You’ve heard of CRISPR, now meet its newer, savvier cousin CRISPR Prime

CRISPR, the revolutionary ability to snip out and alter genes with scissor-like precision, has exploded in popularity over the last few years and is generally seen as the standalone wizard of modern gene-editing. However, it’s not a perfect system, sometimes cutting at the wrong place, not working as intended and leaving scientists scratching their heads. Well, now there’s a new, more exacting upgrade to CRISPR called Prime, with the ability to, in theory, snip out more than 90% of all genetic diseases.

Just what is this new method and how does it work? We turned to IEEE fellow, biomedical researcher and dean of graduate education at Tuft University’s school of engineering Karen Panetta for an explanation.

How does CRISPR Prime editing work?

CRISPR is a powerful genome editor. It utilizes an enzyme called Cas9 that uses an RNA molecule as a guide to navigate to its target DNA. It then edits or modifies the DNA, which can deactivate genes or insert a desired sequence to achieve a behavior. Currently, we are most familiar with the application of genetically modified crops that are resistant to disease.

However, its most promising application is to genetically modify cells to overcome genetic defects or its potential to conquer diseases like cancer.

Some applications of genome editing technology include:

  • Genetically modified mosquitos that can’t carry malaria.
  • In humans, “turning on” a gene that can create fetal type behaving cells that can overcome sickle-cell anemia.

Of course, as with every technology, CRISPR isn’t perfect. It works by cutting the double-stranded DNA at precise locations in the genome. When the cell’s natural repair process takes over, it can cause damage or, in the case where the modified DNA is inserted at the cut site, it can create unwanted off-target mutations.

Some genetic disorders are known to mutate specific DNA bases, so having the ability to edit these bases would be enormously beneficial in terms of overcoming many genetic disorders. However, CRISPR is not well suited for intentionally introducing specific DNA bases, the As, Cs, Ts and Gs that make up the double helix.

Prime editing was intended to overcome this disadvantage, as well as other limitations of CRISPR.

Prime editing can do multi-letter base-editing, which could tackle fatal genetic disorders such as Tay-Sachs, which is caused by a mutation of four DNA letters.

It’s also more precise. I view this as analogous to the precision lasers brought to surgery versus using a hand-held scalpel. It minimized damage, so the healing process was more efficient.

Prime editing can insert, modify or delete individual DNA letters; it also can insert a sequence of multiple letters into a genome with minimal damage to DNA strands.

How effective might Prime editing be?

Imagine being able to prevent cancer and/or hereditary diseases, like breast cancer, from ever occurring by editing out the genes that are makers for cancer. Cancer treatments are usually long, debilitating processes that physically and emotionally drain patients. It also devastates patients’ loved ones who must endure watching helpless on the sidelines as the patient battles to survive.

“Editing out” genetic disorders and/or hereditary diseases to prevent them from ever coming to fruition could also have an enormous impact on reducing the costs of healthcare, effectively helping redefine methods of medical treatment.

It could change lives so that long-term disability care for diseases like Alzheimer’s and special needs education costs could be significantly reduced or never needed.

How did the scientific community get to this point — where did CRISPR/prime editing “come from?”

Scientists recognized CRISPR’s ability to prevent bacteria from infecting more cells and the natural repair mechanism that it initiates after damage occurs, thus having the capacity to halt bacterial infections via genome editing. Essentially, it showed adaptive immunity capabilities.

When might we see CRISPR Prime editing “out in the wild?”

It’s already out there! It has been used for treating sickle-cell anemia and in human embryos to prevent HIV infections from being transmitted to offspring of HIV parents.

So, what’s next?

IEEE engineers, like myself, are always seeking to take the fundamental science and expand it beyond the petri dish to benefit humanity.

In the short term, I think that Prime editing will help generate the type of fetal like cells that are needed to help patients recover and heal as well as developing new vaccines against deadly diseases. It will also allow researchers new, lower cost alternatives and access to Alzheimer’s like cells without obtaining them post-mortem.

Also, AI and deep learning is modeled after human neural networks, so the process of genome editing could potentially help inform and influence new computer algorithms for self-diagnosis and repair, which will become an important aspect of future autonomous systems.

Facebook unveils its first foray into personal digital healthcare tools

Nearly a year and a half after the Cambridge Analytica scandal reportedly scuttled Facebook’s fledgling attempts to enter the healthcare market, the social media giant is launching a tool called “Preventive Health” to prompt its users to get regular checkups and connect them to service providers.

The architect of the new service is Dr. Freddy Abnousi, the head of the company’s healthcare research, who was previously linked to an earlier skunkworks initiative that would collect anonymized hospital data and use a technique called “hashing” to match the data to individuals that exist in both data sets — for research, according to CNBC reporting.

Working with the American Cancer Society; the American College of Cardiology; the American Heart Association; and the Centers for Disease Control and Prevention Facebook is developing a series of digital prompts that will encourage users to get a standard battery of tests that’s important to ensure health for populations of a certain age.

The company’s initial focus is on the top two leading causes of death in the U.S.: heart disease and cancer — along with the flu, which affects millions of Americans each year.

“Heart disease is the number one killer of men and women around the world and in many cases it is 100% preventable. By incorporating prevention reminders into platforms people are accessing every day, we’re giving people the tools they need to be proactive about their heart health,” said Dr. Richard Kovacs, the president of the American College of Cardiology, in a statement.

Users who want to access Facebook’s Preventive Health tools can search in the company’s mobile app to find which checkups are recommended by the company’s partner organizations based on the age and gender of a user.

The tool allows Facebookers to mark when the tests are completed, set reminders to schedule future tests and tell people in their social network about the tool.

Facebook will even direct users to resources on where to have the tests. One thing that the company will not do, Facebook assures potential users, is collect the results of any test.

“Health is particularly personal, so we took privacy and safety into account from the beginning. For example, Preventive Health allows you to set reminders for your future checkups and mark them as done, but it doesn’t provide us, or the health organizations we’re working with, access to your actual test results,” the company wrote in a statement. “Personal information about your activity in Preventive Health is not shared with third parties, such as health organizations or insurance companies, so it can’t be used for purposes like insurance eligibility.”

The company said that people can also use the new health tool to find locations that administer flu shots.

“Flu vaccines can have wide-ranging benefits beyond just preventing the disease, such as reducing the risk of hospitalization, preventing serious medical events for some people with chronic diseases, and protecting women during and after pregnancy,” said Dr. Nancy Messonnier, Director, National Center for Immunization and Respiratory Diseases, CDC, in a statement. “New tools like this will empower users with instant access to information and resources they need to become a flu fighter in their own communities.”

The UK’s National Health Service is launching an AI lab

The UK government has announced it’s rerouting £250M (~$300M) in public funds for the country’s National Health Service (NHS) to set up an artificial intelligence lab that will work to expand the use of AI technologies within the service.

The Lab, which will sit within a new NHS unit tasked with overseeing the digitisation of the health and care system (aka: NHSX), will act as an interface for academic and industry experts, including potentially startups, encouraging research and collaboration with NHS entities (and data) — to drive health-related AI innovation and the uptake of AI-driven healthcare within the NHS. 

Last fall the then new in post health secretary, Matt Hancock, set out a tech-first vision of future healthcare provision — saying he wanted to transform NHS IT so it can accommodate “healthtech” to support “preventative, predictive and personalised care”.

In a press release announcing the AI lab, the Department of Health and Social Care suggested it would seek to tackle “some of the biggest challenges in health and care, including earlier cancer detection, new dementia treatments and more personalised care”.

Other suggested areas of focus include:

  • improving cancer screening by speeding up the results of tests, including mammograms, brain scans, eye scans and heart monitoring
  • using predictive models to better estimate future needs of beds, drugs, devices or surgeries
  • identifying which patients could be more easily treated in the community, reducing the pressure on the NHS and helping patients receive treatment closer to home
  • identifying patients most at risk of diseases such as heart disease or dementia, allowing for earlier diagnosis and cheaper, more focused, personalised prevention
  • building systems to detect people at risk of post-operative complications, infections or requiring follow-up from clinicians, improving patient safety and reducing readmission rates
  • upskilling the NHS workforce so they can use AI systems for day-to-day tasks
  • inspecting algorithms already used by the NHS to increase the standards of AI safety, making systems fairer, more robust and ensuring patient confidentiality is protected
  • automating routine admin tasks to free up clinicians so more time can be spent with patients

Google-owned UK AI specialist DeepMind has been an early mover in some of these areas — inking a partnership with a London-based NHS trust in 2015 to develop a clinical task management app called Streams that’s been rolled out to a number of NHS hospitals.

UK startup, Babylon Health, is another early mover in AI and app-based healthcare, developing a chatbot-style app for triaging primary care which it sells to the NHS. (Hancock himself is a user.)

In the case of DeepMind, the company also hoped to use the same cache of NHS data it obtained for Streams to develop an AI algorithm for earlier detection of a condition called acute kidney injury (AKI).

However the data-sharing partnership ran into trouble when concerns were raised about the legal basis for reusing patient data to develop AI. And in 2017 the UK’s data watchdog found DeepMind’s partner NHS trust had failed to obtain proper consents for the use of patients’ data.

DeepMind subsequently announced its own AI model for predicting AKI — trained on heavily skewed US patient data. It has also inked some AI research partnerships involving NHS patient data — such as this one with Moorfields Eye Hospital, aiming to build AIs to speed up predictions of degenerative eye conditions.

But an independent panel of reviewers engaged to interrogate DeepMind’s health app business raised early concerns about monopoly risks attached to NHS contracts that lock trusts to using its infrastructure for delivering digital healthcare.

Where healthcare AIs are concerned, representative clinical data is the real goldmine — and it’s the NHS that owns that.

So, provided NHSX properly manages the delivery infrastructure for future digital healthcare — to ensure systems adhere to open standards, and no single platform giant is allowed to lock others out — Hancock’s plan to open up NHS IT to the next wave of health-tech could deliver a transformative and healthy market for AI innovative that benefits startups and patients alike.

Commenting on the launch of NHSX in a statement, Hancock said: “We are on the cusp of a huge health tech revolution that could transform patient experience by making the NHS a truly predictive, preventive and personalised health and care service.

“I am determined to bring the benefits of technology to patients and staff, so the impact of our NHS Long Term Plan and this immediate, multimillion pound cash injection are felt by all. It’s part of our mission to make the NHS the best it can be.

“The experts tell us that because of our NHS and our tech talent, the UK could be the world leader in these advances in healthcare, so I’m determined to give the NHS the chance to be the world leader in saving lives through artificial intelligence and genomics.”

Simon Stevens, CEO of NHS England, added: “Carefully targeted AI is now ready for practical application in health services, and the investment announced today is another step in the right direction to help the NHS become a world leader in using these important technologies.

“In the first instance it should help personalise NHS screening and treatments for cancer, eye disease and a range of other conditions, as well as freeing up staff time, and our new NHS AI Lab will ensure the benefits of NHS data and innovation are fully harnessed for patients in this country.”

Google’s SMILY is reverse image search for cancer diagnosis

Spotting and diagnosing cancer is a complex and difficult process even for the dedicated medical professionals who do it for a living. A new tool from Google researchers could improve the process by providing what amounts to reverse image search for suspicious or known cancerous cells. But it’s more than a simple matching algorithm.

Part of the diagnosis process is often examining tissue samples under a microscope and looking for certain telltale signals or shapes that may indicate one or another form of cancer. This can be a long and arduous process because every cancer and every body is different, and the person inspecting the data must not only look at the patient’s cells but also compare them to known cancerous tissues from a database or even a printed book of samples.

As has been amply demonstrated for years now, matching similar images to one another is a job well suited to machine learning agents. It’s what powers things like Google’s reverse image search, where you put in one picture and it finds ones that are visually similar. But this technique has also been used to automate processes in medicine, where a computer system can highlight areas of an X-ray or MRI that have patterns or features it has been trained to recognize.

That’s all well and good, but the complexity of cancer pathology rules out simple pattern recognition between two samples. One may be from the pancreas, another from the lung, for example, meaning the two situations might be completely different despite being visually similar. And an experienced doctor’s “intuition” is not to be replaced, nor would the doctor suffer it to be replaced.

Aware of both the opportunities and limitations here, Google’s research team built SMILY (Similar Medical Images Like Yours), which is a sort of heavily augmented reverse image search built specifically for tissue inspection and cancer diagnosis.

A user puts into the system a new sample from a patient — a huge, high-resolution image of a slide on which a dyed section of tissue is laid out. (This method is standardized and has been for a long time — otherwise how could you compare any two?)

smilygif

Once it’s in the tool, the doctor can inspect it as they would normally, zooming in and panning around. When they see a section that piques their interest, they can draw a box around it and SMILY will perform its image-matching magic, comparing what’s inside the box to the entire corpus of the Cancer Genome Atlas, a huge database of tagged and anonymized samples.

Similar-looking regions pop up in the sidebar, and the user can easily peruse them. That’s useful enough right there. But as the researchers found out while they were building SMILY, what doctors really needed was to be able to get far more granular in what they were looking for. Overall visual similarity isn’t the only thing that matters; specific features within the square may be what the user is looking for, or certain proportions or types of cells.

As the researchers write:

Users needed the ability to guide and refine the search results on a case-by-case basis in order to actually find what they were looking for…This need for iterative search refinement was rooted in how doctors often perform “iterative diagnosis”—by generating hypotheses, collecting data to test these hypotheses, exploring alternative hypotheses, and revisiting or retesting previous hypotheses in an iterative fashion. It became clear that, for SMILY to meet real user needs, it would need to support a different approach to user interaction.

To this end the team added extra tools that let the user specify much more closely what they are interested in, and therefore what type of results the system should return.

First, a user can select a single shape within the area they are concerned with, and the system will focus only on that, ignoring other features that may only be distractions.

Second, the user can select from among the search results one that seems promising and the system will return more like it, less closely tied to the original query. This lets the user go down a sort of rabbit hole of cell features and types, doing that “iterative” process the researchers mentioned above.

refinements

And third, the system was trained to understand when certain features are present in the search result, such as fused glands, tumor precursors, and so on. These can be included or excluded in the search — so if someone is sure it’s not related to this or that feature, they can just sweep all those examples off the table.

In a study of pathologists given the tool to use, the results were promising. The doctors appeared to adopt the tool quickly, not only using its official capabilities but doing things like reshaping the query box to test the results or see if their intuition on a feature being common or troubling was right. “The tools were preferred over a traditional interface, without a loss in diagnostic accuracy,” the researchers write in their paper.

It’s a good start, but clearly still only an experiment. The processes used for diagnosis are carefully guarded and vetted; you can’t just bring in a random new tool and change up the whole thing when people’s lives are on the line. Rather, this is merely a bright start for “future human-ML collaborative systems for expert decision-making,” which may at some point be put into service at hospitals and research centers.

You can read the two papers describing SMILY and the doctor-focused refinements to SMILY here; they were originally presented at CHI 2019 in Glasgow earlier this year.

Paige details first AI pathology tech with clinical-grade accuracy in new research paper

Medical tech and computational pathology startup Paige has published a new article in the peer-reviewed medical journal Nature Medicine, detailing its artificial intelligence-based detection system for identifying prostate cancer, skin cancer and breast cancer, which the company says achieves “near-perfect accuracy.” Paige’s tech, which employs deep learning trained on a dataset of almost 45,000 slide images taken from over 15,000 patients spanning 44 countries, is novel in that it can eschew the need to curate data sets for training first, which greatly decreases cost and time required to build accurate AI-based diagnostic tools.

Last February, Paige announced $25 million in Series A funding, and a partnership with Memorial Sloan Kettering Center (MSK) to gain access to one of the largest single repositories of pathology slides in the world. MSK is also home to the lab of Dr. Thomas Fuchs, Paige’s co-founder and Chief Scientific Officer, and possibly the world’s foremost authority in computational pathology.

Paige’s approach uses much larger data sets than are typically employed in AI-based diagnostics, but without the tight curation that focuses other efforts much more narrowly on specific types of cancer diagnostics. The result, according to the company, is not only better performance, but also a resulting system that its much more generally applicable.

Next up for Paige is to commercialize its technology, which is something it’s already pursuing. The work described in the article published in Nature Medicine has already been employed in technology currently under review by the FDA, albeit for a different final application than the ones described in the study published by the magazine.

 

Careteam aims to unite patients and healthcare providers with a platform approach

How best to untangle the Gordian knot that is navigating your own healthcare? It’s a tricky question, and one that seems to have become only more complicated as technology improves, in many regards — systems don’t necessarily speak to one another, and it’s still hard for an ordinary patient without specialist knowledge to make sense of everything. Careteam is a Canadian startup hoping to address that, looking to replicate the kind of advances made possible by technology in industries like e-commerce and enterprise software.

Careteam co-founder and CEO Dr. Alexandra Greenhill has experienced the frustration of being a tech-savvy person in a world of healthcare that can seem technologically inept — both as a practicing GP and as someone who depends on the healthcare system as a patient and a relative of patients with more sophisticated medical needs.

“I spent more than 15 years innovating within the healthcare system,” Greenhill told me in an interview. “I computerized hospitals, helped doctors adopt electronic medical records and other types of innovation practices. And then for the last eight years, I’ve been in tech, trying to figure out how to build the kind of technology we need in health, and especially digital health.”

All that experience led Greenhill to the realization that while there were many companies building specific solutions for real, but relatively narrow problems, that didn’t reflect how most people experienced care. Greenhill and her team of three other co-founders (Jeremy P. Smith, Robert I. Atwell and Kevin Lysyk) had all had unfortunate, but eye-opening experiences with family members in need of treatment for major diseases.

“You step in and you discover that cancer care, palliative care, post-surgical care — there’s so many things that would have gone wrong if we didn’t have the expertise ourselves,” Greenhill said. “But in the meantime, you end up being sort of pulled into multiple directions and saying ‘this makes no sense.’ You know, I can purchase stuff online in my private life; I can use all kinds of tools in the business world, and yet it’s back to paper and voice in health, which matters most.”

Careteam CEO and founder Dr. Alexandra Greenhill

What Careteam provides is collaboration for care — true collaboration, designed to span patients, their doctors and other healthcare pros, their families and anyone who matters to them in the course of pursuing their care. It provides the ability to communicate instantly, build care plans that integrate all aspects of their tailored health plans, receive custom-configurable notifications and measure progress toward specific goals set by patient and healthcare providers.

Part of the reason this process has become opaque or difficult is precisely due to innovation: Greenhill takes issue with the prevailing narrative that the healthcare industry is somehow allergic to innovation.

“There’s this sort of perception that healthcare doesn’t innovate, but it’s also almost insulting to the healthcare system, because we have innovated — we save people from cancer, where we couldn’t,” she noted. “We cure HIV, in some cases, and we prevent it from being transmitted to unborn babies of mothers with full-blown AIDS and things that in my working lifetime were impossibilities; it was science fiction to help someone with HIV. And, and we’ve managed to do all of that, and it’s a success story. We’ve created complexity, we’ve created people who live with 12 conditions for many, many years and take complicated drug regiments.”

In addition to advances in treatment, Greenhill notes that she and her team couldn’t have build Careteam five years ago, because cloud storage wasn’t secure and everything had to be done on a site-specific instance, and that would’ve been cost-prohibitive to build. In other words, technology has been applied to, and vastly improved, healthcare overall, regardless of the general perception of the industry as an innovation laggard.

That’s why Greenhill’s startup doesn’t shy away from complexity — they embrace it. Careteam is designed not to try to normalize and standardize the varied and highly specialized landscape of healthcare solutions and providers through anything like a one-size-fits-all API. Instead, the company’s tech development is cleverly designed to be flexible when it comes to integrations.

“We collectively spent $1.9 billion in Canada, to try and digitize the healthcare system, create standards and create some exchange between data,” Greenhill said. “The NHS tried the same, big U.S. hospital systems have created their own little sort of islands, including Kaiser and Mayo and others. And the conclusion of all of that is standardization in healthcare just doesn’t seem to catch on.”

Careteam’s approach has been instead to integrate specific clinics, and let practitioners and patients derive benefits and help spur the adoption of the platform to their companion organizations and clinics. It’s a sort of rhizomatic approach that starts with a node central to a patient’s care and spreads through the healthcare professionals and members of the patient’s support network that the product helps. And integration is made possible without technical demands on the part of partners thanks to the work of CTO Lysyk, according to Greenhill.

The Vancouver-based startup is working with the Centre for Aging + Brain Health in Toronto, Ontario in a validation program announced last year, and also raised an initial round of funding in January led by BCF Ventures with participation from Right Side Capital, Globalive Capital, Atrium Ventures, and angels Barney Pell and Ajay Agarwal .

Pitching accuracy rates of over 99% for multiple cancer screens, Thrive launches with $110 million

For more than 25 years the founders of Thrive Earlier Detection have been researching ways to improve the accuracy of liquid biopsy tests.

The fruits of that labor from Dr. Bert Vogelstein, Dr. Kenneth Kinzler and Dr. Nickolas Papadopoulos — all professors and researchers at Johns Hopkins University — is CancerSEEK, a liquid biopsy test that has demonstrated specificity of over 99% in a retrospective study published by Science earlier this year.

By minimizing false positives, in cancer screening tools and providing a test with proven accuracy doctors can take treatment actions earlier, which can lead to better survival rates for cancer patients.

Now, with FDA approval for its tests for pancreatic and ovarian cancer and a new study underway with a large healthcare provider, CancerSEEK is being rolled out to market through Thrive Earlier Detection with the help of a new $110 million round of funding.

Thrive works by analyzing highly targeted sets of DNA and proteins in the blood to detect cancer.

“Over the past 30 years we have made great strides in understanding cancer. Combining this knowledge with the latest in molecular testing technologies, our founders have developed a simple and affordable blood test for the detection of many cancers at relatively early stages,” said Christoph Lengauer, Ph.D., partner at Third Rock Ventures, and co-founder and chief innovation officer of Thrive, in a statement. “We envision a future where routine preventative care includes a blood test for cancer, just as patients are now routinely tested for early stages of heart disease. We know that if cancer is caught early enough, it can often be cured.”

As part of its rollout, the company’s screening tool is being evaluated in DETECT, a study of 10,000 currently healthy individuals that’s being conducted in conjunction with the healthcare organization Geisinger. So far, 10,000 women between the ages of 65 and 75 without a history of cancer have been enrolled in the trial.

“To be truly useful to patients, new medical technology must be developed with rigorous evidence and designed to be affordable and readily integrated into routine medical care,” said Steven J. Kafka, Ph.D., partner at Third Rock Ventures and chief executive officer of Thrive, said in a statement. “With the help of experts and strategic partners, Thrive is launching today to advance a novel test for the earlier detection of multiple cancers, which we aim to augment with an integrated service that helps patients maneuver the often confusing path that follows a cancer diagnosis.”

Third Rock Ventures actually led the Series A financing for Thrive, and comprise the bulk of the company’s executive team, while Kinzler and Papadopoulos — the researchers from Johns Hopkins who developed the technology — will have seats on the company’s board.

Other investors in the round include Bill Maris’ Section 32 investment firm, Casdin Capital, Biomatics Capital, BlueCross BlueShield Venture Partners, Invus, Exact Sciences, Cowin Venture, Camden Partners, Gamma 3 LLC and others.

According to Thrive, ovarian, pancreatic and liver cancers are difficult to detect because they can develop in pathways that aren’t always well understood.

Using CancerSEEK, Thrive hopes to develop a blood-based test that can be used in routine medical care, with the goal of identifying multiple cancer types at earlier stages.

The technology works by following genomic mutations in circulating tumor DNA (ctDNA) and cancer-associated protein markers in plasma to identify abnormalities that are common across multiple cancers. In a retrospective study published by Science in 2018, CancerSEEK was shown to perform with greater than 99% specificity and with sensitivities ranging from 69% to 98% for the detection of five cancer types – ovarian, liver, stomach, pancreas and esophageal, which the company says are cancers for which there no screening tests available for average-risk individuals.

Thrive’s research has attracted an all-star executive team in addition to Lengauer and Kafka from Third Rock. Former Goldman Sachs lead medical technology analyst Isaac Ro is joining the company as chief financial officer, and the company’s head of research is Isaac Kinde, a co-inventor of the CancerSEEK technology.

It’s hard to overstate how transformative the Thrive test could prove to be. Having a blood-based diagnostic test for cancer prevalence and the ability to initiate treatment earlier radically improves the chances for surviving a cancer diagnosis.

 

Using full-body MRIs, Ezra can now detect 11 cancers in men and 13 in women

When Ezra first launched about six months ago, the company was using magnetic resonance imaging machines to test for prostate cancer in men.

But the company’s founder, Emi Gal, always had a larger goal.

“One of the biggest problems in cancer is that there’s no accurate, fast, painless, way to scan for cancer anywhere in the body” Gal said at the time of his company’s debut.

Now he’s several steps closer to a solution. Rather than having to do painful biopsies which often come with significant side effects, Gal’s software can now be used to slash the cost for a full-body MRI scan designed to screen for 11 different types of cancer in men and another 13 types of cancer in women (who have more organs that are likely to develop cancer).

The scans take about an hour and costs just $1,950, compared with the $5,000 to $10,000 that a full-body MRI scan can cost.

That’s still a steep price for customers to pay out of pocket. Insurance companies won’t pay for Ezra’s screens… yet. The company is in talks with some insurance companies and expects to have some pilot projects up in the last quarter of 2018 and first quarter of 2020. The goal, says Gal, is to have Ezra covered by insurers and self-employed insurers.

It’s hard to overstate how vitally important early cancer screening is for patients.

The American Cancer Society estimates that 1.7 million new cases of cancer diagnosed in the U.S. in 2019. For 600,000 people that diagnosis will be a death sentence. Roughly half of cancer patients are detected in the late stage of the disease and only two out of ten late-stage cancer patients survive longer than five years.

Gal knows the toll that can take on patients and families all too well. The serial entrepreneur, who started his first company at 20 and sold it at 30, volunteered at a hospice in his hometown of Bucharest, and became determined to come up with a screen to detect cancer earlier.

Gal started working on Ezra’s cancer-screening toolkit last year, with patient data taken from the National Institute of Health and supplemented with 150 cancer screens from additional patients.

Ezra initially came to market with a single test to screen for prostate cancer using machine learning to diagnose the screens coming off of an abbreviated MRI scan that takes 20 minutes.

All of the MRI sequences that Gal’s company uses are FDA approved, but the machine learning algorithms the company has developed has not been cleared, yet.

While Ezra can screen for different cancers, the firm’s technology doesn’t offer a diagnosis. That’s still up to a physician and requires additional testing. “We’re turning MRIs from what is a diagnostic test into a screening test,” says Gal.

“What we’ve done is removed the sequences not necessary for screening and brought the liver scan down to 15 minutes [and] the total scanning time down to an hour,” Gal says.

Rather than building out its own network of MRI machines to conduct the tests, Ezra has partnered with the MRI facility network RadNet on testing. The company also offers post-diagnosis consultations to help direct patients who are diagnosed with cancer to seek proper treatment.

The company is currently working in nine centers across New York and intends to expand to San Francisco and Los Angeles later this year.

Gal’s vision for early cancer screening was appealing enough to rake in $4 million in financing from investors including Founders Future, Credo Ventures, Seedcamp, Esther Dyson and other angel investors including SoundCloud co-founder Alex Ljung.

Ultimately, Ezra’s success will hinge on whether it can continue to drive down costs with its direct-to-consumer pitch, or become a diagnostic tool that insurers embrace.

“Over time, our goal is to build different AIs for different organs to decrease the cost even further,” says Gal.

These Johns Hopkins students are slashing breast cancer biopsy costs

Over 2 million women were diagnosed with breast cancer in 2018. And while the diagnosis doesn’t have to be a death sentence for women in countries like the United States, in developing countries three times as many women die from the disease.

Breast cancer survival rates range from 80% or over in North America, Sweden and Japan to around 60% in middle-income countries and below 40% in low-income countries, according to data provided the World Health Organization.

And the WHO blames these low survival rates in less developed countries on the lack of early detection programs, which result in a higher proporation of women presenting with late-stage disease. The problem is exacerbated by a lack of adequate diagnostic technologies and treatment facilities, according to the WHO.

A group of Johns Hopkins University undergraduates believe they have found a solution. The four women, none of whom are over 21-years-old, have developed a new, low-cost, disposable core needle biopsy technology for physicians and nurses that could dramatically reduce cost and waste, thereby increasing the availability of screening technologies in emerging markets.

They’ve taken the technology they developed at Johns Hopkins University and created a new startup called Ithemba, which means “hope” in Swahili, to commercialize their device. While the company is still in its early days, the women recently won the undergraduate Lemelson-MIT Student Prize competition, and has received $60,000 in non-dilutive grant funding and a $10,000 prize associated with the Lemelson award.

Students at Johns Hopkins had been working through the problem of developing low-cost diagnostic tools for breast cancer for the past three years, spurred on by Dr. Susan Harvey, the head of Johns Hopkins Section of Breast Imaging.

While Dr. Harvey presented the problem, and several students tried to tackle it, Ithemba’s co-founders — the biomedical engineering undergrads Laura Hinson, Madeline Lee, Sophia Triantis, and Valerie Zawicki — were the first to bring a solution to market.

Ithemba co-founders Laura Hinson, Madeline Lee, Valerie Zawicki and Sophia Triantis

The 21-year-old Zawicki, who grew up in Long Beach, Calif., has a personal connection to the work the team is doing. When she was just five years old her mother was diagnosed with breast cancer, and the cost of treatment and toll it took on the family forced the family to separate. “My sister moved in with my grandparents,” Zawicki says, while her mother underwent treatment. “When I came to college I was looking for a way to make an impact in the healthcare space and was really inspired by the care my mom received.”

The same is true for Zawicki’s co-founder, Triantis.

“We have an opportunity to  solve problems that really need solving,” says Triantis, a 20-year-old undergraduate. “Breast cancer has affected so many people close to me… It is the most common cancer among women [and] the fact that women in low resource settings do not have the same standard of diagnostic care really inspired me to work on a solution.”

What the four women have made is a version of a core-needled biopsy that has a lower risk of contamination than the reusable devices that are currently on the market and is cheaper than the expensive disposable needles that are the only other option, the founders say.

We’ve designed a novel, disposable portion that attaches to the reusable device and the disposable portion has an ability to trap contaminants that would come back through the needle into the device,” says Triantis. “What we’ve created is a way to trap that and have that full portion be disposable and making the device as easy to clean as possible… with a bleach wipe.”

Ithemba’s low-cost reusable core-needle biopsy device

The company is currently in the process of doing benchtop tests on the device, and will look to file a 510K to be certified as a Class 2 medical device. Already a clinic in South Africa and a hospital in Peru are on board as early customers for the new biopsy tool.

At the heart of the new tool is a mechanism which prevents blood from being drawn back into a needle. The team argues it makes reusable needles much less susceptible to contamination and can replace the disposable needles that are too expensive for many emerging market clinics and hospitals.

Zawicki had been working on the problem for a while when Hinson, Lee, and Triantis joined up. “I joined the team when the problem was presented,” says Zawicki. “The project began with this problem that was pitched three years ago, but the four of us are really those that have brought this to life in terms of a device.”

Crucially for the team, Johns Hopkins was fully supportive of the women taking their intellectual property and owning it themselves. “We received written approval from the tech transfer office to file independently,” says Zawicki. “That is really unique.” 

Coupled with the Lemelson award, Ithemba sees a clear path to ownership of the intellectual property and is filing patents on its device.

Zawicki says that it could be anywhere from three to five years before the device makes it on to the market, but there’s the potential for partnerships with big companies in the biopsy space that could accelerate that time to market.

“Once we get that process solidified and finalize our design we will wrap up our benchtop testing so we can move toward clinical trials by next summer, in 2020,” Zawicki says.

Jio Health combines online and offline healthcare in Southeast Asia, starting in Vietnam

The internet is often lauded for the potential to increase the impact of a range of primary services in emerging markets, including education, commerce, banking and healthcare. While many of those platforms are now being built, a few are finding that a hybrid approach combining online and offline is advantageous.

That’s exactly what Jio Health, a ‘full stack’ (forgive the phrase) healthcare startup is bringing to consumers in Southeast Asia, starting in Vietnam.

The company started out as a U.S-based venture that worked with healthcare providers around the ‘Obamacare’ initiative, before sensing the opportunity overseas and relocating to Vietnam, the Southeast Asian market of 95 million people and a fast-growing young population.

Today, it operates an online healthcare app and a physical facility in Saigon, it also has licenses for prescriptions and over the counter drug sales. The serviced launched nearly a year ago, already the company has some 130 staff, including 70 caregivers — including doctors — and a tech team of 30.

The idea is to offer services digitally, but also provide a physical location for when it is needed. Therein, the company ensures that “every element of that journey” is controlled and of the required standard, that’s in contrast to services that partner with hospitals or other care centers.

The scope of Jio Health’s services range from pediatrics to primary care, chronic disease management and ancillary services, which will soon cover areas like eye care, dermatology and cancer.

“Our initial research [before moving] found that healthcare in Vietnam was unlike the U.S,” Raghu Rai, founder and CEO of Jio Health, told TechCrunch in an interview. “Spending is primarily driven by the consumer (out of pocket) and there’s no real digital infrastructure to speak of.”

Rai — a U.S. citizen — said doctors typically “have minutes per patient” and get through “hundreds” of consultations in every morning shift. That gave him an idea to make things more efficient.

“We can probably address north of 80 percent of consumers health needs,” he said of Jio Health,” but we also have referral partnerships with certain hospitals.”

Raghu Rai is CEO and founder of Jio Health

The process begins when a consumer downloads the Jio Health app and inputs primary information. A representative is then dispatched to visit the consumer in person, potentially within “hours” of the submission of information, according to Rai.

He believes that Jio Health can save its users money and time by using remote consultancy for many diagnoses. The company also works with health insurance companies, for areas like annual checkups, and Rai said that McDonald’s and 7-Eleven are among the corporations that offer Jio Health among the providers for their staff, they’re not exclusive.

This week, Jio Health announced that it has closed a $5 million Series A funding from Southeast Asia’s Monk’s Hill Ventures . Rai said the company plans to use the capital for expansion. In particular, he said, the company is adding new care categories this month — including eye care and dermatology — and it is working towards expanding its brand through marketing.

Further down the line, Rai said the company hopes to expand to Hanoi before the end of this year. While there is interest in moving into other markets within Southeast Asia, that isn’t about to happen soon.

“We have begun to investigate other markets but at this point feel the market in Vietnam is substantial in itself,” he told TechCrunch. “It’s very plausible that we’d be looking at international expansion plans in 2020… we’re going to be focused on Southeast Asia.”