration that zooms in from the patient's body (far left) to the material's composition and interactions with muscle tissue (lower right)
Wyss Institute

Dubbed MAGENTA (short for "mechanically active gel-elastomer-nitinol tissue adhesive"), the anti-atrophy system includes an engineered spring made from nitinol, a shape memory alloy (SMA) that can rapidly actuate when heated. Researchers control the spring with a wired microprocessor unit that determines the frequency and duration of muscle contractions and stretches.

The system also includes an elastomer matrix forming the device's body and providing insulation for the heated SMA. In addition, a layer of "tough adhesive" keeps MAGENTA aligned with the muscles' natural movement axis while transmitting stimulation deep into muscle tissue.

"While untreated muscles and muscles treated with the device but not stimulated significantly wasted away during this period, the actively stimulated muscles showed reduced muscle wasting," said first-author and Wyss Technology Development Fellow Sungmin Nam, Ph.D. "Our approach could also promote the recovery of muscle mass that already had been lost over a three-week period of immobilization, and induce the activation of the major biochemical mechanotransduction pathways known to elicit protein synthesis and muscle growth."

The team also experimented with a wireless version, using laser light rather than electrical wiring to actuate the SMA spring. Although this approach showed reduced effectiveness due to fat tissue absorbing some of the laser light, the researchers believe this approach still holds potential and warrants further research.

Soft robotic device stimulates muscles, sparks hope for ALS and MS patients

Today, muscle atrophy is often unavoidable when you can't move due to severe injury, old age or diseases like amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS). However, Harvard researchers see hope in soft robotics that could someday stretch and contract the muscles of patients unable to do so themselves.

The Harvard engineers tested a new mechanostimulation system on mice, successfully preventing or assisting in their recovery from muscle atrophy. The team implanted the "soft robotic device" on a mouse's hind limb, which they immobilized in a cast-like enclosure for around two weeks. While the control group's untreated muscles wasted away as expected, the actively stimulated muscles showed reduced degradation. The researchers believe their system can eventually lead to implants helping humans with atrophy.

Its promise stems from its ability to induce a small mechanical muscle strain that mirrors natural stimulation during exercise. Moreover, while keeping atrophy at bay, the device didn't lead to any severe tissue inflammation or damage.

"There is a good chance that distinct soft robotic approaches with their unique effects on muscle tissue could open up disease or injury-specific mechano-therapeutic avenues," said David Mooney, Ph.D., the paper's senior author and Harvard's Wyss Institute engineering faculty member.

Illustration that zooms in from the patient's body (far left) to the material's composition and interactions with muscle tissue (lower right)
Wyss Institute

Dubbed MAGENTA (short for "mechanically active gel-elastomer-nitinol tissue adhesive"), the anti-atrophy system includes an engineered spring made from nitinol, a shape memory alloy (SMA) that can rapidly actuate when heated. Researchers control the spring with a wired microprocessor unit that determines the frequency and duration of muscle contractions and stretches.

The system also includes an elastomer matrix forming the device's body and providing insulation for the heated SMA. In addition, a layer of "tough adhesive" keeps MAGENTA aligned with the muscles' natural movement axis while transmitting stimulation deep into muscle tissue.

"While untreated muscles and muscles treated with the device but not stimulated significantly wasted away during this period, the actively stimulated muscles showed reduced muscle wasting," said first-author and Wyss Technology Development Fellow Sungmin Nam, Ph.D. "Our approach could also promote the recovery of muscle mass that already had been lost over a three-week period of immobilization, and induce the activation of the major biochemical mechanotransduction pathways known to elicit protein synthesis and muscle growth."

The team also experimented with a wireless version, using laser light rather than electrical wiring to actuate the SMA spring. Although this approach showed reduced effectiveness due to fat tissue absorbing some of the laser light, the researchers believe this approach still holds potential and warrants further research.

VR-controlled robots are being designed to treat injured soldiers

If you think of robots in the military, your mind may conjure dystopian images of science-fiction battlefields with AI-powered machines trading laser fire. But in a much more humane application, UK researchers are developing a potentially lifesaving medical system equivalent to a VR triage video call.

University of Sheffield researchers are working on a telepresence system to treat military personnel during combat. The plan is for offsite medics to don virtual reality headsets and control a battlefield robot. The machine can take the patient's vitals with the same technology used in robotic surgery.

Currently, injured combatants often have to see medical technicians with limited on-hand resources. These paramedics often do their jobs at significant personal risk (and, if contagious diseases and contamination are factors, a risk to others as well). If the patient needs further care, moving them to a safe location with proper resources could take hours or days.

The planned telepresence system would allow medical technicians to work offsite, using the robot to gather data like the patient's temperature or blood pressure. For example, the machines could take mouth swabs and draw blood samples from the patient's arm. In addition, it could send photos and videos of injuries to the offsite medical workers, allowing them to assess and perhaps even treat the patient remotely.

Project co-lead Sanja Dogramadzi, a professor at the University of Sheffield's Department of Automatic Control and Systems Engineering, sees the initiative as a lifesaving measure. "Developing a remotely-operated robotic system would significantly improve safety by reducing the amount of danger military personnel are exposed to on the frontline. Our platform uses the latest technology and would integrate it in a way that hasn't been done before."

VR-controlled robots are being designed to treat injured soldiers

If you think of robots in the military, your mind may conjure dystopian images of science-fiction battlefields with AI-powered machines trading laser fire. But in a much more humane application, UK researchers are developing a potentially lifesaving medical system equivalent to a VR triage video call.

University of Sheffield researchers are working on a telepresence system to treat military personnel during combat. The plan is for offsite medics to don virtual reality headsets and control a battlefield robot. The machine can take the patient's vitals with the same technology used in robotic surgery.

Currently, injured combatants often have to see medical technicians with limited on-hand resources. These paramedics often do their jobs at significant personal risk (and, if contagious diseases and contamination are factors, a risk to others as well). If the patient needs further care, moving them to a safe location with proper resources could take hours or days.

The planned telepresence system would allow medical technicians to work offsite, using the robot to gather data like the patient's temperature or blood pressure. For example, the machines could take mouth swabs and draw blood samples from the patient's arm. In addition, it could send photos and videos of injuries to the offsite medical workers, allowing them to assess and perhaps even treat the patient remotely.

Project co-lead Sanja Dogramadzi, a professor at the University of Sheffield's Department of Automatic Control and Systems Engineering, sees the initiative as a lifesaving measure. "Developing a remotely-operated robotic system would significantly improve safety by reducing the amount of danger military personnel are exposed to on the frontline. Our platform uses the latest technology and would integrate it in a way that hasn't been done before."

YouTube opens up a verification program for healthcare professionals

YouTube is attempting to make it easier for folks to find reliable and high-quality health information on the platform. It's opening up its health product features to certain healthcare professionals and information providers in the US. It started offering those features last year to educational institutions, public health departments, hospitals and government bodies. "This new step will allow us to expand to include high quality information from a wider group of healthcare channels," Dr. Garth Graham, the global head of YouTube Health, wrote in a blog post.

The features include labels under videos that clearly state the information is coming from a healthcare professional or accredited organization. When a user searches for a term such as "bipolar" or "breast cancer," they may see a carousel of videos under the label “From health sources” near the top of the search results.

YouTube says healthcare professionals can apply for the program starting today. They'll need to submit proof of their medical license and for their YouTube account to be in good standing. They'll also need to follow the Council of Medical Specialty Societies, the National Academy of Medicine and the World Health Organization best practices for sharing health information. YouTube plans to expand the program to more markets and other types of medical specialties.

Helping people obtain credible health information from a verified professional is inherently a positive move. YouTube will still have to tread carefully with this program, given the COVID-19 and vaccine misinformation that has been rife on the platform over the last few years. Meanwhile, YouTube points out that people shouldn't consider health-related information they learn from verified professionals as medical advice (and nor will the videos apply to everyone). You'd still be best served to get in touch with a healthcare provider if you have a medical concern and to contact emergency services if the need arises.

The cutting-edge cellular therapies aiming to ease America’s organ shortage

Despite being the wealthiest nation on the face of the planet, the United States chronically runs short of transplantable organs. Kidneys are far and away the most sought-after organ for transplantation, followed by livers. While the liver is the only human organ known capable of regenerating itself, if you damage yours badly enough for long enough — as some 30 million Americans have — then the only treatment is a transplant. Assuming you can even acquire one for doctors to stick in you. Every year demand for replacement livers outstrips supply by a scope of tens of thousands.

“Only one-third of those on the liver transplant waiting list will be transplanted, and the demand for livers is projected to increase 23 percent in the next 20 years,” a multidisciplinary team of researchers observed in 2016’s Liver-Regenerative Transplantation: Regrow and Reset. “Exacerbating the organ shortage problem, the donor pool is expected to shrink further because of the obesity epidemic. Liver steatosis [aka fatty liver disease] is increasingly common in donors and is a significant risk factor in liver transplantation.”

To address this critical shortage, the study authors note that doctors have explored a variety of cutting-edge regimens, from cell repopulation and tissue engineering, nanoparticles to genomics, mechanical aids to porcine-derived xenotransplantation, all with varying degrees of success. Cellular repopulation has been used for years, a process that injects healthy liver cells into the patient’s damaged organ through a portal vein where they adhere themselves to the existing cellular scaffolding and grow into new, functional liver tissue.

Professor Karl Oldhafer, chief physician of general and visceral surgery at the Asklepios Hospital Hamburg-Barmbek, shows a tumor inside a piece of a liver which was removed during surgery, one of the first surgeries of its kind in Germany with the support of a tablet computer to access and visualize planning data, in Hamburg August 15, 2013. The tablet computer uses augmented reality, which allows the liver to be filmed with an iPad and overlaid during an operation with virtual 3D models reconstructed from the real organ. Developed by Fraunhofer MEVIS in Bremen, this procedure helps locate critical structures such as tumors and vessels and is expected to improve the quality of transferring pre-operational resection plans into actual surgery.     REUTERS/Fabian Bimmer (GERMANY - Tags: HEALTH)
Fabian Bimmer / reuters

“Creating an immediately available and inexhaustible supply of functioning liver cells from autologous tissue would allow early intervention in patients with hepatic failure and would allow liver cells to be infused over a longer period of time,” the 2016 study’s authors note. “Combined with recent advances in genome-editing technology, such liver cells could be used widely to treat devastating liver-based inborn errors of metabolism and to eliminate the need for a life-long regimen of immunosuppressive drugs and their complications.” The downside to this technique is the pace at which the donor cells proliferate, making it a poor tool against acute liver failure.

Extracellular Vesicle-based therapies, on the other hand, leverage the body’s intracellular communications pathways to deliver drugs with, “high bioavailability, exceptional biocompatibility, and low immunogenicity,” according to 2020’s Extracellular Vesicle-Based Therapeutics: Preclinical and Clinical Investigations. “They provide a means for intercellular communication and the transmission of bioactive compounds to targeted tissues, cells, and organs” including “fibroblasts, neuronal cells, macrophages, and even cancer cells.”

EVs are the postal letters that cells send one another. They come in a variety of sizes from 30 to 1000 nm and have exterior membranes studded with multiple adhesive proteins that grant them entry into any number of different types of cells. Exploiting the biological equivalent to a janitor’s key ring, researchers have begun tucking therapeutic nanoparticles into EVs and using them to discreetly inject treatments into the targeted cells. However, these treatments are still in the experimental stages and are most effective against acute liver failure and inborn metabolic diseases rather than end-stage liver failure.

SRBAL
Mayo Clinic

Mechanical aids, the hepatocytic equivalent to a dialysis machine, like the Mayo Spheroid Reservoir Bioartificial Liver (SRBAL, above) are ideal for treating cases of acute liver failure, able to take over the entirety of the patient’s liver function externally and immediately. However, such procedures are both expensive and temporary. The SRBAL can only support a patient for up to two weeks, making it more suitable for keeping someone alive until a donor can be located rather than as a permanent, pacemaker-like solution.

The bioprinting and implantation of replacement livers has also shown promise, though they too are still in early development and largely not near ready for widespread adoption. Interspecies transplantation using genetically-engineered pig organs are a bit closer to clinical use, with surgeons successfully transplanting a porcine heart into a human patient for the first time this past January (though he died of complications two months later). Pig kidneys and livers have similarly been transplanted into human recipients, often with less drastic side effects than death.

No matter where the transplanted organ comes from, getting it into the patient is invariably going to involve a significant surgical procedure. However, the Lygenesis company recently unveiled its non-invasive solution: tricking the patient’s body into growing a series of miniature, ectopic liver “organoids” in its own lymphatic system like a crop of blood-scrubbing potatoes.

For those of you who dozed through high school bio, a quick recap of terms. The lymphatic system is a part of the immune system that serves to circulate some 20 liters of lymph throughout your body, absorb excess interstitial fluids back into the bloodstream, and incubate critical lymphocytes like T-cells. Organoids, on the other hand, are biological masses artificially grown from stem cells that perform the same functions as natural organs, but do so ectopically, in that they function in a different part of the body as a regular liver. Blood-scrubbing potatoes are self-explanatory.

“Fundamentally, Lygenesis uses the lymph node, your body's natural bio reactors typically used for T-cells,” company CEO and co-founder Michael Hufford, told Engadget. “We hijacked that same biology, we engraft our therapies into the lymph nodes to grow functioning ectopic organs.”

“We use an outpatient endoscopic ultrasound procedure where we're going down through the mouth of the patient using standard endoscopic equipment,” Hufford continued. “We engraft ourselves there in minutes under light sedation, so it's very low medical risk and also is really quite inexpensive.” He notes that the average cost for a proper, in-hospital liver transplant will set you back around a million dollars. Lygenesis’ outpatient procedure “is billed at a couple of thousand or so,” he said.

More importantly, the Lygenesis technique doesn’t require a full donated liver, or even a large fraction of one. In fact, each donated organ can be split among several dozen recipients. “Using our technology a single donated liver can reach 75 or more patients,” Hofford said. The process of converting a single donated liver into all those engraftable samples takes a team of three technicians more than six hours and 70 steps to complete. The process does not involve any gene manipulation, such as CRISPR editing.

This process is quite necessary as patients cannot donate culturable liver cells to themselves. “Once you have end-stage liver disease, you typically have a very fibrotic liver,” Hofford noted. “It will bleed at the slightest sort of intervention.” Even the simple act of collecting cellular samples can quickly turn deadly if the wrong bit of organ is bisected.

And it’s not only the transplant recipients themselves who are unable to donate. Hofford estimates between 30 and 40 percent of donated livers are too worn to be successfully transplanted. “One of the benefits of our technology is we're using organs that have been donated but will otherwise be discarded,” he said.

Once engrafted into a lymph node, the liver organoid will grow and vascularize over the course of two to three months, until it is large enough to begin supporting the existing liver. Hufford points out that even with end-stage disease, a liver can retain up to 30 percent of its original functionality, so these organoids are designed to augment and support the existing organ rather than replace it outright.

Lygenesis is currently in Phase 2A of the FDA approval process, meaning that a small group of four patients have each received a single engraftment in a lymph node located in their central body cavity near the liver itself (the body has more than 500 lymph nodes and apparently this treatment can technically target any of them). Should this initial test prove successful subsequent study groups will receive increasing numbers of engraftment, up to a half dozen, to help the company and federal regulators figure out the optimal number of organoids to treat the disease.

While the liver’s inherent regenerative capabilities make it an ideal candidate for this procedure, the company is also developing similar treatments for the kidneys, pancreas and thymus gland as well as inborn metabolic liver ailments like maple syrup urine disease. These efforts are all at much earlier points in development than the company’s end stage liver work. “Within the next five years, we would love to see our liver program submitted to the FDA as a new biologic therapy and be commercially available,” Hufford said. “I think that'd be a realistic timeframe.”

The cutting-edge cellular therapies aiming to ease America’s organ shortage

Despite being the wealthiest nation on the face of the planet, the United States chronically runs short of transplantable organs. Kidneys are far and away the most sought-after organ for transplantation, followed by livers. While the liver is the only human organ known capable of regenerating itself, if you damage yours badly enough for long enough — as some 30 million Americans have — then the only treatment is a transplant. Assuming you can even acquire one for doctors to stick in you. Every year demand for replacement livers outstrips supply by a scope of tens of thousands.

“Only one-third of those on the liver transplant waiting list will be transplanted, and the demand for livers is projected to increase 23 percent in the next 20 years,” a multidisciplinary team of researchers observed in 2016’s Liver-Regenerative Transplantation: Regrow and Reset. “Exacerbating the organ shortage problem, the donor pool is expected to shrink further because of the obesity epidemic. Liver steatosis [aka fatty liver disease] is increasingly common in donors and is a significant risk factor in liver transplantation.”

To address this critical shortage, the study authors note that doctors have explored a variety of cutting-edge regimens, from cell repopulation and tissue engineering, nanoparticles to genomics, mechanical aids to porcine-derived xenotransplantation, all with varying degrees of success. Cellular repopulation has been used for years, a process that injects healthy liver cells into the patient’s damaged organ through a portal vein where they adhere themselves to the existing cellular scaffolding and grow into new, functional liver tissue.

Professor Karl Oldhafer, chief physician of general and visceral surgery at the Asklepios Hospital Hamburg-Barmbek, shows a tumor inside a piece of a liver which was removed during surgery, one of the first surgeries of its kind in Germany with the support of a tablet computer to access and visualize planning data, in Hamburg August 15, 2013. The tablet computer uses augmented reality, which allows the liver to be filmed with an iPad and overlaid during an operation with virtual 3D models reconstructed from the real organ. Developed by Fraunhofer MEVIS in Bremen, this procedure helps locate critical structures such as tumors and vessels and is expected to improve the quality of transferring pre-operational resection plans into actual surgery.     REUTERS/Fabian Bimmer (GERMANY - Tags: HEALTH)
Fabian Bimmer / reuters

“Creating an immediately available and inexhaustible supply of functioning liver cells from autologous tissue would allow early intervention in patients with hepatic failure and would allow liver cells to be infused over a longer period of time,” the 2016 study’s authors note. “Combined with recent advances in genome-editing technology, such liver cells could be used widely to treat devastating liver-based inborn errors of metabolism and to eliminate the need for a life-long regimen of immunosuppressive drugs and their complications.” The downside to this technique is the pace at which the donor cells proliferate, making it a poor tool against acute liver failure.

Extracellular Vesicle-based therapies, on the other hand, leverage the body’s intracellular communications pathways to deliver drugs with, “high bioavailability, exceptional biocompatibility, and low immunogenicity,” according to 2020’s Extracellular Vesicle-Based Therapeutics: Preclinical and Clinical Investigations. “They provide a means for intercellular communication and the transmission of bioactive compounds to targeted tissues, cells, and organs” including “fibroblasts, neuronal cells, macrophages, and even cancer cells.”

EVs are the postal letters that cells send one another. They come in a variety of sizes from 30 to 1000 nm and have exterior membranes studded with multiple adhesive proteins that grant them entry into any number of different types of cells. Exploiting the biological equivalent to a janitor’s key ring, researchers have begun tucking therapeutic nanoparticles into EVs and using them to discreetly inject treatments into the targeted cells. However, these treatments are still in the experimental stages and are most effective against acute liver failure and inborn metabolic diseases rather than end-stage liver failure.

SRBAL
Mayo Clinic

Mechanical aids, the hepatocytic equivalent to a dialysis machine, like the Mayo Spheroid Reservoir Bioartificial Liver (SRBAL, above) are ideal for treating cases of acute liver failure, able to take over the entirety of the patient’s liver function externally and immediately. However, such procedures are both expensive and temporary. The SRBAL can only support a patient for up to two weeks, making it more suitable for keeping someone alive until a donor can be located rather than as a permanent, pacemaker-like solution.

The bioprinting and implantation of replacement livers has also shown promise, though they too are still in early development and largely not near ready for widespread adoption. Interspecies transplantation using genetically-engineered pig organs are a bit closer to clinical use, with surgeons successfully transplanting a porcine heart into a human patient for the first time this past January (though he died of complications two months later). Pig kidneys and livers have similarly been transplanted into human recipients, often with less drastic side effects than death.

No matter where the transplanted organ comes from, getting it into the patient is invariably going to involve a significant surgical procedure. However, the Lygenesis company recently unveiled its non-invasive solution: tricking the patient’s body into growing a series of miniature, ectopic liver “organoids” in its own lymphatic system like a crop of blood-scrubbing potatoes.

For those of you who dozed through high school bio, a quick recap of terms. The lymphatic system is a part of the immune system that serves to circulate some 20 liters of lymph throughout your body, absorb excess interstitial fluids back into the bloodstream, and incubate critical lymphocytes like T-cells. Organoids, on the other hand, are biological masses artificially grown from stem cells that perform the same functions as natural organs, but do so ectopically, in that they function in a different part of the body as a regular liver. Blood-scrubbing potatoes are self-explanatory.

“Fundamentally, Lygenesis uses the lymph node, your body's natural bio reactors typically used for T-cells,” company CEO and co-founder Michael Hufford, told Engadget. “We hijacked that same biology, we engraft our therapies into the lymph nodes to grow functioning ectopic organs.”

“We use an outpatient endoscopic ultrasound procedure where we're going down through the mouth of the patient using standard endoscopic equipment,” Hufford continued. “We engraft ourselves there in minutes under light sedation, so it's very low medical risk and also is really quite inexpensive.” He notes that the average cost for a proper, in-hospital liver transplant will set you back around a million dollars. Lygenesis’ outpatient procedure “is billed at a couple of thousand or so,” he said.

More importantly, the Lygenesis technique doesn’t require a full donated liver, or even a large fraction of one. In fact, each donated organ can be split among several dozen recipients. “Using our technology a single donated liver can reach 75 or more patients,” Hofford said. The process of converting a single donated liver into all those engraftable samples takes a team of three technicians more than six hours and 70 steps to complete. The process does not involve any gene manipulation, such as CRISPR editing.

This process is quite necessary as patients cannot donate culturable liver cells to themselves. “Once you have end-stage liver disease, you typically have a very fibrotic liver,” Hofford noted. “It will bleed at the slightest sort of intervention.” Even the simple act of collecting cellular samples can quickly turn deadly if the wrong bit of organ is bisected.

And it’s not only the transplant recipients themselves who are unable to donate. Hofford estimates between 30 and 40 percent of donated livers are too worn to be successfully transplanted. “One of the benefits of our technology is we're using organs that have been donated but will otherwise be discarded,” he said.

Once engrafted into a lymph node, the liver organoid will grow and vascularize over the course of two to three months, until it is large enough to begin supporting the existing liver. Hufford points out that even with end-stage disease, a liver can retain up to 30 percent of its original functionality, so these organoids are designed to augment and support the existing organ rather than replace it outright.

Lygenesis is currently in Phase 2A of the FDA approval process, meaning that a small group of four patients have each received a single engraftment in a lymph node located in their central body cavity near the liver itself (the body has more than 500 lymph nodes and apparently this treatment can technically target any of them). Should this initial test prove successful subsequent study groups will receive increasing numbers of engraftment, up to a half dozen, to help the company and federal regulators figure out the optimal number of organoids to treat the disease.

While the liver’s inherent regenerative capabilities make it an ideal candidate for this procedure, the company is also developing similar treatments for the kidneys, pancreas and thymus gland as well as inborn metabolic liver ailments like maple syrup urine disease. These efforts are all at much earlier points in development than the company’s end stage liver work. “Within the next five years, we would love to see our liver program submitted to the FDA as a new biologic therapy and be commercially available,” Hufford said. “I think that'd be a realistic timeframe.”