Ganesh Sambasivam, Ph.D.
CSO & Co-Founder, Anthem Biosciences India
Preclinical Outsourcing to India
The outsourcing segment is witnessing rapid changes with respect to the nature of work outsourced and the location. Cost is the major driver but other considerations such as infrastructure and government policies can also be important drivers for decision making. The last couple of years have been a trying time for all CROs. The global economic meltdown has hit research budgets especially hard. The new challenges facing Contract Research Organizations call for a radically revised approach and a new model that would push the boundaries of this business further and would blur the line between client and vendor further. I believe the term Contract Research Organization (CRO), is a misnomer to begin with (often confused with Clinical Research Organization), has now morphed into a new type of company viz Contract Innovation Services (CIS). Clients are no longer just happy to outsource odds and ends of the development piece but are looking to their vendors for a massive amount of innovation input. This input is increasingly across both the chemistry and discovery domains. This new paradigm calls for CIS companies to develop new platforms, create intellectual propertythat is of service to clients andinnovate processes to meet new found customer expectations.
Claudia AM Wheeler-Kingshott, Ph.D.
University Reader in Magnetic Resonance Physics, Department of Neuroinflammation, UCL Institute of Neurology, London, UK
Abstract
Detecting neuronal activity in vivo non-invasively is possible with a number of techniques. Amongst these, in 1990 functional magnetic resonance imaging (fMRI) was proposed as a technique that has a great ability to spatially map brain activity by exploiting the blood oxygenation level dependent (BOLD) contrast mechanism [1, 2]. In fact, neuronal activation triggers a demand for oxygen and induces a localised increase in blood flow and blood volume, which actually exceeds the metabolic needs. This in turns causes an increase of oxyhaemoglobin in the venous compartment, which is a transient phenomenon and is accompanied by a transient change (decrease) in the concentration of deoxyhaemoglobin. Due to its paramagnetic properties, the amount of deoxyhaemoglobin present in the venous blood affects the local magnetic field seen by the spins (protons) and determines the local properties of the MR signal. A decrease in deoxyhaemoglobin during neuronal activity, therefore, induces local variations of this magnetic field that increases the average transverse relaxation time of tissue, measured via the T2* parameter [3]. This means that there is an increase of the MR signal (of the order of a few %, typically <5%) linked to metabolic changes happening during brain function. Activation can be inferred at different brain locations by performing tasks while acquiring the MR signal and comparing periods of rest to periods of activity.
The macroscopic changes of the BOLD signal are well characterised, while the reason for the increased blood supply, exceeding demands, needs further thoughts. Here we will discuss two approaches for explaining the BOLD phenomenon, one that links it to adenosine triphosphate production [4] and enzyme saturation, the other that relates it to the very slow diffusion of oxygen through the blood-brain-barrier with a consequent compensatory high demand of oxygen [5]. Some evidence of restricted oxygen diffusion has been shown by means of hypercapnia [6], although it is not excluded that both mechanisms may be present.
Overall, the BOLD signal changes theory and its physiological basis will be presented and discussed.
References
- Ogawa, S., et al., Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci U S A, 1990. 87(24): p. 9868-72.
- Kwong, K.K., et al., Dynamic magnetic resonance imaging of human brain activity during primary sensory stimulation. Proc Natl Acad Sci U S A, 1992. 89(12): p. 5675-9.
- Bandettini PA, et al. Spin-echo and gradient-echo EPI of human brain activation using BOLD contrast: a comparative study at 1.5 T. NMR Biomed. 1994 Mar;7(1-2):12-20
- Fox, P.T., et al., Nonoxidative glucose consumption during focal physiologic neural activity. Science, 1988. 241(4864): p. 462-4.
- Gjedde, A., et al. Reduction of functional capillary density in human brain after stroke. J Cereb Blood Flow Metab, 1990. 10(3): p. 317-26.
- Hoge, R.D., et al., Linear coupling between cerebral blood flow and oxygen consumption in activated human cortex. Proc Natl Acad Sci U S A, 1999. 96(16): p. 9403-8.
Jaydeep Unni, Ph.D.
Sr. Project Manager, Robert Bosch Healthcare Systems, Palo Alto, CA
Remote Patient Monitoring – Challenges and Opportunities
Remote Patient Monitoring (RPM) is gaining importance and acceptance with rising number of chronic disease conditions and with increase in the aging population. As instances of Heart diseases, Diabetes etc are increasing the demand for these technologies are increasing. RPM devices typically collect patient vital sign data and in some case also patient responses to health related questions. Thus collected data is then transmitted through various modalities (wireless/Bluetooth/cellular) to Hospitals/Doctor’s office for clinical evaluation. With these solutions Doctors are able to access patient’s vital data ‘any time any where’ thus enabling them to intervene on a timely and effective manner. For older adult population chronic disease management, post-acute care management and safety monitoring are areas were RPM finds application. That said, there are significant challenges in adoption of Remote Patient Monitoring including patient willingness and compliance for adoption, affordability, availability of simpler/smarter technology to mention a few. But experts contend that if implemented correctly Remote Patient Monitoring can contain healthcare expenditure by reducing avoidable hospitalization while greatly improving quality of care.