1
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Vincent DE, Moazami N, D’Alessandro D, Fraser JF, Heinsar S, Roche ET, Ayers BC, Singh M, Langer N, Deshpande SR, Jaquiss R, Fukamachi K, Rabi SA, Osho A, Kuroda T, Karimov JH, Miyamoto T, Sethu P, Giridharan GA, Kvernebo K, Copland J. Pulsatile ECMO: The Future of Mechanical Circulatory Support for Severe Cardiogenic Shock. JACC Basic Transl Sci 2024; 9:456-458. [PMID: 38680959 PMCID: PMC11055198 DOI: 10.1016/j.jacbts.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
| | | | | | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Ellen T. Roche
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Brian C. Ayers
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Manisha Singh
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Nina Langer
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Monash University, Melbourne, Victoria, Australia
| | | | - R.D.B. Jaquiss
- Children’s Medical Centers/UT Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Asishana Osho
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Taiyo Kuroda
- Cleveland Clinic, Learner Research Institute, Cleveland, Ohio, USA
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2
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Park C, Singh M, Saeed MY, Nguyen CT, Roche ET. Biorobotic hybrid heart as a benchtop cardiac mitral valve simulator. Device 2024; 2:100217. [PMID: 38312504 PMCID: PMC10836162 DOI: 10.1016/j.device.2023.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
In this work, we developed a high-fidelity beating heart simulator that provides accurate mitral valve pathophysiology. The benchtop platform is based on a biorobotic hybrid heart that combines preserved intracardiac tissue with soft robotic cardiac muscle providing dynamic left ventricular motion and precise anatomical features designed for testing intracardiac devices, particularly for mitral valve repair. The heart model is integrated into a mock circulatory loop, and the active myocardium drives fluid circulation producing physiological hemodynamics without an external pulsatile pump. Using biomimetic soft robotic technology, the heart can replicate both ventricular and septal wall motion, as well as intraventricular pressure-volume relationships. This enables the system to recreate the natural motion and function of the mitral valve, which allows us to demonstrate various surgical and interventional techniques. The biorobotic cardiovascular simulator allows for real-time hemodynamic data collection, direct visualization of the intracardiac procedure, and compatibility with clinical imaging modalities.
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Affiliation(s)
- Clara Park
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
| | - Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
| | - Mossab Y. Saeed
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA 02115
| | - Christopher T. Nguyen
- Cardiovascular Research Center, Massachusetts General Hospital; Charlestown, MA, USA 02114
- Cardiovascular Innovation Research Center, Heart Vascular Thoracic Institute, Cleveland Clinic; Cleveland, OH, USA 44195
- Imaging Sciences, Imaging Institute, Cleveland Clinic; Cleveland, OH, USA 44195
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic; Cleveland, OH, USA 44196
| | - Ellen T. Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
- Department of Mechanical Engineering, Massachusetts Institute of Technology; Cambridge, MA, USA 02139
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3
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Ward NA, Hanley S, Tarpey R, Schreiber LHJ, O'Dwyer J, Roche ET, Duffy GP, Dolan EB. Intermittent actuation attenuates fibrotic behaviour of myofibroblasts. Acta Biomater 2024; 173:80-92. [PMID: 37967693 DOI: 10.1016/j.actbio.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/31/2023] [Accepted: 11/09/2023] [Indexed: 11/17/2023]
Abstract
The foreign body response (FBR) to implanted materials culminates in the deposition of a hypo-permeable, collagen rich fibrotic capsule by myofibroblast cells at the implant site. The fibrotic capsule can be deleterious to the function of some medical implants as it can isolate the implant from the host environment. Modulation of fibrotic capsule formation has been achieved using intermittent actuation of drug delivery implants, however the mechanisms underlying this response are not well understood. Here, we use analytical, computational, and in vitro models to understand the response of human myofibroblasts (WPMY-1 stromal cell line) to intermittent actuation using soft robotics and investigate how actuation can alter the secretion of collagen and pro/anti-inflammatory cytokines by these cells. Our findings suggest that there is a mechanical loading threshold that can modulate the fibrotic behaviour of myofibroblasts, by reducing the secretion of soluble collagen, transforming growth factor beta-1 and interleukin 1-beta, and upregulating the anti-inflammatory interleukin-10. By improving our understanding of how cells involved in the FBR respond to mechanical actuation, we can harness this technology to improve functional outcomes for a wide range of implanted medical device applications including drug delivery and cell encapsulation platforms. STATEMENT OF SIGNIFICANCE: A major barrier to the successful clinical translation of many implantable medical devices is the foreign body response (FBR) and resultant deposition of a hypo-permeable fibrotic capsule (FC) around the implant. Perturbation of the implant site using intermittent actuation (IA) of soft-robotic implants has previously been shown to modulate the FBR and reduce FC thickness. However, the mechanisms of action underlying this response were largely unknown. Here, we investigate how IA can alter the activity of myofibroblast cells, and ultimately suggest that there is a mechanical loading threshold within which their fibrotic behaviour can be modulated. These findings can be harnessed to improve functional outcomes for a wide range of medical implants, particularly drug delivery and cell encapsulation devices.
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Affiliation(s)
- Niamh A Ward
- Biomedical Engineering, School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Shirley Hanley
- Flow Cytometry Core Facility, University of Galway, Galway, Ireland
| | - Ruth Tarpey
- Biomedical Engineering, School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland; Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Lucien H J Schreiber
- Biomedical Engineering, School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland; Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Joanne O'Dwyer
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA; Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Garry P Duffy
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland; Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland; CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland
| | - Eimear B Dolan
- Biomedical Engineering, School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland; CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland.
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4
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Singh M, Teodorescu DL, Rowlett M, Wang SX, Balcells M, Park C, Bernardo B, McGarel S, Reeves C, Mehra MR, Zhao X, Yuk H, Roche ET. A Tunable Soft Silicone Bioadhesive for Secure Anchoring of Diverse Medical Devices to Wet Biological Tissue. Adv Mater 2024; 36:e2307288. [PMID: 37865838 DOI: 10.1002/adma.202307288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/21/2023] [Indexed: 10/23/2023]
Abstract
Silicone is utilized widely in medical devices for its compatibility with tissues and bodily fluids, making it a versatile material for implants and wearables. To effectively bond silicone devices to biological tissues, a reliable adhesive is required to create a long-lasting interface. BioAdheSil, a silicone-based bioadhesive designed to provide robust adhesion on both sides of the interface is introduced here, facilitating bonding between dissimilar substrates, namely silicone devices and tissues. The adhesive's design focuses on two key aspects: wet tissue adhesion capability and tissue-infiltration-based long-term integration. BioAdheSil is formulated by mixing soft silicone oligomers with siloxane coupling agents and absorbents for bonding the hydrophobic silicone device to hydrophilic tissues. Incorporation of biodegradable absorbents eliminates surface water and controls porosity, while silane crosslinkers provide interfacial strength. Over time, BioAdheSil transitions from nonpermeable to permeable through enzyme degradation, creating a porous structure that facilitates cell migration and tissue integration, potentially enabling long-lasting adhesion. Experimental results demonstrate that BioAdheSil outperforms commercial adhesives and elicits no adverse response in rats. BioAdheSil offers practical utility for adhering silicone devices to wet tissues, including long-term implants and transcutaneous devices. Here, its functionality is demonstrated through applications such as tracheal stents and left ventricular assist device lines.
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Affiliation(s)
- Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Debbie L Teodorescu
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, 90048, USA
| | - Meagan Rowlett
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Sophie X Wang
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Mercedes Balcells
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Bioengineering Department, Institut Químic de Sarrià, Ramon Llull Univ, Barcelona, Spain, 08017
| | - Clara Park
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Bruno Bernardo
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Sian McGarel
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Charlotte Reeves
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Mandeep R Mehra
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Hyunwoo Yuk
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- SanaHeal, Inc, Cambridge, MA, 02139, USA
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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5
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Lee Y, Koehler F, Dillon T, Loke G, Kim Y, Marion J, Antonini MJ, Garwood I, Sahasrabudhe A, Nagao K, Zhao X, Fink Y, Roche ET, Anikeeva P. Magnetically Actuated Fiber-Based Soft Robots. Adv Mater 2023; 35:e2301916. [PMID: 37269476 PMCID: PMC10526629 DOI: 10.1002/adma.202301916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/13/2023] [Indexed: 06/05/2023]
Abstract
Broad adoption of magnetic soft robotics is hampered by the sophisticated field paradigms for their manipulation and the complexities in controlling multiple devices. Furthermore, high-throughput fabrication of such devices across spatial scales remains challenging. Here, advances in fiber-based actuators and magnetic elastomer composites are leveraged to create 3D magnetic soft robots controlled by unidirectional fields. Thermally drawn elastomeric fibers are instrumented with a magnetic composite synthesized to withstand strains exceeding 600%. A combination of strain and magnetization engineering in these fibers enables programming of 3D robots capable of crawling or walking in magnetic fields orthogonal to the plane of motion. Magnetic robots act as cargo carriers, and multiple robots can be controlled simultaneously and in opposing directions using a single stationary electromagnet. The scalable approach to fabrication and control of magnetic soft robots invites their future applications in constrained environments where complex fields cannot be readily deployed.
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Affiliation(s)
- Youngbin Lee
- Department of Materials Science and Engineering, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- Research Laboratory of Electronics, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
| | - Florian Koehler
- Research Laboratory of Electronics, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
| | - Tom Dillon
- Department of Mechanical Engineering, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
| | - Gabriel Loke
- Department of Materials Science and Engineering, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- Research Laboratory of Electronics, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
| | - Yoonho Kim
- Department of Mechanical Engineering, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
| | - Juliette Marion
- Department of Materials Science and Engineering, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- Research Laboratory of Electronics, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
| | - Marc-Joseph Antonini
- Research Laboratory of Electronics, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
| | - Indie Garwood
- Harvard/MIT Health Science & Technology Graduate Program; Cambridge, MA 02139, USA
| | - Atharva Sahasrabudhe
- Research Laboratory of Electronics, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- McGovern Institute for Brain Research, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- Department of Chemistry, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
| | - Keisuke Nagao
- Department of Materials Science and Engineering, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- Research Laboratory of Electronics, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
| | - Yoel Fink
- Department of Materials Science and Engineering, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- Research Laboratory of Electronics, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
| | - Ellen T. Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
| | - Polina Anikeeva
- Department of Materials Science and Engineering, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- Research Laboratory of Electronics, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- McGovern Institute for Brain Research, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology; Cambridge, MA 02139, USA
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6
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Beatty R, Mendez KL, Schreiber LHJ, Tarpey R, Whyte W, Fan Y, Robinson ST, O'Dwyer J, Simpkin AJ, Tannian J, Dockery P, Dolan EB, Roche ET, Duffy GP. Soft robot-mediated autonomous adaptation to fibrotic capsule formation for improved drug delivery. Sci Robot 2023; 8:eabq4821. [PMID: 37647382 DOI: 10.1126/scirobotics.abq4821] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 08/02/2023] [Indexed: 09/01/2023]
Abstract
The foreign body response impedes the function and longevity of implantable drug delivery devices. As a dense fibrotic capsule forms, integration of the device with the host tissue becomes compromised, ultimately resulting in device seclusion and treatment failure. We present FibroSensing Dynamic Soft Reservoir (FSDSR), an implantable drug delivery device capable of monitoring fibrotic capsule formation and overcoming its effects via soft robotic actuations. Occlusion of the FSDSR porous membrane was monitored over 7 days in a rodent model using electrochemical impedance spectroscopy. The electrical resistance of the fibrotic capsule correlated to its increase in thickness and volume. Our FibroSensing membrane showed great sensitivity in detecting changes at the abiotic/biotic interface, such as collagen deposition and myofibroblast proliferation. The potential of the FSDSR to overcome fibrotic capsule formation and maintain constant drug dosing over time was demonstrated in silico and in vitro. Controlled closed loop release of methylene blue into agarose gels (with a comparable fold change in permeability relating to 7 and 28 days in vivo) was achieved by adjusting the magnitude and frequency of pneumatic actuations after impedance measurements by the FibroSensing membrane. By sensing fibrotic capsule formation in vivo, the FSDSR will be capable of probing and adapting to the foreign body response through dynamic actuation changes. Informed by real-time sensor signals, this device offers the potential for long-term efficacy and sustained drug dosing, even in the setting of fibrotic capsule formation.
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Affiliation(s)
- Rachel Beatty
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- SFI Centre for Advanced Materials and BioEngineering Research (AMBER), Trinity College Dublin, Dublin, Ireland
| | - Keegan L Mendez
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lucien H J Schreiber
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Ruth Tarpey
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland
- Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
| | - William Whyte
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Scott T Robinson
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- SFI Centre for Advanced Materials and BioEngineering Research (AMBER), Trinity College Dublin, Dublin, Ireland
| | - Joanne O'Dwyer
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Andrew J Simpkin
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland
| | - Joseph Tannian
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Peter Dockery
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
| | - Eimear B Dolan
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland
- Biomedical Engineering, School of Engineering, University of Galway, Galway, Ireland
| | - Ellen T Roche
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Garry P Duffy
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, University of Galway, Galway, Ireland
- SFI Centre for Advanced Materials and BioEngineering Research (AMBER), Trinity College Dublin, Dublin, Ireland
- CÚRAM, Centre for Research in Medical Devices, University of Galway, Galway, Ireland
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Rosalia L, Ozturk C, Wang SX, Quevedo-Moreno D, Saeed MY, Mauskapf A, Roche ET. Soft robotics-enabled large animal model of HFpEF hemodynamics for device testing. bioRxiv 2023:2023.07.26.550654. [PMID: 37547009 PMCID: PMC10402006 DOI: 10.1101/2023.07.26.550654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major challenge in cardiovascular medicine, accounting for approximately 50% of all cases of heart failure. Due to the lack of effective therapies for this condition, the mortality associated with HFpEF remains higher than that of most cancers. Despite the ongoing efforts, no medical device has yet received FDA approval. This is largely due to the lack of an in vivo model of the HFpEF hemodynamics, resulting in the inability to evaluate device effectiveness in vivo prior to clinical trials. Here, we describe the development of a highly tunable porcine model of HFpEF hemodynamics using implantable soft robotic sleeves, where controlled actuation of a left ventricular and an aortic sleeve can recapitulate changes in ventricular compliance and afterload associated with a broad spectrum of HFpEF hemodynamic phenotypes. We demonstrate the feasibility of the proposed model in preclinical testing by evaluating the hemodynamic response of the model post-implantation of an interatrial shunt device, which was found to be consistent with findings from in silico studies and clinical trials. This work addresses several of the limitations associated with previous models of HFpEF, such as their limited hemodynamic fidelity, elevated costs, lengthy development time, and low throughput. By showcasing exceptional versatility and tunability, the proposed platform has the potential to revolutionize the current approach for HFpEF device development and selection, with the goal of improving the quality of life for the 32 million people affected by HFpEF worldwide.
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Rosalia L, Wang SX, Ozturk C, Huang W, Bonnemain J, Beatty R, Duffy GP, Nguyen CT, Roche ET. Soft robotic platform for controlled, progressive and reversible aortic constriction in a small animal model. Res Sq 2023:rs.3.rs-3100659. [PMID: 37503291 PMCID: PMC10371154 DOI: 10.21203/rs.3.rs-3100659/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Our understanding of cardiac remodeling processes due to left ventricular pressure overload derives largely from animal models of aortic banding. However, these studies fail to simultaneously enable control over disease progression and reversal, hindering their clinical relevance. Here, we describe a method for controlled, progressive, and reversible aortic banding based on an implantable expandable actuator that can be finely controlled to modulate aortic banding and debanding in a rat model. Through catheterization, imaging, and histologic studies, we demonstrate that our model can recapitulate the hemodynamic and structural changes associated with pressure overload in a controllable manner. We leverage the ability of our model to enable non-invasive aortic debanding to show that these changes can be partly reversed due to cessation of the biomechanical stimulus. By recapitulating longitudinal disease progression and reversibility, this model could elucidate fundamental mechanisms of cardiac remodeling and optimize timing of intervention for pressure overload.
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Affiliation(s)
- Luca Rosalia
- Health Sciences and Technology Program, Harvard University - Massachusetts Institute of Technology, Cambridge, 02139-4307, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, 02139-4307, MA, USA
| | - Sophie X. Wang
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, 02139-4307, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, 02215, MA, USA
| | - Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, 02139-4307, MA, USA
| | - Wei Huang
- Koch Institute For Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, 02142, MA, USA
| | - Jean Bonnemain
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, 02139-4307, MA, USA
- Department of Adult Intensive Care Medicine, Lausanne University Hospital, Lausanne, 1011, Switzerland
| | - Rachel Beatty
- Anatomy and Regenerative Medicine Institute, College of Medicine Nursing and Health Sciences, University of Galway, Ireland, Galway, H91 W2TY, Ireland
| | - Garry P. Duffy
- Anatomy and Regenerative Medicine Institute, College of Medicine Nursing and Health Sciences, University of Galway, Ireland, Galway, H91 W2TY, Ireland
| | - Christopher T. Nguyen
- Department of Cardiovascular Medicine, Radiology, and Biomedical Engineering, Cleveland Clinic, Cleveland, 44195, OH, USA
| | - Ellen T. Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, 02139-4307, MA, USA
- Koch Institute For Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, 02142, MA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, 02139, MA, USA
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9
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Mendez K, Whyte W, Freedman BR, Fan Y, Varela CE, Singh M, Cintron-Cruz JC, Rothenbücher SE, Li J, Mooney DJ, Roche ET. Mechanoresponsive Drug Release from a Flexible, Tissue-Adherent, Hybrid Hydrogel Actuator. Adv Mater 2023:e2303301. [PMID: 37310046 DOI: 10.1002/adma.202303301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/22/2023] [Indexed: 06/14/2023]
Abstract
Soft robotic technologies for therapeutic biomedical applications require conformal and atraumatic tissue coupling that is amenable to dynamic loading for effective drug delivery or tissue stimulation. This intimate and sustained contact offers vast therapeutic opportunities for localized drug release. Herein, a new class of hybrid hydrogel actuator (HHA) that facilitates enhanced drug delivery is introduced. The multi-material soft actuator can elicit a tunable mechanoresponsive release of charged drug from its alginate/acrylamide hydrogel layer with temporal control. Dosing control parameters include actuation magnitude, frequency, and duration. The actuator can safely adhere to tissue via a flexible, drug-permeable adhesive bond that can withstand dynamic device actuation. Conformal adhesion of the hybrid hydrogel actuator to tissue leads to improved mechanoresponsive spatial delivery of the drug. Future integration of this hybrid hydrogel actuator with other soft robotic assistive technologies can enable a synergistic, multi-pronged treatment approach for the treatment of disease.
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Affiliation(s)
- Keegan Mendez
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 01239, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, 02139, USA
| | - William Whyte
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 01239, USA
| | - Benjamin R Freedman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 01238, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, 02138, USA
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Claudia E Varela
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 01239, USA
| | - Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 01239, USA
| | - Juan C Cintron-Cruz
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 01238, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, 02138, USA
| | - Sandra E Rothenbücher
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 01239, USA
| | - Jianyu Li
- Department of Mechanical Engineering, McGill University, Montreal, QC, H3A 0C3, Canada
| | - David J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 01238, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, 02138, USA
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 01239, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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10
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Rosalia L, Ozturk C, Goswami D, Bonnemain J, Wang SX, Bonner B, Weaver JC, Puri R, Kapadia S, Nguyen CT, Roche ET. Soft robotic patient-specific hydrodynamic model of aortic stenosis and ventricular remodeling. Sci Robot 2023; 8:eade2184. [PMID: 36812335 PMCID: PMC10280738 DOI: 10.1126/scirobotics.ade2184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
Aortic stenosis (AS) affects about 1.5 million people in the United States and is associated with a 5-year survival rate of 20% if untreated. In these patients, aortic valve replacement is performed to restore adequate hemodynamics and alleviate symptoms. The development of next-generation prosthetic aortic valves seeks to provide enhanced hemodynamic performance, durability, and long-term safety, emphasizing the need for high-fidelity testing platforms for these devices. We propose a soft robotic model that recapitulates patient-specific hemodynamics of AS and secondary ventricular remodeling which we validated against clinical data. The model leverages 3D-printed replicas of each patient's cardiac anatomy and patient-specific soft robotic sleeves to recreate the patients' hemodynamics. An aortic sleeve allows mimicry of AS lesions due to degenerative or congenital disease, whereas a left ventricular sleeve recapitulates loss of ventricular compliance and diastolic dysfunction (DD) associated with AS. Through a combination of echocardiographic and catheterization techniques, this system is shown to recreate clinical metrics of AS with greater controllability compared with methods based on image-guided aortic root reconstruction and parameters of cardiac function that rigid systems fail to mimic physiologically. Last, we leverage this model to evaluate the hemodynamic benefit of transcatheter aortic valves in a subset of patients with diverse anatomies, etiologies, and disease states. Through the development of a high-fidelity model of AS and DD, this work demonstrates the use of soft robotics to recreate cardiovascular disease, with potential applications in device development, procedural planning, and outcome prediction in industrial and clinical settings.
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Affiliation(s)
- Luca Rosalia
- Health Sciences and Technology Program, Harvard–Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, USA
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Debkalpa Goswami
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Health Sciences and Technology, ETH-Zürich, Zürich, Switzerland
- Institute of Robotics and Intelligent Systems, ETH-Zürich, Zürich, Switzerland
| | - Jean Bonnemain
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sophie X. Wang
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Benjamin Bonner
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, USA
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - James C. Weaver
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher T. Nguyen
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, USA
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ellen T. Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
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11
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Hu L, Bonnemain J, Saeed MY, Singh M, Quevedo Moreno D, Vasilyev NV, Roche ET. An implantable soft robotic ventilator augments inspiration in a pig model of respiratory insufficiency. Nat Biomed Eng 2023; 7:110-123. [PMID: 36509912 PMCID: PMC9991903 DOI: 10.1038/s41551-022-00971-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/26/2022] [Indexed: 12/14/2022]
Abstract
Severe diaphragm dysfunction can lead to respiratory failure and to the need for permanent mechanical ventilation. Yet permanent tethering to a mechanical ventilator through the mouth or via tracheostomy can hinder a patient's speech, swallowing ability and mobility. Here we show, in a porcine model of varied respiratory insufficiency, that a contractile soft robotic actuator implanted above the diaphragm augments its motion during inspiration. Synchronized actuation of the diaphragm-assist implant with the native respiratory effort increased tidal volumes and maintained ventilation flow rates within the normal range. Robotic implants that intervene at the diaphragm rather than at the upper airway and that augment physiological metrics of ventilation may restore respiratory performance without sacrificing quality of life.
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Affiliation(s)
- Lucy Hu
- Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jean Bonnemain
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mossab Y Saeed
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Diego Quevedo Moreno
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Nikolay V Vasilyev
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
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12
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Quevedo-Moreno D, Roche ET. Design and Modeling of Fabric-Shelled Pneumatic Bending Soft Actuators. IEEE Robot Autom Lett 2023. [DOI: 10.1109/lra.2023.3264734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Diego Quevedo-Moreno
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ellen T. Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
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13
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Gollob SD, Mendoza MJ, Koo BHB, Centeno E, Vela EA, Roche ET. A length-adjustable vacuum-powered artificial muscle for wearable physiotherapy assistance in infants. Front Robot AI 2023; 10:1190387. [PMID: 37213243 PMCID: PMC10192875 DOI: 10.3389/frobt.2023.1190387] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023] Open
Abstract
Soft pneumatic artificial muscles are increasingly popular in the field of soft robotics due to their light-weight, complex motions, and safe interfacing with humans. In this paper, we present a Vacuum-Powered Artificial Muscle (VPAM) with an adjustable operating length that offers adaptability throughout its use, particularly in settings with variable workspaces. To achieve the adjustable operating length, we designed the VPAM with a modular structure consisting of cells that can be clipped in a collapsed state and unclipped as desired. We then conducted a case study in infant physical therapy to demonstrate the capabilities of our actuator. We developed a dynamic model of the device and a model-informed open-loop control system, and validated their accuracy in a simulated patient setup. Our results showed that the VPAM maintains its performance as it grows. This is crucial in applications such as infant physical therapy where the device must adapt to the growth of the patient during a 6-month treatment regime without actuator replacement. The ability to adjust the length of the VPAM on demand offers a significant advantage over traditional fixed-length actuators, making it a promising solution for soft robotics. This actuator has potential for various applications that can leverage on demand expansion and shrinking, including exoskeletons, wearable devices, medical robots, and exploration robots.
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Affiliation(s)
- Samuel Dutra Gollob
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Mijaíl Jaén Mendoza
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia, Lima, Peru
| | - Bon Ho Brandon Koo
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Esteban Centeno
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia, Lima, Peru
| | - Emir A. Vela
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia, Lima, Peru
- Research Center in Bioengineering, Universidad de Ingenieria y Tecnologia, Lima, Peru
- *Correspondence: Ellen T. Roche, ; Emir A. Vela,
| | - Ellen T. Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
- *Correspondence: Ellen T. Roche, ; Emir A. Vela,
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14
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Ozturk C, Schmid Daners M, Zhao X, Roche ET, Nguyen CT. Editorial: Cardiovascular engineering. Front Cardiovasc Med 2022; 9:1089794. [DOI: 10.3389/fcvm.2022.1089794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022] Open
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15
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Rosalia L, Ozturk C, Coll-Font J, Fan Y, Nagata Y, Singh M, Goswami D, Mauskapf A, Chen S, Eder RA, Goffer EM, Kim JH, Yurista S, Bonner BP, Foster AN, Levine RA, Edelman ER, Panagia M, Guerrero JL, Roche ET, Nguyen CT. A soft robotic sleeve mimicking the haemodynamics and biomechanics of left ventricular pressure overload and aortic stenosis. Nat Biomed Eng 2022; 6:1134-1147. [PMID: 36163494 PMCID: PMC9588718 DOI: 10.1038/s41551-022-00937-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
Preclinical models of aortic stenosis can induce left ventricular pressure overload and coarsely control the severity of aortic constriction. However, they do not recapitulate the haemodynamics and flow patterns associated with the disease. Here we report the development of a customizable soft robotic aortic sleeve that can mimic the haemodynamics and biomechanics of aortic stenosis. By allowing for the adjustment of actuation patterns and blood-flow dynamics, the robotic sleeve recapitulates clinically relevant haemodynamics in a porcine model of aortic stenosis, as we show via in vivo echocardiography and catheterization studies, and a combination of in vitro and computational analyses. Using in vivo and in vitro magnetic resonance imaging, we also quantified the four-dimensional blood-flow velocity profiles associated with the disease and with bicommissural and unicommissural defects re-created by the robotic sleeve. The design of the sleeve, which can be adjusted on the basis of computed tomography data, allows for the design of patient-specific devices that may guide clinical decisions and improve the management and treatment of patients with aortic stenosis.
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Affiliation(s)
- Luca Rosalia
- Health Sciences and Technology Program, Harvard - Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA,Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA
| | - Jaume Coll-Font
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Yiling Fan
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA,Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA,Department of Mechanical Engineering, Massachusetts Institute of Technology, 33 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Yasufumi Nagata
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, 55 Fruit Boston, MA 02114, USA,Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA
| | - Debkalpa Goswami
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA
| | - Adam Mauskapf
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, 55 Fruit Boston, MA 02114, USA
| | - Shi Chen
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Robert A. Eder
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Efrat M. Goffer
- Health Sciences and Technology Program, Harvard - Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA
| | - Jo H. Kim
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Salva Yurista
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Benjamin P. Bonner
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Anna N. Foster
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA
| | - Robert A. Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, 55 Fruit Boston, MA 02114, USA,Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Elazer R. Edelman
- Health Sciences and Technology Program, Harvard - Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA,Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis Street, Boston, MA 02115, USA
| | - Marcello Panagia
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,Cardiovascular Medicine Section, Department of Medicine, Boston University Medical Center, 715 Albany Street, Boston, MA 02118, USA
| | - Jose L. Guerrero
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA
| | - Ellen T. Roche
- Health Sciences and Technology Program, Harvard - Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 45 Carleton Street, Cambridge, MA 02139, USA,Department of Mechanical Engineering, Massachusetts Institute of Technology, 33 Massachusetts Avenue, Cambridge, MA 02139, USA,Correspondence and requests for materials should be addressed to ;
| | - Christopher T. Nguyen
- Health Sciences and Technology Program, Harvard - Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA,Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA,A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street Charlestown, MA 02129, USA,Department of Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA,Cardiovascular Innovation Research Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA,Correspondence and requests for materials should be addressed to ;
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16
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Whyte W, Goswami D, Wang SX, Fan Y, Ward NA, Levey RE, Beatty R, Robinson ST, Sheppard D, O'Connor R, Monahan DS, Trask L, Mendez KL, Varela CE, Horvath MA, Wylie R, O'Dwyer J, Domingo-Lopez DA, Rothman AS, Duffy GP, Dolan EB, Roche ET. Dynamic actuation enhances transport and extends therapeutic lifespan in an implantable drug delivery platform. Nat Commun 2022; 13:4496. [PMID: 35922421 PMCID: PMC9349266 DOI: 10.1038/s41467-022-32147-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
Fibrous capsule (FC) formation, secondary to the foreign body response (FBR), impedes molecular transport and is detrimental to the long-term efficacy of implantable drug delivery devices, especially when tunable, temporal control is necessary. We report the development of an implantable mechanotherapeutic drug delivery platform to mitigate and overcome this host immune response using two distinct, yet synergistic soft robotic strategies. Firstly, daily intermittent actuation (cycling at 1 Hz for 5 minutes every 12 hours) preserves long-term, rapid delivery of a model drug (insulin) over 8 weeks of implantation, by mediating local immunomodulation of the cellular FBR and inducing multiphasic temporal FC changes. Secondly, actuation-mediated rapid release of therapy can enhance mass transport and therapeutic effect with tunable, temporal control. In a step towards clinical translation, we utilise a minimally invasive percutaneous approach to implant a scaled-up device in a human cadaveric model. Our soft actuatable platform has potential clinical utility for a variety of indications where transport is affected by fibrosis, such as the management of type 1 diabetes. Drug delivery implants suffer from diminished release profiles due to fibrous capsule formation over time. Here, the authors use soft robotic actuation to modulate the immune response of the host to maintain drug delivery over the longer-term and to perform controlled release in vivo.
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Affiliation(s)
- William Whyte
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Debkalpa Goswami
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sophie X Wang
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Niamh A Ward
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Biomedical Engineering, National University of Ireland Galway, Galway, Ireland
| | - Ruth E Levey
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland
| | - Rachel Beatty
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland
| | - Scott T Robinson
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland
| | - Declan Sheppard
- Department of Radiology, University Hospital, Galway, Ireland
| | - Raymond O'Connor
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland
| | - David S Monahan
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland
| | - Lesley Trask
- Department of Biomedical Engineering, National University of Ireland Galway, Galway, Ireland
| | - Keegan L Mendez
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Claudia E Varela
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Markus A Horvath
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Robert Wylie
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland
| | - Joanne O'Dwyer
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Biomedical Engineering, National University of Ireland Galway, Galway, Ireland
| | - Daniel A Domingo-Lopez
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland
| | - Arielle S Rothman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Garry P Duffy
- Anatomy and Regenerative Medicine Institute (REMEDI), National University of Ireland Galway, Galway, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland
| | - Eimear B Dolan
- Department of Biomedical Engineering, National University of Ireland Galway, Galway, Ireland.
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA.
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17
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Gollob SD, Poss J, Memoli G, Roche ET. A Multi-Material, Anthropomorphic Metacarpophalangeal Joint With Abduction and Adduction Actuated by Soft Artificial Muscles. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3161714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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18
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Abstract
The treatment of end-stage heart failure has evolved substantially with advances in medical treatment, cardiac transplantation, and mechanical circulatory support (MCS) devices such as left ventricular assist devices and total artificial hearts. However, current MCS devices are inherently blood contacting and can lead to potential complications including pump thrombosis, hemorrhage, stroke, and hemolysis. Attempts to address these issues and avoid blood contact led to the concept of compressing the failing heart from the epicardial surface and the design of direct cardiac compression (DCC) devices. We review the fundamental concepts related to DCC, present the foundational devices and recent devices in the research and commercialization stages, and discuss the milestones required for clinical translation and adoption of this technology. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 24 is June 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Jean Bonnemain
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Department of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland;
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA;
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.,Department of Mechanical Engineering and Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA;
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19
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Hu L, Gau D, Nixon J, Klein M, Fan Y, Menary G, Roche ET. Precurved, Fiber-Reinforced Actuators Enable Pneumatically Efficient Replication of Complex Biological Motions. Soft Robot 2022; 9:293-308. [PMID: 34000210 PMCID: PMC9639240 DOI: 10.1089/soro.2020.0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Much of the research on bioinspired soft robotics has focused on capturing the interplay of biological form and function. However, existing soft robotic actuators are mostly made with linear or planar fabrication orientations that do not represent the resting geometry of complex biological systems, such as curved musculature. This work introduces the ability to create fiber-reinforced actuators with precurved configurations. By tuning variables such as dimensions and fiber angles, an optimization algorithm can prescribe the mechanical fabrication parameters to create a fiber-reinforced actuator that can generate controlled motion to follow a desired input trajectory. Precurved configurations introduce an additional optimization parameter, the initial bend angle, allowing for a more accurate and robust algorithm and generating a median percent error of <1%. With a customized software tool, we can take existing motion data from biological systems-such as medical imaging-and build soft robotic actuators optimized to replicate these trajectories. We can predict the motion of precurved actuators both analytically and numerically and replicate the motion experimentally, with excellent trajectory matching between the three. In constructing actuators that better match the native forms found within biological systems, we find that precurved actuators are more efficient than their initially straight counterparts. This pneumatic efficiency allows for the use of control systems with lower power and precision, lowering the economic cost of the associated control hardware, while more accurately replicating the biological motion. Taking two examples from biology, that of the human diaphragm during respiration and that of a jellyfish bell during locomotion, we design and generate fiber reinforced actuators to mimic these motions.
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Affiliation(s)
- Lucy Hu
- Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Institute of Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Dominik Gau
- Department of Mechanical Engineering, Technical University of Munich, Munich, Germany
| | - James Nixon
- School of Mechanical and Aerospace Engineering, Queens University, Belfast, United Kingdom
| | - Melissa Klein
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Gary Menary
- School of Mechanical and Aerospace Engineering, Queens University, Belfast, United Kingdom
| | - Ellen T. Roche
- Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Institute of Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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20
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Ozturk C, Rosalia L, Roche ET. A Multi-Domain Simulation Study of a Pulsatile-Flow Pump Device for Heart Failure With Preserved Ejection Fraction. Front Physiol 2022; 13:815787. [PMID: 35145432 PMCID: PMC8822361 DOI: 10.3389/fphys.2022.815787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/05/2022] [Indexed: 12/02/2022] Open
Abstract
Mechanical circulatory support (MCS) devices are currently under development to improve the physiology and hemodynamics of patients with heart failure with preserved ejection fraction (HFpEF). Most of these devices, however, are designed to provide continuous-flow support. While it has been shown that pulsatile support may overcome some of the complications hindering the clinical translation of these devices for other heart failure phenotypes, the effects that it may have on the HFpEF physiology are still unknown. Here, we present a multi-domain simulation study of a pulsatile pump device with left atrial cannulation for HFpEF that aims to alleviate left atrial pressure, commonly elevated in HFpEF. We leverage lumped-parameter modeling to optimize the design of the pulsatile pump, computational fluid dynamic simulations to characterize hydraulic and hemolytic performance, and finite element modeling on the Living Heart Model to evaluate effects on arterial, left atrial, and left ventricular hemodynamics and biomechanics. The findings reported in this study suggest that pulsatile-flow support can successfully reduce pressures and associated wall stresses in the left heart, while yielding more physiologic arterial hemodynamics compared to continuous-flow support. This work therefore supports further development and evaluation of pulsatile support MCS devices for HFpEF.
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Affiliation(s)
- Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Luca Rosalia
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
- Health Sciences and Technology Program, Harvard – Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Ellen T. Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
- *Correspondence: Ellen T. Roche,
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21
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Singh M, Park C, Roche ET. Decellularization Following Fixation of Explanted Aortic Valves as a Strategy for Preserving Native Mechanical Properties and Function. Front Bioeng Biotechnol 2022; 9:803183. [PMID: 35071211 PMCID: PMC8770733 DOI: 10.3389/fbioe.2021.803183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
Mechanical or biological aortic valves are incorporated in physical cardiac simulators for surgical training, educational purposes, and device testing. They suffer from limitations including either a lack of anatomical and biomechanical accuracy or a short lifespan, hence limiting the authentic hands-on learning experience. Medical schools utilize hearts from human cadavers for teaching and research, but these formaldehyde-fixed aortic valves contort and stiffen relative to native valves. Here, we compare a panel of different chemical treatment methods on explanted porcine aortic valves and evaluate the microscopic and macroscopic features of each treatment with a primary focus on mechanical function. A surfactant-based decellularization method after formaldehyde fixation is shown to have mechanical properties close to those of the native aortic valve. Valves treated in this method were integrated into a custom-built left heart cardiac simulator to test their hemodynamic performance. This decellularization, post-fixation technique produced aortic valves which have ultimate stress and elastic modulus in the range of the native leaflets. Decellularization of fixed valves reduced the valvular regurgitation by 60% compared to formaldehyde-fixed valves. This fixation method has implications for scenarios where the dynamic function of preserved valves is required, such as in surgical trainers or device test rigs.
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Affiliation(s)
- Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Clara Park
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
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22
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Rosalia L, Lamberti KK, Landry MK, Leclerc CM, Shuler FD, Hanumara NC, Roche ET. A Soft Robotic Sleeve for Compression Therapy of the Lower Limb. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:1280-1283. [PMID: 34891519 DOI: 10.1109/embc46164.2021.9630924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
'We present the development of a soft robotic-inspired device for lower limb compression therapy with application in the treatment of lymphedema. This device integrates the control capabilities of pneumatic devices with the wearability and low cost of compression garments. The design consists of a three-layered soft robotic sleeve that ensures safe skin contact, controls compression, and secures the device to the patient limb. The expandable component is made of interconnected pockets of various heights, which passively create a graduated compression profile along the lower limb. The system is inflated by a pump and a microcontroller-actuated valve, with force sensors embedded in the sleeve that monitor the pressure applied to the limb. Testing on healthy individualsq demonstrated the ability to reach clinically relevant target pressures (30, 40, 50 mmHg) and establish a distal-to-proximal descending pressure gradient of approximately 40 mmHg. Device function was shown to be robust against variations in subject anatomy.Clinical Relevance- This system provides controllable, graduated, compression therapy to lymphedema patients in an economical, portable, and customizable package.
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23
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Yuk H, Wu J, Sarrafian TL, Mao X, Varela CE, Roche ET, Griffiths LG, Nabzdyk CS, Zhao X. Rapid and coagulation-independent haemostatic sealing by a paste inspired by barnacle glue. Nat Biomed Eng 2021; 5:1131-1142. [PMID: 34373600 PMCID: PMC9254891 DOI: 10.1038/s41551-021-00769-y] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/22/2021] [Indexed: 02/07/2023]
Abstract
Tissue adhesives do not normally perform well on tissues that are covered with blood or other bodily fluids. Here we report the design, adhesion mechanism and performance of a paste that haemostatically seals tissues in less than 15 s, independently of the blood-coagulation rate. With a design inspired by barnacle glue (which strongly adheres to wet and contaminated surfaces owing to adhesive proteins embedded in a lipid-rich matrix), the paste consists of a blood-repelling hydrophobic oil matrix containing embedded microparticles that covalently crosslink with tissue surfaces on the application of gentle pressure. It slowly resorbs over weeks, sustains large pressures (approximately 350 mm Hg of burst pressure in a sealed porcine aorta), makes tough (interfacial toughness of 150-300 J m-2) and strong (shear and tensile strengths of, respectively, 40-70 kPa and 30-50 kPa) interfaces with blood-covered tissues, and outperforms commercial haemostatic agents in the sealing of bleeding porcine aortas ex vivo and of bleeding heart and liver tissues in live rats and pigs. The paste may aid the treatment of severe bleeding, even in individuals with coagulopathies.
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Affiliation(s)
- Hyunwoo Yuk
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA,Correspondence and requests for materials should be addressed to H.Y. (), C.S.N. (), and X.Z. ()
| | - Jingjing Wu
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tiffany L. Sarrafian
- Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Xinyu Mao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Claudia E. Varela
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Ellen T. Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | | | - Christoph S. Nabzdyk
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA,Correspondence and requests for materials should be addressed to H.Y. (), C.S.N. (), and X.Z. ()
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA,Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA,Correspondence and requests for materials should be addressed to H.Y. (), C.S.N. (), and X.Z. ()
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24
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Rosalia L, Ozturk C, Shoar S, Fan Y, Malone G, Cheema FH, Conway C, Byrne RA, Duffy GP, Malone A, Roche ET, Hameed A. Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction. JACC Basic Transl Sci 2021; 6:772-795. [PMID: 34754993 PMCID: PMC8559325 DOI: 10.1016/j.jacbts.2021.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 12/28/2022]
Abstract
Characterized by a rapidly increasing prevalence, elevated mortality and rehospitalization rates, and inadequacy of pharmaceutical therapies, heart failure with preserved ejection fraction (HFpEF) has motivated the widespread development of device-based solutions. HFpEF is a multifactorial disease of various etiologies and phenotypes, distinguished by diminished ventricular compliance, diastolic dysfunction, and symptoms of heart failure despite a normal ejection performance; these symptoms include pulmonary hypertension, limited cardiac reserve, autonomic imbalance, and exercise intolerance. Several types of atrial shunts, left ventricular expanders, stimulation-based therapies, and mechanical circulatory support devices are currently under development aiming to target one or more of these symptoms by addressing the associated mechanical or hemodynamic hallmarks. Although the majority of these solutions have shown promising results in clinical or preclinical studies, no device-based therapy has yet been approved for the treatment of patients with HFpEF. The purpose of this review is to discuss the rationale behind each of these devices and the findings from the initial testing phases, as well as the limitations and challenges associated with their clinical translation.
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Key Words
- BAT, baroreceptor activation therapy
- CCM, cardiac contractility modulation
- CRT, cardiac resynchronization therapy
- HF, heart failure
- HFmEF, heart failure with mid-range ejection fraction
- HFpEF
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- IASD, Interatrial Shunt Device
- LAAD, left atrial assist device
- LAP, left atrial pressure
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MCS, mechanical circulatory support
- NYHA, New York Heart Association
- PCWP, pulmonary capillary wedge pressure
- QoL, quality of life
- TAA, transapical approach
- atrial shunt devices
- electrostimulation
- heart failure devices
- heart failure with preserved ejection fraction
- left ventricular expanders
- mechanical circulatory support
- neuromodulation
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Affiliation(s)
- Luca Rosalia
- Health Sciences and Technology Program, Harvard–Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Grainne Malone
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Faisal H. Cheema
- HCA Healthcare, Houston, Texas, USA
- University of Houston, College of Medicine, Houston, Texas, USA
| | - Claire Conway
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Robert A. Byrne
- Department of Cardiology, Mater Private Hospital, Dublin, Ireland
- Cardiovascular Research, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Garry P. Duffy
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Anatomy & Regenerative Medicine Institute, School of Medicine, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
- Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
- Advanced Materials for Biomedical Engineering and Regenerative Medicine, Trinity College Dublin, and National University of Ireland Galway, Galway, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Andrew Malone
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ellen T. Roche
- Health Sciences and Technology Program, Harvard–Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Aamir Hameed
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
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25
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Mendoza MJ, Gollob SD, Lavado D, Koo BHB, Cruz S, Roche ET, Vela EA. A Vacuum-Powered Artificial Muscle Designed for Infant Rehabilitation. Micromachines (Basel) 2021; 12:971. [PMID: 34442593 PMCID: PMC8400328 DOI: 10.3390/mi12080971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/26/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
The majority of soft pneumatic actuators for rehabilitation exercises have been designed for adult users. Specifically, there is a paucity of soft rehabilitative devices designed for infants with upper and lower limb motor disabilities. We present a low-profile vacuum-powered artificial muscle (LP-VPAM) with dimensions suitable for infants. The actuator produced a maximum force of 26 N at vacuum pressures of -40 kPa. When implemented in an experimental model of an infant leg in an antagonistic-agonist configuration to measure resultant knee flexion, the actuator generated knee flexion angles of 43° and 61° in the prone and side-lying position, respectively.
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Affiliation(s)
- Mijaíl Jaén Mendoza
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia—UTEC, Lima 15063, Peru; (M.J.M.); (D.L.)
| | - Samuel Dutra Gollob
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (S.D.G.); (B.H.B.K.)
| | - Diego Lavado
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia—UTEC, Lima 15063, Peru; (M.J.M.); (D.L.)
| | - Bon Ho Brandon Koo
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (S.D.G.); (B.H.B.K.)
| | - Segundo Cruz
- Instituto Nacional de Salud del Niño de San Borja, Lima 15037, Peru;
| | - Ellen T. Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (S.D.G.); (B.H.B.K.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Emir A. Vela
- Department of Mechanical Engineering, Universidad de Ingenieria y Tecnologia—UTEC, Lima 15063, Peru; (M.J.M.); (D.L.)
- Research Centre in Bioengineering, Universidad de Ingenieria y Tecnologia—UTEC, Lima 15063, Peru
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26
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Fan Y, Coll-Font J, van den Boomen M, Kim JH, Chen S, Eder RA, Roche ET, Nguyen CT. Characterization of Exercise-Induced Myocardium Growth Using Finite Element Modeling and Bayesian Optimization. Front Physiol 2021; 12:694940. [PMID: 34434115 PMCID: PMC8381603 DOI: 10.3389/fphys.2021.694940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/19/2021] [Indexed: 02/03/2023] Open
Abstract
Cardiomyocyte growth can occur in both physiological (exercised-induced) and pathological (e.g., volume overload and pressure overload) conditions leading to left ventricular (LV) hypertrophy. Studies using animal models and histology have demonstrated the growth and remodeling process at the organ level and tissue-cellular level, respectively. However, the driving factors of growth and the mechanistic link between organ, tissue, and cellular growth remains poorly understood. Computational models have the potential to bridge this gap by using constitutive models that describe the growth and remodeling process of the myocardium coupled with finite element (FE) analysis to model the biomechanics of the heart at the organ level. Using subject-specific imaging data of the LV geometry at two different time points, an FE model can be created with the inverse method to characterize the growth parameters of each subject. In this study, we developed a framework that takes in vivo cardiac magnetic resonance (CMR) imaging data of exercised porcine model and uses FE and Bayesian optimization to characterize myocardium growth in the transverse and longitudinal directions. The efficacy of this framework was demonstrated by successfully predicting growth parameters of 18 synthetic LV targeted masks which were generated from three LV porcine geometries. The framework was further used to characterize growth parameters in 4 swine subjects that had been exercised. The study suggested that exercise-induced growth in swine is prone to longitudinal cardiomyocyte growth (58.0 ± 19.6% after 6 weeks and 79.3 ± 15.6% after 12 weeks) compared to transverse growth (4.0 ± 8.0% after 6 weeks and 7.8 ± 9.4% after 12 weeks). This framework can be used to characterize myocardial growth in different phenotypes of LV hypertrophy and can be incorporated with other growth constitutive models to study different hypothetical growth mechanisms.
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Affiliation(s)
- Yiling Fan
- Cardiovascular Bioengineering and Imaging Laboratory, Cardiology Division, Massachusetts General Hospital, Charlestown, MA, United States,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Jaume Coll-Font
- Cardiovascular Bioengineering and Imaging Laboratory, Cardiology Division, Massachusetts General Hospital, Charlestown, MA, United States,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States,Harvard Medical School, Boston, MA, United States
| | - Maaike van den Boomen
- Cardiovascular Bioengineering and Imaging Laboratory, Cardiology Division, Massachusetts General Hospital, Charlestown, MA, United States,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States,Harvard Medical School, Boston, MA, United States
| | - Joan H. Kim
- Cardiovascular Bioengineering and Imaging Laboratory, Cardiology Division, Massachusetts General Hospital, Charlestown, MA, United States
| | - Shi Chen
- Cardiovascular Bioengineering and Imaging Laboratory, Cardiology Division, Massachusetts General Hospital, Charlestown, MA, United States
| | - Robert Alan Eder
- Cardiovascular Bioengineering and Imaging Laboratory, Cardiology Division, Massachusetts General Hospital, Charlestown, MA, United States
| | - Ellen T. Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States,Harvard Medical School, Boston, MA, United States,*Correspondence: Ellen T. Roche,
| | - Christopher T. Nguyen
- Cardiovascular Bioengineering and Imaging Laboratory, Cardiology Division, Massachusetts General Hospital, Charlestown, MA, United States,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States,Harvard Medical School, Boston, MA, United States,Christopher T. Nguyen,
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27
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Goswami D, Domingo‐Lopez DA, Ward NA, Millman JR, Duffy GP, Dolan EB, Roche ET. Design Considerations for Macroencapsulation Devices for Stem Cell Derived Islets for the Treatment of Type 1 Diabetes. Adv Sci (Weinh) 2021; 8:e2100820. [PMID: 34155834 PMCID: PMC8373111 DOI: 10.1002/advs.202100820] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/24/2021] [Indexed: 05/08/2023]
Abstract
Stem cell derived insulin producing cells or islets have shown promise in reversing Type 1 Diabetes (T1D), yet successful transplantation currently necessitates long-term modulation with immunosuppressant drugs. An alternative approach to avoiding this immune response is to utilize an islet macroencapsulation device, where islets are incorporated into a selectively permeable membrane that can protect the transplanted cells from acute host response, whilst enabling delivery of insulin. These macroencapsulation systems have to meet a number of stringent and challenging design criteria in order to achieve the ultimate goal of reversing T1D. In this progress report, the design considerations and functional requirements of macroencapsulation systems are reviewed, specifically for stem-cell derived islets (SC-islets), highlighting distinct design parameters. Additionally, a perspective on the future for macroencapsulation systems is given, and how incorporating continuous sensing and closed-loop feedback can be transformative in advancing toward an autonomous biohybrid artificial pancreas.
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Affiliation(s)
- Debkalpa Goswami
- Institute for Medical Engineering and ScienceMassachusetts Institute of TechnologyCambridgeMA02139USA
| | - Daniel A. Domingo‐Lopez
- Department of AnatomyCollege of Medicine, Nursing, and Health SciencesNational University of Ireland GalwayGalwayH91 TK33Ireland
| | - Niamh A. Ward
- Department of Biomedical EngineeringSchool of EngineeringCollege of Science and EngineeringNational University of Ireland GalwayGalwayH91 TK33Ireland
| | - Jeffrey R. Millman
- Division of Endocrinology, Metabolism & Lipid ResearchWashington University School of MedicineSt. LouisMO63110USA
- Department of Biomedical EngineeringWashington University in St. LouisSt. LouisMO63110USA
| | - Garry P. Duffy
- Department of AnatomyCollege of Medicine, Nursing, and Health SciencesNational University of Ireland GalwayGalwayH91 TK33Ireland
- Advanced Materials and BioEngineering Research Centre (AMBER)Trinity College DublinDublinD02 PN40Ireland
- CÚRAM, Centre for Research in Medical DevicesNational University of Ireland GalwayGalwayH91 TK33Ireland
| | - Eimear B. Dolan
- Department of Biomedical EngineeringSchool of EngineeringCollege of Science and EngineeringNational University of Ireland GalwayGalwayH91 TK33Ireland
| | - Ellen T. Roche
- Institute for Medical Engineering and ScienceMassachusetts Institute of TechnologyCambridgeMA02139USA
- Department of Mechanical EngineeringMassachusetts Institute of TechnologyCambridgeMA02139USA
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28
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Byrne O, Coulter F, Roche ET, O'Cearbhaill ED. In silico design of additively manufacturable composite synthetic vascular conduits and grafts with tuneable compliance. Biomater Sci 2021; 9:4343-4355. [PMID: 33724267 DOI: 10.1039/d0bm02169e] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Benchtop testing of endovascular medical devices under accurately simulated physiological conditions is a critical part of device evaluation prior to clinical assessment. Currently, glass, acrylic and silicone vascular models are predominantly used as anatomical simulator test beds for in vitro testing. However, most current models lack the ability to mimic the non-linear radial compliance of native vessels and are typically limited to being compliance-matched at a single mean pressure comparison point or not at all. Hence, a degree of caution needs to be shown when analysing results from such models under simulated physiological or pathophysiological conditions. Similarly, the clinical translation of proposed biomimetic compliance-matched vascular grafts has undoubtedly been curtailed due to performance and material limitations. Here, we propose a new design for synthetic vessels where compliance can be precisely modulated across a wide physiological pressure range by customising design parameters. Building on previously demonstrated methods of 3D printing composite compliant cylindrical structures, we demonstrate proof of principle in creating composite vascular constructs designed via a finite element model. Our constructs are 3D printable and consist of a soft silicone matrix with embedded polyurethane fibres. The fibre layer consists of circumferential sinusoidal waves with an amplitude that can be altered to result in tuneable internal radial compliances of 5.2-15.9%/mmHg × 10-2 at a mean pressure of 100 mmHg. Importantly, the design presented here allows preservation of the non-linear exponentially decaying compliance curve of native arteries and veins with an increasing mean pressure. This model offers a design toolbox for 3D printable vascular models that offer biomimetic compliance. The robust nature of this model will lead to rapidly accelerating the design process for biomimetic vascular anatomical simulators, lumped parameter model flow loops, endovascular device benchtop testbeds, and compliance-matched synthetic grafts.
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Affiliation(s)
- Oisín Byrne
- School of Mechanical and Materials Engineering, UCD Centre for Biomedical Engineering, University College Dublin, Belfield, Ireland and CÚRAM, the SFI Research Centre for Medical Devices, Ireland
| | - Fergal Coulter
- School of Mechanical and Materials Engineering, UCD Centre for Biomedical Engineering, University College Dublin, Belfield, Ireland and Complex Materials, Department of Materials, ETH Zurich, Zurich, Switzerland
| | - Ellen T Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA and Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Eoin D O'Cearbhaill
- School of Mechanical and Materials Engineering, UCD Centre for Biomedical Engineering, University College Dublin, Belfield, Ireland and CÚRAM, the SFI Research Centre for Medical Devices, Ireland
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29
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Singh M, Varela CE, Whyte W, Horvath MA, Tan NCS, Ong CB, Liang P, Schermerhorn ML, Roche ET, Steele TWJ. Minimally invasive electroceutical catheter for endoluminal defect sealing. Sci Adv 2021; 7:eabf6855. [PMID: 33811080 PMCID: PMC11057783 DOI: 10.1126/sciadv.abf6855] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
Surgical repair of lumen defects is associated with periprocedural morbidity and mortality. Endovascular repair with tissue adhesives may reduce host tissue damage, but current bioadhesive designs do not support minimally invasive deployment. Voltage-activated tissue adhesives offer a new strategy for endoluminal repair. To facilitate the clinical translation of voltage-activated adhesives, an electroceutical patch (ePATCH) paired with a minimally invasive catheter with retractable electrodes (CATRE) is challenged against the repair of in vivo and ex vivo lumen defects. The ePATCH/CATRE platform demonstrates the sealing of lumen defects up to 2 millimeters in diameter on wet tissue substrates. Water-tight seals are flexible and resilient, withstanding over 20,000 physiological relevant stress/strain cycles. No disruption to electrical signals was observed when the ePATCH was electrically activated on the beating heart. The ePATCH/CATRE platform has diverse potential applications ranging from endovascular treatment of pseudo-aneurysms/fistulas to bioelectrodes toward electrophysiological mapping.
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Affiliation(s)
- Manisha Singh
- NTU-Northwestern Institute for Nanomedicine (NNIN), Interdisciplinary Graduate School (IGS), Nanyang Technological University (NTU), 50 Nanyang Drive, Singapore 637553, Singapore
- School of Materials Science and Engineering (MSE), Nanyang Technological University (NTU), Singapore 639798, Singapore
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Claudia E Varela
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA
| | - William Whyte
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA
| | - Markus A Horvath
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA
| | - Nigel C S Tan
- School of Materials Science and Engineering (MSE), Nanyang Technological University (NTU), Singapore 639798, Singapore
| | - Chee Bing Ong
- Histopathology/Advanced Molecular Pathology Lab, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology, and Research, 61 Biopolis Drive, Singapore 138673, Singapore
| | - Patric Liang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Terry W J Steele
- NTU-Northwestern Institute for Nanomedicine (NNIN), Interdisciplinary Graduate School (IGS), Nanyang Technological University (NTU), 50 Nanyang Drive, Singapore 637553, Singapore.
- School of Materials Science and Engineering (MSE), Nanyang Technological University (NTU), Singapore 639798, Singapore
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30
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Gollob SD, Park C, Koo BHB, Roche ET. A Modular Geometrical Framework for Modelling the Force-Contraction Profile of Vacuum-Powered Soft Actuators. Front Robot AI 2021; 8:606938. [PMID: 33763454 PMCID: PMC7983108 DOI: 10.3389/frobt.2021.606938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/15/2021] [Indexed: 11/18/2022] Open
Abstract
In this paper, we present a generalized modeling tool for predicting the output force profile of vacuum-powered soft actuators using a simplified geometrical approach and the principle of virtual work. Previous work has derived analytical formulas to model the force-contraction profile of specific actuators. To enhance the versatility and the efficiency of the modelling process we propose a generalized numerical algorithm based purely on geometrical inputs, which can be tailored to the desired actuator, to estimate its force-contraction profile quickly and for any combination of varying geometrical parameters. We identify a class of linearly contracting vacuum actuators that consists of a polymeric skin guided by a rigid skeleton and apply our model to two such actuators-vacuum bellows and Fluid-driven Origami-inspired Artificial Muscles-to demonstrate the versatility of our model. We perform experiments to validate that our model can predict the force profile of the actuators using its geometric principles, modularly combined with design-specific external adjustment factors. Our framework can be used as a versatile design tool that allows users to perform parametric studies and rapidly and efficiently tune actuator dimensions to produce a force-contraction profile to meet their needs, and as a pre-screening tool to obviate the need for multiple rounds of time-intensive actuator fabrication and testing.
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Affiliation(s)
- Samuel Dutra Gollob
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Clara Park
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Bon Ho Brandon Koo
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Ellen T Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
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Abstract
Scientific efforts in the field of computational modeling of cardiovascular diseases have largely focused on heart failure with reduced ejection fraction (HFrEF), broadly overlooking heart failure with preserved ejection fraction (HFpEF), which has more recently become a dominant form of heart failure worldwide. Motivated by the paucity of HFpEF in silico representations, two distinct computational models are presented in this paper to simulate the hemodynamics of HFpEF resulting from left ventricular pressure overload. First, an object-oriented lumped-parameter model was developed using a numerical solver. This model is based on a zero-dimensional (0D) Windkessel-like network, which depends on the geometrical and mechanical properties of the constitutive elements and offers the advantage of low computational costs. Second, a finite element analysis (FEA) software package was utilized for the implementation of a multidimensional simulation. The FEA model combines three-dimensional (3D) multiphysics models of the electro-mechanical cardiac response, structural deformations, and fluid cavity-based hemodynamics and utilizes a simplified lumped-parameter model to define the flow exchange profiles among different fluid cavities. Through each approach, both the acute and chronic hemodynamic changes in the left ventricle and proximal vasculature resulting from pressure overload were successfully simulated. Specifically, pressure overload was modeled by reducing the orifice area of the aortic valve, while chronic remodeling was simulated by reducing the compliance of the left ventricular wall. Consistent with the scientific and clinical literature of HFpEF, results from both models show (i) an acute elevation of transaortic pressure gradient between the left ventricle and the aorta and a reduction in the stroke volume and (ii) a chronic decrease in the end-diastolic left ventricular volume, indicative of diastolic dysfunction. Finally, the FEA model demonstrates that stress in the HFpEF myocardium is remarkably higher than in the healthy heart tissue throughout the cardiac cycle.
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Affiliation(s)
- Luca Rosalia
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology; Health Science and Technology Program, Harvard/Massachusetts Institute of Technology
| | - Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology; Health Science and Technology Program, Harvard/Massachusetts Institute of Technology; Department of Mechanical Engineering, Massachusetts Institute of Technology;
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32
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Rosalia L, Ozturk C, Van Story D, Horvath MA, Roche ET. Object‐Oriented Lumped‐Parameter Modeling of the Cardiovascular System for Physiological and Pathophysiological Conditions. Adv Theory Simul 2021. [DOI: 10.1002/adts.202000216] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Luca Rosalia
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
- Harvard‐MIT Program in Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Caglar Ozturk
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - David Van Story
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Markus A. Horvath
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
- Harvard‐MIT Program in Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Ellen T. Roche
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
- Harvard‐MIT Program in Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
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33
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Deng J, Yuk H, Wu J, Varela CE, Chen X, Roche ET, Guo CF, Zhao X. Electrical bioadhesive interface for bioelectronics. Nat Mater 2021; 20:229-236. [PMID: 32989277 DOI: 10.1038/s41563-020-00814-2] [Citation(s) in RCA: 195] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 08/26/2020] [Indexed: 05/27/2023]
Abstract
Reliable functions of bioelectronic devices require conformal, stable and conductive interfaces with biological tissues. Integrating bioelectronic devices with tissues usually relies on physical attachment or surgical suturing; however, these methods face challenges such as non-conformal contact, unstable fixation, tissue damage, and/or scar formation. Here, we report an electrical bioadhesive (e-bioadhesive) interface, based on a thin layer of a graphene nanocomposite, that can provide rapid (adhesion formation within 5 s), robust (interfacial toughness >400 J m-2) and on-demand detachable integration of bioelectronic devices on diverse wet dynamic tissues. The electrical conductivity (>2.6 S m-1) of the e-bioadhesive interface further allows bidirectional bioelectronic communications. We demonstrate biocompatibility, applicability, mechanical and electrical stability, and recording and stimulation functionalities of the e-bioadhesive interface based on ex vivo porcine and in vivo rat models. These findings offer a promising strategy to improve tissue-device integration and enhance the performance of biointegrated electronic devices.
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Affiliation(s)
- Jue Deng
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen, China
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Hyunwoo Yuk
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jingjing Wu
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen, China
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Claudia E Varela
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - Xiaoyu Chen
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ellen T Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Chuan Fei Guo
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen, China.
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
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34
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Abstract
Biosensors allow rapid, accurate, continuous measurement of glucose and insulin in live rats.
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Affiliation(s)
- Ellen T. Roche
- Department of Mechanical Engineering and Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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35
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Abstract
A self-healing microcapsule loaded with leukemia-associated antigens, epitope peptides, and PD-1 antibody demonstrates sustained delivery of a leukemia vaccine.
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Affiliation(s)
- Ellen T. Roche
- Department of Mechanical Engineering and the Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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36
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Roche ET. Catheters gain arrays of sensors and actuators. Nat Biomed Eng 2020; 4:939-940. [PMID: 33093667 DOI: 10.1038/s41551-020-00636-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
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37
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Abstract
Optogenetic stimulation of vagal preganglionic neurons preserved left ventricular ejection fraction in an experimental heart failure model.
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Affiliation(s)
- Ellen T. Roche
- Institute for Medical Engineering and Science and the Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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38
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Roche ET. Minimally Invasive Delivery of Tissue Engineered Heart Valves to the Pulmonary Annulus. JACC Basic Transl Sci 2020; 5:829-830. [PMID: 32876644 PMCID: PMC7452324 DOI: 10.1016/j.jacbts.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Ellen T. Roche
- Institute for Medical Engineering and Science and Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
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39
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Duffy GP, Robinson ST, O'Connor R, Wylie R, Mauerhofer C, Bellavia G, Straino S, Cianfarani F, Mendez K, Beatty R, Levey R, O'Sullivan J, McDonough L, Kelly H, Roche ET, Dolan EB. Therapeutic Resevoirs: Implantable Therapeutic Reservoir Systems for Diverse Clinical Applications in Large Animal Models (Adv. Healthcare Mater. 11/2020). Adv Healthc Mater 2020. [DOI: 10.1002/adhm.202070035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Horvath MA, Hu L, Mueller T, Hochstein J, Rosalia L, Hibbert KA, Hardin CC, Roche ET. An organosynthetic soft robotic respiratory simulator. APL Bioeng 2020; 4:026108. [PMID: 32566890 PMCID: PMC7286700 DOI: 10.1063/1.5140760] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/18/2020] [Indexed: 11/24/2022] Open
Abstract
In this work, we describe a benchtop model that recreates the motion and function of the diaphragm using a combination of advanced robotic and organic tissue. First, we build a high-fidelity anthropomorphic model of the diaphragm using thermoplastic and elastomeric material based on clinical imaging data. We then attach pneumatic artificial muscles to this elastomeric diaphragm, pre-programmed to move in a clinically relevant manner when pressurized. By inserting this diaphragm as the divider between two chambers in a benchtop model—one representing the thorax and the other the abdomen—and subsequently activating the diaphragm, we can recreate the pressure changes that cause lungs to inflate and deflate during regular breathing. Insertion of organic lungs in the thoracic cavity demonstrates this inflation and deflation in response to the pressures generated by our robotic diaphragm. By tailoring the input pressures and timing, we can represent different breathing motions and disease states. We instrument the model with multiple sensors to measure pressures, volumes, and flows and display these data in real-time, allowing the user to vary inputs such as the breathing rate and compliance of various components, and so they can observe and measure the downstream effect of changing these parameters. In this way, the model elucidates fundamental physiological concepts and can demonstrate pathology and the interplay of components of the respiratory system. This model will serve as an innovative and effective pedagogical tool for educating students on respiratory physiology and pathology in a user-controlled, interactive manner. It will also serve as an anatomically and physiologically accurate testbed for devices or pleural sealants that reside in the thoracic cavity, representing a vast improvement over existing models and ultimately reducing the requirement for testing these technologies in animal models. Finally, it will act as an impactful visualization tool for educating and engaging the broader community.
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41
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Duffy GP, Robinson ST, O'Connor R, Wylie R, Mauerhofer C, Bellavia G, Straino S, Cianfarani F, Mendez K, Beatty R, Levey R, O'Sullivan J, McDonough L, Kelly H, Roche ET, Dolan EB. Implantable Therapeutic Reservoir Systems for Diverse Clinical Applications in Large Animal Models. Adv Healthc Mater 2020; 9:e2000305. [PMID: 32339411 DOI: 10.1002/adhm.202000305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Indexed: 12/25/2022]
Abstract
Regenerative medicine approaches, specifically stem cell technologies, have demonstrated significant potential to treat a diverse array of pathologies. However, such approaches have resulted in a modest clinical benefit, which may be attributed to poor cell retention/survival at the disease site. A delivery system that facilitates regional and repeated delivery to target tissues can provide enhanced clinical efficacy of cell therapies when localized delivery of high doses of cells is required. In this study, a new regenerative reservoir platform (Regenervoir) is described for use in large animal models, with relevance to cardiac, abdominal, and soft tissue pathologies. Regenervoir incorporates multiple novel design features essential for clinical translation, with a focus on scalability, mechanism of delivery, fixation to target tissue, and filling/refilling with a therapeutic cargo, and is demonstrated in an array of clinical applications that are easily translated to human studies. Regenervoir consists of a porous reservoir fabricated from a single material, a flexible thermoplastic polymer, capable of delivering cargo via fill lines to target tissues. A radiopaque shear thinning hydrogel can be delivered to the therapy reservoir and multiple fixation methods (laparoscopic tacks and cyanoacrylate bioadhesive) can be used to secure Regenervoir to target tissues through a minimally invasive approach.
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Affiliation(s)
- Garry P. Duffy
- Anatomy & Regenerative Medicine Institute (REMEDI)School of Medicine, College of Medicine Nursing and Health SciencesNational University of Ireland Galway H91 W5P7 Ireland
- Advanced Materials and BioEngineering Research Centre (AMBER)Trinity College Dublin Dublin D02 PN40 Ireland
- CÚRAM, Centre for Research in Medical DevicesNational University of Ireland Galway Galway H91 TK33 Ireland
| | - Scott T. Robinson
- Anatomy & Regenerative Medicine Institute (REMEDI)School of Medicine, College of Medicine Nursing and Health SciencesNational University of Ireland Galway H91 W5P7 Ireland
- Advanced Materials and BioEngineering Research Centre (AMBER)Trinity College Dublin Dublin D02 PN40 Ireland
- Department of SurgeryUniversity of Michigan Ann Arbor MI 48109 USA
| | - Raymond O'Connor
- Anatomy & Regenerative Medicine Institute (REMEDI)School of Medicine, College of Medicine Nursing and Health SciencesNational University of Ireland Galway H91 W5P7 Ireland
| | - Robert Wylie
- Anatomy & Regenerative Medicine Institute (REMEDI)School of Medicine, College of Medicine Nursing and Health SciencesNational University of Ireland Galway H91 W5P7 Ireland
| | - Ciaran Mauerhofer
- Anatomy & Regenerative Medicine Institute (REMEDI)School of Medicine, College of Medicine Nursing and Health SciencesNational University of Ireland Galway H91 W5P7 Ireland
| | | | | | | | - Keegan Mendez
- Institute for Medical Engineering and ScienceMassachusetts Institute of Technology Cambridge MA 02139 USA
- Harvard‐MIT Program in Health Sciences and Technology Cambridge MA 02139 USA
| | - Rachel Beatty
- Anatomy & Regenerative Medicine Institute (REMEDI)School of Medicine, College of Medicine Nursing and Health SciencesNational University of Ireland Galway H91 W5P7 Ireland
- Advanced Materials and BioEngineering Research Centre (AMBER)Trinity College Dublin Dublin D02 PN40 Ireland
| | - Ruth Levey
- Anatomy & Regenerative Medicine Institute (REMEDI)School of Medicine, College of Medicine Nursing and Health SciencesNational University of Ireland Galway H91 W5P7 Ireland
| | - Janice O'Sullivan
- Anatomy & Regenerative Medicine Institute (REMEDI)School of Medicine, College of Medicine Nursing and Health SciencesNational University of Ireland Galway H91 W5P7 Ireland
| | - Liam McDonough
- School of Pharmacy and Molecular SciencesRoyal College of Surgeons in Ireland 111 St. Stephen's Green Dublin 2 D02 VN51 Ireland
- Tissue Engineering Research GroupDepartment of AnatomyRoyal College of Surgeons in Ireland 123 St. Stephen's Green Dublin 2 D02 YN77 Ireland
| | - Helena Kelly
- School of Pharmacy and Molecular SciencesRoyal College of Surgeons in Ireland 111 St. Stephen's Green Dublin 2 D02 VN51 Ireland
- Tissue Engineering Research GroupDepartment of AnatomyRoyal College of Surgeons in Ireland 123 St. Stephen's Green Dublin 2 D02 YN77 Ireland
| | - Ellen T. Roche
- Institute for Medical Engineering and ScienceMassachusetts Institute of Technology Cambridge MA 02139 USA
- Harvard‐MIT Program in Health Sciences and Technology Cambridge MA 02139 USA
- Department of Mechanical EngineeringMassachusetts Institute of Technology Cambridge MA 02139 USA
| | - Eimear B. Dolan
- Anatomy & Regenerative Medicine Institute (REMEDI)School of Medicine, College of Medicine Nursing and Health SciencesNational University of Ireland Galway H91 W5P7 Ireland
- Department of Biomedical Engineering School of Engineering, College of Science and EngineeringNational University of Ireland Galway H91 TK33 Ireland
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42
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Park C, Fan Y, Hager G, Yuk H, Singh M, Rojas A, Hameed A, Saeed M, Vasilyev NV, Steele TWJ, Zhao X, Nguyen CT, Roche ET. An organosynthetic dynamic heart model with enhanced biomimicry guided by cardiac diffusion tensor imaging. Sci Robot 2020; 5:eaay9106. [PMID: 33022595 PMCID: PMC7545316 DOI: 10.1126/scirobotics.aay9106] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/08/2020] [Indexed: 01/07/2023]
Abstract
The complex motion of the beating heart is accomplished by the spatial arrangement of contracting cardiomyocytes with varying orientation across the transmural layers, which is difficult to imitate in organic or synthetic models. High-fidelity testing of intracardiac devices requires anthropomorphic, dynamic cardiac models that represent this complex motion while maintaining the intricate anatomical structures inside the heart. In this work, we introduce a biorobotic hybrid heart that preserves organic intracardiac structures and mimics cardiac motion by replicating the cardiac myofiber architecture of the left ventricle. The heart model is composed of organic endocardial tissue from a preserved explanted heart with intact intracardiac structures and an active synthetic myocardium that drives the motion of the heart. Inspired by the helical ventricular myocardial band theory, we used diffusion tensor magnetic resonance imaging and tractography of an unraveled organic myocardial band to guide the design of individual soft robotic actuators in a synthetic myocardial band. The active soft tissue mimic was adhered to the organic endocardial tissue in a helical fashion using a custom-designed adhesive to form a flexible, conformable, and watertight organosynthetic interface. The resulting biorobotic hybrid heart simulates the contractile motion of the native heart, compared with in vivo and in silico heart models. In summary, we demonstrate a unique approach fabricating a biomimetic heart model with faithful representation of cardiac motion and endocardial tissue anatomy. These innovations represent important advances toward the unmet need for a high-fidelity in vitro cardiac simulator for preclinical testing of intracardiac devices.
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Affiliation(s)
- Clara Park
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Gregor Hager
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Mechanical Engineering, Technical University of Munich, Munich, Germany
| | - Hyunwoo Yuk
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- NTU-Northwestern Institute for Nanomedicine, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
| | - Allison Rojas
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Aamir Hameed
- Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Mossab Saeed
- Harvard Medical School, Boston, MA, USA
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Nikolay V Vasilyev
- Harvard Medical School, Boston, MA, USA
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Terry W J Steele
- NTU-Northwestern Institute for Nanomedicine, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christopher T Nguyen
- Harvard Medical School, Boston, MA, USA.
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA, USA
| | - Ellen T Roche
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
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43
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Dolan EB, Varela CE, Mendez K, Whyte W, Levey RE, Robinson ST, Maye E, O'Dwyer J, Beatty R, Rothman A, Fan Y, Hochstein J, Rothenbucher SE, Wylie R, Starr JR, Monaghan M, Dockery P, Duffy GP, Roche ET. An actuatable soft reservoir modulates host foreign body response. Sci Robot 2019; 4:4/33/eaax7043. [PMID: 33137787 DOI: 10.1126/scirobotics.aax7043] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/01/2019] [Indexed: 12/18/2022]
Abstract
The performance of indwelling medical devices that depend on an interface with soft tissue is plagued by complex, unpredictable foreign body responses. Such devices-including breast implants, biosensors, and drug delivery devices-are often subject to a collection of biological host responses, including fibrosis, which can impair device functionality. This work describes a milliscale dynamic soft reservoir (DSR) that actively modulates the biomechanics of the biotic-abiotic interface by altering strain, fluid flow, and cellular activity in the peri-implant tissue. We performed cyclical actuation of the DSR in a preclinical rodent model. Evaluation of the resulting host response showed a significant reduction in fibrous capsule thickness (P = 0.0005) in the actuated DSR compared with non-actuated controls, whereas the collagen density and orientation were not changed. We also show a significant reduction in myofibroblasts (P = 0.0036) in the actuated group and propose that actuation-mediated strain reduces differentiation and proliferation of myofibroblasts and therefore extracellular matrix production. Computational models quantified the effect of actuation on the reservoir and surrounding fluid. By adding a porous membrane and a therapy reservoir to the DSR, we demonstrate that, with actuation, we could (i) increase transport of a therapy analog and (ii) enhance pharmacokinetics and time to functional effect of an inotropic agent. The dynamic reservoirs presented here may act as a versatile tool to further understand, and ultimately to ameliorate, the host response to implantable biomaterials.
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Affiliation(s)
- E B Dolan
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland.,Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C E Varela
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - K Mendez
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - W Whyte
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.,Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - R E Levey
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - S T Robinson
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Maye
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J O'Dwyer
- Biomedical Engineering, College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland.,Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - R Beatty
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - A Rothman
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Y Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - J Hochstein
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, USA
| | - S E Rothenbucher
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - R Wylie
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J R Starr
- Epidemiology and Biostatistics Core, The Forsyth Institute, 245 First Street, Cambridge, MA, USA
| | - M Monaghan
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - P Dockery
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland.,CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - G P Duffy
- Anatomy and Regenerative Medicine Institute (REMEDI), School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland. .,Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland.,Advanced Materials and BioEngineering Research Centre (AMBER), Trinity College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - E T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
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44
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Shirazi RN, Islam S, Weafer FM, Whyte W, Varela CE, Villanyi A, Ronan W, McHugh P, Roche ET. Multiscale Computational Modeling: Multiscale Experimental and Computational Modeling Approaches to Characterize Therapy Delivery to the Heart from an Implantable Epicardial Biomaterial Reservoir (Adv. Healthcare Mater. 16/2019). Adv Healthc Mater 2019. [DOI: 10.1002/adhm.201970068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Reyhaneh Neghabat Shirazi
- Discipline of Biomedical Engineering, College of Engineering and Informatics(NUI Galway) Galway H91 HX31 Ireland
| | - Shahrin Islam
- Department of Mechanical EngineeringMassachusetts Institute of Technology Cambridge MA 02139 USA
- Institute for Medical Engineering and ScienceMassachusetts Institute of Technology Cambridge MA 02139 USA
| | - Fiona M. Weafer
- Discipline of Biomedical Engineering, College of Engineering and Informatics(NUI Galway) Galway H91 HX31 Ireland
| | - William Whyte
- Institute for Medical Engineering and ScienceMassachusetts Institute of Technology Cambridge MA 02139 USA
| | - Claudia E. Varela
- Institute for Medical Engineering and ScienceMassachusetts Institute of Technology Cambridge MA 02139 USA
| | - Agnes Villanyi
- Institute for Medical Engineering and ScienceMassachusetts Institute of Technology Cambridge MA 02139 USA
| | - William Ronan
- Discipline of Biomedical Engineering, College of Engineering and Informatics(NUI Galway) Galway H91 HX31 Ireland
| | - Peter McHugh
- Discipline of Biomedical Engineering, College of Engineering and Informatics(NUI Galway) Galway H91 HX31 Ireland
| | - Ellen T. Roche
- Discipline of Biomedical Engineering, College of Engineering and Informatics(NUI Galway) Galway H91 HX31 Ireland
- Department of Mechanical EngineeringMassachusetts Institute of Technology Cambridge MA 02139 USA
- Institute for Medical Engineering and ScienceMassachusetts Institute of Technology Cambridge MA 02139 USA
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45
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Shirazi RN, Islam S, Weafer FM, Whyte W, Varela CE, Villanyi A, Ronan W, McHugh P, Roche ET. Multiscale Experimental and Computational Modeling Approaches to Characterize Therapy Delivery to the Heart from an Implantable Epicardial Biomaterial Reservoir. Adv Healthc Mater 2019; 8:e1900228. [PMID: 31322319 DOI: 10.1002/adhm.201900228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/07/2019] [Indexed: 02/05/2023]
Abstract
Delivery of therapeutic-laden biomaterials to the epicardial surface of the heart presents a promising method of treating a variety of diseased conditions by offering targeted, localized release with limited systemic recirculation and enhanced myocardial tissue uptake. A vast range of biomaterials and therapeutic agents using this approach been investigated. However, the fundamental factors that govern transport of the drug molecules from the biomaterials to the tissue are not well understood. Here, the transport of a drug analog from a biomaterial reservoir to the epicardial surface is characterized using experimental techniques and microscale modeling. Using the experimentally determined parameters, a multiscale model of transport is developed. The model is then used to study the effect of important design parameters such as loading conditions, biomaterial geometry, and orientation relative to the cardiac fibers on drug delivery to the myocardium. The simulations highlight the significance of the cardiac fiber anisotropy as a crucial factor in governing drug distribution on the epicardial surface and limiting factor for penetration into the myocardium. The multiscale model can be useful for rapid iteration of different device concepts and for determination of designs for epicardial drug delivery that may be optimal and most promising for the ultimate therapeutic goal.
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Affiliation(s)
- Reyhaneh Neghabat Shirazi
- Discipline of Biomedical Engineering, College of Engineering and Informatics(NUI Galway) Galway H91 HX31 Ireland
| | - Shahrin Islam
- Department of Mechanical EngineeringMassachusetts Institute of Technology Cambridge MA 02139 USA
- Institute for Medical Engineering and ScienceMassachusetts Institute of Technology Cambridge MA 02139 USA
| | - Fiona M. Weafer
- Discipline of Biomedical Engineering, College of Engineering and Informatics(NUI Galway) Galway H91 HX31 Ireland
| | - William Whyte
- Institute for Medical Engineering and ScienceMassachusetts Institute of Technology Cambridge MA 02139 USA
| | - Claudia E. Varela
- Institute for Medical Engineering and ScienceMassachusetts Institute of Technology Cambridge MA 02139 USA
| | - Agnes Villanyi
- Institute for Medical Engineering and ScienceMassachusetts Institute of Technology Cambridge MA 02139 USA
| | - William Ronan
- Discipline of Biomedical Engineering, College of Engineering and Informatics(NUI Galway) Galway H91 HX31 Ireland
| | - Peter McHugh
- Discipline of Biomedical Engineering, College of Engineering and Informatics(NUI Galway) Galway H91 HX31 Ireland
| | - Ellen T. Roche
- Discipline of Biomedical Engineering, College of Engineering and Informatics(NUI Galway) Galway H91 HX31 Ireland
- Department of Mechanical EngineeringMassachusetts Institute of Technology Cambridge MA 02139 USA
- Institute for Medical Engineering and ScienceMassachusetts Institute of Technology Cambridge MA 02139 USA
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Varela CE, Fan Y, Roche ET. Optimizing Epicardial Restraint and Reinforcement Following Myocardial Infarction: Moving Towards Localized, Biomimetic, and Multitherapeutic Options. Biomimetics (Basel) 2019; 4:E7. [PMID: 31105193 PMCID: PMC6477619 DOI: 10.3390/biomimetics4010007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/31/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
The mechanical reinforcement of the ventricular wall after a myocardial infarction has been shown to modulate and attenuate negative remodeling that can lead to heart failure. Strategies include wraps, meshes, cardiac patches, or fluid-filled bladders. Here, we review the literature describing these strategies in the two broad categories of global restraint and local reinforcement. We further subdivide the global restraint category into biventricular and univentricular support. We discuss efforts to optimize devices in each of these categories, particularly in the last five years. These include adding functionality, biomimicry, and adjustability. We also discuss computational models of these strategies, and how they can be used to predict the reduction of stresses in the heart muscle wall. We discuss the range of timing of intervention that has been reported. Finally, we give a perspective on how novel fabrication technologies, imaging techniques, and computational models could potentially enhance these therapeutic strategies.
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Affiliation(s)
- Claudia E Varela
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA.
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Yiling Fan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Ellen T Roche
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA.
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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48
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Roche ET, Horvath MA, Wamala I, Alazmani A, Song SE, Whyte W, Machaidze Z, Payne CJ, Weaver JC, Fishbein G, Kuebler J, Vasilyev NV, Mooney DJ, Pigula FA, Walsh CJ. Soft robotic sleeve supports heart function. Sci Transl Med 2018; 9:9/373/eaaf3925. [PMID: 28100834 DOI: 10.1126/scitranslmed.aaf3925] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 12/23/2016] [Indexed: 12/19/2022]
Abstract
There is much interest in form-fitting, low-modulus, implantable devices or soft robots that can mimic or assist in complex biological functions such as the contraction of heart muscle. We present a soft robotic sleeve that is implanted around the heart and actively compresses and twists to act as a cardiac ventricular assist device. The sleeve does not contact blood, obviating the need for anticoagulation therapy or blood thinners, and reduces complications with current ventricular assist devices, such as clotting and infection. Our approach used a biologically inspired design to orient individual contracting elements or actuators in a layered helical and circumferential fashion, mimicking the orientation of the outer two muscle layers of the mammalian heart. The resulting implantable soft robot mimicked the form and function of the native heart, with a stiffness value of the same order of magnitude as that of the heart tissue. We demonstrated feasibility of this soft sleeve device for supporting heart function in a porcine model of acute heart failure. The soft robotic sleeve can be customized to patient-specific needs and may have the potential to act as a bridge to transplant for patients with heart failure.
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Affiliation(s)
- Ellen T Roche
- School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA.,Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA.,Discipline of Biomedical Engineering, College of Engineering and Informatics, National University of Ireland, Galway, Ireland
| | - Markus A Horvath
- School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA.,Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA.,Technische Universität München, Boltzmannstraße 15, 85748 Garching, Germany
| | - Isaac Wamala
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Ali Alazmani
- School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA.,Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA.,Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.,School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, U.K
| | - Sang-Eun Song
- School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA.,Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA.,Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816, USA
| | - William Whyte
- School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA.,Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA.,Advanced Materials and Bioengineering Research Centre, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
| | - Zurab Machaidze
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Christopher J Payne
- School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA.,Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA
| | - James C Weaver
- Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA
| | - Gregory Fishbein
- Department of Anatomic and Clinical Pathology, Ronald Reagan UCLA (University of California, Los Angeles) Medical Center, Los Angeles, CA 90095, USA
| | - Joseph Kuebler
- Department of Cardiology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Nikolay V Vasilyev
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - David J Mooney
- School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA.,Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA
| | - Frank A Pigula
- Department of Cardiac Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. .,Cardiovascular Surgery, School of Medicine, University of Louisville, Louisville, KY 40202, USA
| | - Conor J Walsh
- School of Engineering and Applied Sciences, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA. .,Wyss Institute for Biologically Inspired Engineering, 3 Blackfan Circle, Longwood, Boston, MA 02115, USA
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Abstract
INTRODUCTION Robots have been employed in cardiovascular therapy as surgical tools and for automation of hospital systems. Soft robots are a new kind of robot made of soft deformable materials, that are uniquely suited for biomedical applications because they are inherently less likely to injure body tissues and more likely to adapt to biological environments. Awareness of the soft robotic systems under development will help promote clinician involvement in their successful clinical translation. Areas covered: The most advanced soft robotic systems, across the size scale from nano to macro, that have shown the most promise for clinical application in cardiovascular therapy because they offer solutions where a clear therapeutic need still exists. We discuss nano and micro scale technology that could help improve targeted therapy for cardiac regeneration in ischemic heart disease, and soft robots for mechanical circulatory support. Additionally, we suggest where the gaps in the technology currently lie. Expert commentary: Soft robotic technology has now matured from the proof-of-concept phase to successful animal testing. With further refinement in materials and clinician guided application, they will be a useful complement for cardiovascular therapy.
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Affiliation(s)
- Isaac Wamala
- a Klinik für Herz- , Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin , Berlin , Germany
| | - Ellen T Roche
- b Discipline of Biomedical Engineering , College of Engineering and Informatics, National University of Ireland , Galway , Ireland
| | - Frank A Pigula
- c Rudd Heart and Lung Center , University of Louisville - Jewish Hospital , Louisville , USA
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50
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Payne CJ, Wamala I, Abah C, Thalhofer T, Saeed M, Bautista-Salinas D, Horvath MA, Vasilyev NV, Roche ET, Pigula FA, Walsh CJ. An Implantable Extracardiac Soft Robotic Device for the Failing Heart: Mechanical Coupling and Synchronization. Soft Robot 2017; 4:241-250. [PMID: 29182083 DOI: 10.1089/soro.2016.0076] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Soft robotic devices have significant potential for medical device applications that warrant safe synergistic interaction with humans. This article describes the optimization of an implantable soft robotic system for heart failure whereby soft actuators wrapped around the ventricles are programmed to contract and relax in synchrony with the beating heart. Elastic elements integrated into the soft actuators provide recoiling function so as to aid refilling during the diastolic phase of the cardiac cycle. Improved synchronization with the biological system is achieved by incorporating the native ventricular pressure into the control system to trigger assistance and synchronize the device with the heart. A three-state electro-pneumatic valve configuration allows the actuators to contract at different rates to vary contraction patterns. An in vivo study was performed to test three hypotheses relating to mechanical coupling and temporal synchronization of the actuators and heart. First, that adhesion of the actuators to the ventricles improves cardiac output. Second, that there is a contraction-relaxation ratio of the actuators which generates optimal cardiac output. Third, that the rate of actuator contraction is a factor in cardiac output.
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Affiliation(s)
- Christopher J Payne
- 1 John A. Paulson Harvard School of Engineering and Applied Science, Harvard University , Cambridge, Massachusetts
- 2 Wyss Institute for Biologically Inspired Engineering, Harvard University , Cambridge, Massachusetts
| | - Isaac Wamala
- 3 Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Colette Abah
- 1 John A. Paulson Harvard School of Engineering and Applied Science, Harvard University , Cambridge, Massachusetts
- 2 Wyss Institute for Biologically Inspired Engineering, Harvard University , Cambridge, Massachusetts
| | - Thomas Thalhofer
- 1 John A. Paulson Harvard School of Engineering and Applied Science, Harvard University , Cambridge, Massachusetts
- 2 Wyss Institute for Biologically Inspired Engineering, Harvard University , Cambridge, Massachusetts
- 4 Department of Mechanical Engineering, Technical University of Munich , Munich, Germany
| | - Mossab Saeed
- 3 Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | | | - Markus A Horvath
- 1 John A. Paulson Harvard School of Engineering and Applied Science, Harvard University , Cambridge, Massachusetts
- 2 Wyss Institute for Biologically Inspired Engineering, Harvard University , Cambridge, Massachusetts
- 5 Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology , Cambridge, Massachusetts
| | - Nikolay V Vasilyev
- 3 Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Ellen T Roche
- 1 John A. Paulson Harvard School of Engineering and Applied Science, Harvard University , Cambridge, Massachusetts
- 2 Wyss Institute for Biologically Inspired Engineering, Harvard University , Cambridge, Massachusetts
- 6 Discipline of Biomedical Engineering, College of Engineering and Informatics, National University of Ireland , Galway, Ireland
| | - Frank A Pigula
- 3 Boston Children's Hospital , Harvard Medical School, Boston, Massachusetts
- 7 Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine , Louisville, Kentucky
| | - Conor J Walsh
- 1 John A. Paulson Harvard School of Engineering and Applied Science, Harvard University , Cambridge, Massachusetts
- 2 Wyss Institute for Biologically Inspired Engineering, Harvard University , Cambridge, Massachusetts
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