What if doctors could — right in their office — detect and destroy the very first malignant cells that were going to cause cancer in your breast? What if — in a simple procedure — surgeons could inject you with millions of single-cell vacuum cleaners that would scour through your body, "eating" and "digesting" the plaque clogging your arteries and then dump it into your bloodstream as harmless waste to be carried to your kidneys and eliminated? What if tiny "factories" could be implanted in the pancreas of your diabetic child to manufacture and deliver the blood sugar-lowering insulin her own body can't produce?
For more information on the super-small world of nanomedicine:
"Nanotechnology: A gentle introduction to the next big idea," by Mark Ratner and Daniel Ratner
"The Next Big Think Is Really Small," by Jack Uldrich and Deb Newberry
"Unbounding the Future," by Erick Drexler and Chris Peterson
"Understanding Nanotechnology," by the editors of Scientific American
Bioengineering Consortium, www.becon2.nih.gov/nano.htm
Foresight Institute, www.foresight.org/nanomedicine
Nano Network (Cleveland-based), www.nano-network.org
National Nanotechnology Initiative, www.nano.gov
Ohio MicroElectro Mechanical Systems Association, www.ohiomems.org
Small Times Magazine (follows the nanotechnology industry), www.smalltimes.com
The Maple Fund (focuses on nanotechnological innovation), www.maplefund.com
None of the above scenarios are mere wishful thinking or science fiction.
These close encounters of a medical kind are a major goal of nanotechnology, a subatomic blending of physics, chemistry, engineering and biology that will revolutionize the way we live. Nanomedicine is an arm of nanotechnology that's going to revolutionize health care.
A big part of this revolution is occurring in the Cleveland area. "The major medical and academic institutions [here] are heavily involved and invested in the kind of nano-scale research — in cell biology, engineering, computer science, genetics — that's going to produce [these new technologies]," says Dr. Joe Nadeau, head of the department of genetics at Case School of Medicine and co-director of its Center for Computational Genomics and Systems Biology.
From small to super-small
Previous microlevel research here (if you can see it with a microscope, it's microlevel research) gave the world miniaturized or motorized surgical tools, minimally invasive surgery and palm-sized pacemakers. Today's research has taken a quantum leap into the world of the super-small.
How small is "super-small"?
Line up 10 hydrogen atoms — the smallest known atoms — and you'll approximate the length of one nanometer. Stretch a meter stick from New York City to Los Angeles and you could actually see a nanometer: It would be about the size of an aspirin.
"One nanometer is one-billionth of a meter; that's about 1/80,000th the width of a human hair. Or, to put another way, 1/10,000th of an inch is about 2,500 nanometers," explains Dr. Shuvo Roy, co-founder of The Cleveland Clinic's BioMicro Electro Mechanical Systems (BioMEMS) Lab and a nationally recognized expert in all things small. (As such, he helped coordinate the two-day NanoMedicine Summit and one-day National Cancer Institute Nanotechnology and Cancer Seminar held at The Clinic last month.)
Nanomedicine involves breaking down elements — atoms, proteins, synthetic polymers and so on — to change their characteristics, then reconfiguring the resulting bits and pieces, called nanoparticles, to create nano-sized devices, drugs and other materials that can treat, cure or repair tissue at the cellular level.
Most human cells are between 10,000 and 20,000 nanometers in diameter, with membrane coverings that have pores between 100 and 200 nanometers in diameter. Drugs and devices less than 100 nanometers in diameter are going to be able to get inside cells; glom on to the targeted proteins, enzymes, genes or whatever is causing a problem; and do their job. Devices or therapies that don't need to work inside cells can be larger in diameter. They could attach to the surface of targeted cells or cell clusters and carry larger and/or multiple payloads.
While nanomedical research here is going on in just about every clinical arena, it's farther ahead in some areas than others.
Disease detection is one aspect where research is more advanced. Many researchers are looking at, and some have even found, ways to create disease-specific sensors or tags. These detectors, coated with proteins or other materials that cause them to latch on to a diseased cell, can be "read" outside the body.
"When they are perfected, diagnosis is going to become more [tissue] specific and there is going to be much faster turnaround on tests," says Roy. "Ultimately, tests that had to be sent out to a lab are going to be done right in the doctor's office."
Tremendous effort is also being devoted to "targeted" drug delivery. Employing the same technologies used to create the sensors and tags, researchers are developing drugs and drug-delivery containers to combat everything from cystic fibrosis to AIDS to cancer. The containers will target only bad cells because they'll be coated with materials that will allow them to land only on the cells they were meant for or to release their drug load only under specific conditions.
Targeted drug delivery is going to revolutionize the treatment of cancer. "When you can target your therapy to specific cells, you are not destroying other tissue," explains Dr. Derek Raghavan, head of The Cleveland Clinic's Taussig Cancer Center. "And because you know where and when the treatment has arrived, you can measure how it's working — or if it's working."
Research in Northeast Ohio isn't just focused on drug delivery. Headquartered in Cleveland, Ferro Corp., a longtime producer of ceramic and porcelain coatings, is doing research on nanoparticle coatings for use in drug containers.
And work isn't focused solely on prescription medications. Cleveland-based Five Star Technologies is using processes based on local research to manufacture an over-the-counter cough syrup and a throat spray that "work" better because they're nano-engineered.
"These are just the first of a series of products that we are developing that fit into the health-care and personal-care markets," says Five Star president and CEO Jim Mazzella.
Another promising area of research is tissue engineering, the use of nanoscaffolding or templates to help damaged body tissues repair or rebuild themselves. The BioMEMS Lab is working specifically on a nano-engineered scaffolding that will help repair bone breaks faster and/or restore bone loss.
"This research is really going to help older people and postmenopausal women," says Roy.
With a bit of retooling, many of the abovementioned devices might even be turned into super-small repairmen (nanobots, some call them) that could bring along their own materials (genes, cell molecules, enzyme particles) to perform repairs that could untangle the neurospaghetti that causes Alzheimer's disease or replant dead retinal cones and rods to restore eyesight.
What effect will the research bubbling away in local and national labs have when it finally hits doctors' offices in Northeast Ohio?
"Every area of medicine — imaging, diagnosis, treatment — is going to become a lot less invasive," predicts Roy. "Every field of medicine, whether it's oncology or psychiatry, is going to benefit from it. But if I had to pick the one [area] that's going to benefit the most, at least initially, I'd have to say it's cancer."
Not just for sick people
The groundbreaking nanomedical research taking place in Northeast Ohio isn't going to have a positive impact only on the region's physical health; it's going to have a salubrious effect on our fiscal health, too.
Northeast Ohio has the potential to become a nanomedicine powerhouse, similar to Boston, San Francisco or Baltimore, according to Dr. Mary Jane Saunders, director of the Biomedical and Health Institute at Cleveland State University and a former administrator with the National Science Foundation.
"We have basic strengths in three important areas — medicine, manufacturing and materials production — where people understand what nanotechnology is," points out Cleveland-based Mark Brandt, managing partner of The Maple Fund, a venture-capital firm specializing in early stage nanotechnology investment.
Putting on another hat — that of founder of Nano-Network, a consortium promoting nanotechnology in Northeast Ohio — Brandt adds, "By connecting researchers, executives and financiers interested in nanotechnology, we've fostered new collaborations and accelerated research efforts. -- That has increased awareness of the important role of nanotechnology here and expanded the region's capacity to support research and commercialization efforts."
Saunders says that means "there is now tremendous potential for spin-off start-up companies … and the potential to get real products, based on research, out into the market rapidly."
Lack of investment money isn't holding things up, locally or nationally. In fact, because of the aging population, investors see nanomedicine as a sure bet. Also, the federal government is funding nanomedical research lavishly due to its potential security applications.
Yet, things aren't moving as fast as they might. It takes time, skill and nanotools to design and assemble, molecule by molecule, nanodevices, drugs and therapies — and then there's the time it takes for new products to receive FDA approval. "A lot of the stuff that's ready to come out of [research] labs right now isn't going to be available for five or 10 years," notes Brandt.
Also holding things up is lack of consensus on important issues: how and which doctors will use nanodevices, how much nanotherapies will cost, who will be eligible for them and who won't, et cetera. Debate on those issues is often skirted right now.
"There is going to have to be a lot of education about it. Most of us [doctors] grew up in a micromedical world and medicine is practiced differently on the nanoscale," says pediatrician-researcher Dr. Pamela B. Davis, a professor working in genetic therapies at Case School of Medicine.
Yet another stumbling block is the mixed message people are getting about nanomedicine, says Dr. Laura Siminoff, a professor of bioethics working in the area of nanotechnology at Case School of Medicine. "People hear the promise — the hype that is marketing, that gets funding — for nanotechnology and think it's going to be here soon. What my colleagues — chemists, engineers, physicists — are saying is that we are at least a decade away from seeing what this can really do."
Citing Michael Crichton's popular thriller "Prey" — about dronelike nanobots that go on a rampage against the human race — she adds that "hype" goes the other way, too.
"This is not nanobots vs. the best thing since sliced bread. Nanotechnology has risks and benefits," Siminoff says. "Our challenge is to better understand the technology now, so that we can acknowledge the risks and get the word out about both."