With the aging of the baby boomer generation and improving life expectancy, our nation is experiencing a seismic demographic shift. So the launch this year of the new Johns Hopkins Engineering Aging Alliance couldn’t be timelier. Based at Johns Hopkins Bayview Medical Center, it will bring together student engineers to work in “innovation incubators” with students from the schools of Nursing, Public Health, and Medicine, guided by clinician-mentors from the School of Medicine. The vision: to break down existing silos so that clinicians can identify the health problems their aging patients face and engineers can come up with carefully tailored solutions—solutions that will move quickly into pilot studies and clinical trials.
Much of the new work will build on existing research advances at the Whiting School in areas such as artificial intelligence, image recognition, machine vision, and chemical and biomolecular engineering. In the briefs that follow, we capture just some of ways that Johns Hopkins engineers are already laying the groundwork for a happier, healthier old age.
A Leg Up on Hip Fractures
Hip fractures can be deadly for older adults; the one-year mortality rate after sustaining a hip fracture has been estimated to be 23%. One proposed method to prevent hip fractures in patients with osteoporosis is to strengthen the femur by injecting it with bone cement, a procedure known as femoroplasty. Led by Russell Taylor (CS) and Mehran Armand (MechE), Johns Hopkins researchers are developing robotic technology that will allow surgeons to personalize surgical plans for femoroplasty patients. A major innovation of their prototype is an enhanced vision system that offers multiple views of the femur for preoperative planning.
While an early diagnosis of Parkinson’s disease provides the greatest potential benefits for therapies that may slow or stop the disease’s progression and improve a patient’s quality of life, identifying early PD remains a challenging task. Clinical diagnosis is based mainly on a physician’s assessment of motor signs, including changes to the voice—changes that often are observable only years after significant neurological damage already has occurred. Najim Dehak (ECE) and his team are working with neurologists to enable accurate, early diagnosis of PD using speech processing and machine learning tools capable of identifying PD-specific changes to speech that cannot be perceived by the human ear. Already, using this technology, the researchers can identify PD with 94% accuracy.
Getting Moving Before Surgery
Major surgery puts older patients at high risk of complications. While preliminary studies indicate that physical conditioning before surgery leads to fewer complications, shorter recoveries, and lower costs, such findings have been compromised by unreliable data gathering and compliance, notes Anton Dahbura (CS). With colleagues from the School of Medicine, he developed a platform for gathering accurate patient activity data via wearable monitors and sharing this information with patients. In a current study, he is investigating whether data feedback impacts patients’ presurgical activity levels and if there is an association between the frequency, duration, and timing of presurgical activity and clinical outcomes.
An App for Parkinson’s
A difficulty doctors face in helping patients effectively manage Parkinson’s disease is that symptoms fluctuate—worse one day, better the next. A smartphone app developed by Suchi Saria (CS) could help doctors get a more accurate picture of patient symptoms over time. Patients daily complete five tasks that evaluate their gait, voice, finger movement, balance, and reaction time, and the app uses a novel machine learning approach to calculate a score. Doctors hope this precise and detailed data will inform more effective and individualized treatment for patients with PD.
Swimming with Bandit the Dolphin
After a stroke, many patients suffer from weakness on one side of their body. But there appears to be a window of time when the brain can trigger a phase of self-repair. Could Bandit the dolphin help in that recovery process? John Krakauer and Omar Ahmad, founders of the KATA Design studio in Neurology, along with their collaborators, have shown that it can. They have developed an immersive, interactive video game that uses a novel form of animation combined with exploratory arm movements and varying levels of cognitive challenge to rehabilitate arm and hand movement following stroke. Recently, the researchers took Bandit from the hospital rehab setting and into the community with a clinical trial involving healthy older people to see whether those who play the game see improvement in their cognitive and physical health.
Hearts in Space
Beating heart tissues—contained in a specially designed tissue chip the size of a small cellphone—spent about a month at the International Space Station last spring as part of a research project led by Deok-Ho Kim (BME). Space’s low-gravity environment can cause changes in the human body that are similar to accelerated aging processes, which allowed Kim and colleagues to study age-related heart conditions—conditions that might take years to develop on Earth. “We hope the results can help us better understand and someday counteract the aging process,” says Kim, whose team used human induced pluripotent stem cells to grow the heart muscle cells in a bioengineered chip that mimics the function of the adult human heart. In their work’s second phase, the researchers hope to send heart tissues back to the ISS in about two years to test a variety of drugs “to see which ones will best ameliorate the potentially harmful effects of microgravity on cardiac function,” says Johns Hopkins postdoctoral fellow Jonathan Tsui.
Biomarker for Brain Atrophy
While cerebral atrophy can be a normal part of the aging process, abnormal cerebral atrophy can signal the presence of debilitating neurological diseases, including Alzheimer’s, Parkinson’s, and Huntington’s. Because early and accurate diagnosis is key to managing all of these conditions, being able to differentiate between normal and abnormal atrophy is important. Jerry Prince (ECE) has developed ACAPULCO, a program that can automatically and precisely measure regional cerebellar volumes. “It will enable us to establish a baseline from which disease could be assessed,” Prince says. “It will be added to the ‘arsenal’ of imaging biomarkers that are used routinely to both diagnose and assess treatment.”
Earlier Clues to Alzheimer’s
An estimated 5.7 million people over age 65 in the United States are living with the devastation of Alzheimer’s disease, and the quest for a cure has been elusive. Early detection could help people better prepare and even guide potential treatments, note Michael Miller (BME) and Laurent Younes (AMS), who are investigating ways to detect Alzheimer’s risk in patients before symptoms—such as cognitive impairment—appear. By combining brain MRI data and cerebrospinal fluid analysis with cognitive testing, they have identified significant change points that precede symptom onset, including biochemical and anatomic changes. These can present a decade or more before clinical symptoms are observed.
Tissue Mechanics and Rejuvenations
As we age, our tissues not only change their strength and elasticity but also lose their ability to heal, which could ultimately lead to tissue dysfunction. Researchers like Sharon Gerecht (ChemBE) study how the aging extracellular matrix —the complex network into which cells reside in all tissues and organs—regulates cell behavior, ultimately leading to tissue dysfunction. The team is focusing on understanding how these processes impact the function of the blood vessels throughout our body. The researchers engineer biomaterials with altered structural and mechanical properties and interface them with human stem cells to recapitulate aging tissue in the lab. They aim to identify therapeutic targets and develop stem cell grafts to slow (or even reverse) the ravages of aging on our tissues.
Going to the Wall
Older adults are at greater risk of many eye diseases and ailments, including cataracts, macular degeneration, and glaucoma. Understanding the biomechanical mechanisms that drive these age-related eye conditions will bring researchers closer to developing better treatment options, notes Vicky Nguyen (MechE). To this end, she is using a combination of experimental methods and computational modeling to characterize the effects of age and disease on various eye structures. A current study led by Nguyen aims to measure the strain response to pressure of the optic nerve head, a key contributor to glaucoma. Insights from this work are guiding the development of new therapeutic interventions for glaucoma that alter the mechanical properties of the eye wall to slow the progression of optic nerve damage.
When Cells Go Wrong
Some 70% of cancer deaths occur in people older than 65, and advancing age is a risk factor for diseases ranging from cardiovascular disorders and diabetes to arthritis. But why? What is it about aging that makes people susceptible to disease? Denis Wirtz (ChemBE), an expert in the molecular and biophysical mechanisms of cell motility and nuclear dynamics, is delving into the role that cellular dysfunction plays in the aging process. His goal is to tease apart what is happening at the cellular level to identify biomarkers that predict the onset of aging-related disorders so therapies can eventually mitigate them.
A Window into Disease
As cells age, they accumulate genetic and molecular changes that lead to dysfunctions and manifest as disease. Jude Phillip (BME), a researcher in the Institute for NanoBioTechnology, investigates how these changes set the groundwork for disease development, including cancer and frailty. “As integrators of molecular signals, cells offer a unique window into disease biology,” Phillip says. With a better understanding of the structures and behaviors of aging cells, Phillip aims to develop strategies and technologies to target, delay, and mitigate aging’s harmful effects, modifying aging’s unhealthy trajectory.