[SHAPE YOUR FUTURE]

(Slam) Ow!
As anyone who’s stubbed a toe in the dark
or spent an hour searching for their keys knows
we're often limited by what we can or cannot see.
In fact, even our own bodies can be black boxes.
Today, I want to take you through a vision of health care
that scientists and engineers, myself included, are building.
We are creating a diagnostic lab inside your body
that can provide a continuous analysis of your health
so that we can better see what's happening in patients.
Currently, if someone is sick,
we may diagnose them by using a biopsy
to bring disease tissue outside the body where we can see it.
We do this if we suspect, for instance, that a growth might be cancerous.
Unfortunately, this approach can't work all the time
because of two major problems.
First, some tissues, like brains or spinal cords,
can't be routinely biopsied.
And second, doctors often don't know which tissue is causing the problem,
so they don't know what to biopsy.
So far, we've dealt with these issues using external medical tests,
like MRIs or blood tests.
These provide a broad overview of the health of a patient,
but they can't see the molecular and cellular changes
that occur within tissues,
and they certainly can't provide enough information
to proactively treat patients before symptoms develop.
This is unfortunate
because it's these invisible changes that ultimately cause disease.
Our inability to measure these changes
results in a disparity between what we can see on a test
and what we know is happening in patients.
Let's take multiple sclerosis as an example.
In MS, which is an autoimmune disease,
the immune system attacks two specific tissues:
the brain and the spinal cord,
resulting in damage and in some cases, paralysis.
Now, we obviously can't catch MS by routinely biopsying people's brains,
where there would be abundant and active disease-inducing cells.
And we can't catch it using a blood test
because the MS-inducing cells are so rare and inactive in the blood
that we simply can't see them.
Even brain imaging technologies like MRI can't provide the information we need
to be proactive about MS.
So we need to rethink how we see.
My coworkers at the University of Michigan and I decided to do just that.
Instead of taking an outside-in approach to diagnostics,
we're taking an inside-out approach.
We are creating implantable sites
that have similarities to other sites in the body,
and will improve our vision by giving us real-time access
to molecular and cellular information about diseased tissues.
These insights will enable us to predict the onset of disease
and even identify therapies likely to work in an individual patient.
So what does this inside-out approach look like?
Step one is to engineer new tissues just under the skin.
These tissues have similarities to other inaccessible sites in the body,
like the brain or the lungs.
By implanting a porous plastic disk made of FDA-approved biomaterials,
I can harness the body's natural responses to allow cells to migrate into the disk,
survive at the site and form a tissue.
Eventually, we're left with an engineered tissue
with integrated immune cells,
just the cells we need for diagnosis.
Although these tissues are complex and chronically inflamed,
they're also innocuous
and after a few weeks, nearly imperceptible.
Our engineered tissues contain information not present in the blood,
and they can help bridge the gap
between what we can see on a traditional test
and cellular changes we know occur in disease.
Step two is to read this signal.
Currently, I could take a biopsy of my engineered site and analyze it
because I made them accessible just under the skin.
But it would certainly be better
if we could incorporate and read a sensor noninvasively.
Within the next decade,
rapidly converging technologies could enable diagnosis at such an implant
by harnessing simple detectors,
like a blood pressure cuff or smartwatch does now.
The mechanisms for diagnosing and monitoring disease
could be as simple as opening an app, like Candy Crush on your phone.
Step three is to harness the huge array of knowledge
in fields like engineering and material science
to improve these implants and our ability to read their data.
Eventually, tens, if not hundreds of individual engineered tissues
with integrated sensors
may be implantable with a single application.
Now, this approach to diagnosis is unconventional, to be sure,
but it is robust.
So far, my colleagues and I have used it
to diagnose models of metastatic cancer,
type 1 diabetes, multiple sclerosis and organ transplant rejection.
But this is just the beginning of what we can see.
With continuous improvements,
we will be able to truly create
a diagnostic lab inside your body
that provides a continuous analysis of your health.
By changing how we see what's going wrong in patients,
we will be able to diagnose and treat diseases better
and faster than ever before.
If you're willing to rethink how you see,
you may be surprised what comes into view.
Thank you.