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Nano Treatment


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    kumarradha is offline Newbie
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    Nano Treatment

    I have read an article regarding regarding nano technology treatment for various diseases in RANI, Tamil weekly issue dated 13/1/2013 by Dr. Y.Abdul Haleem. I want to know more about since I suffer kidney disease for past 11 years

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    Re: Try to Answer the Questions

    Quote Originally Posted by kumarradha View Post
    I have read an article regarding regarding nano technology treatment for various diseases in RANI, Tamil weekly issue dated 13/1/2013 by Dr. Y.Abdul Haleem. I want to know more about since I suffer kidney disease for past 11 years
    Contact Dr.Venu in PSG Hospital, Peelamedu, Coimbatore. Fix an appointment with him and you can clear your doubts. Nephrology is considered as superspeciality department in this hospital.

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    Re: Nano Treatment

    Dear Sir, please go through the following article on Nano Technology application in kidney disease. this may clear all your doubts.


    The Role of Bottom-up Nanotechnology in Kidney Disease: An Expert Commentary by Allen R. Nissenson, MD



    There are 2 general ways to produce nanomaterials. The first is to start with a bulk material and then break it into smaller pieces using mechanical, chemical or other form of energy -- this is called top-down. Another way is to synthesize the material from atomic or molecular species via chemical reactions, allowing for the precursor particles to grow in size -- this is called bottom-up. Nanotechnology, the ability to work at the atomic and molecular levels, is encouraging research and development investments in pharmaceutical discovery, diagnostics, and drug delivery and is coming to the forefront in the field of renal substitution therapy. Anne G. Le, PharmD, RPh, Editorial Director of Medscape Nephrology, spoke with Allen R. Nissenson, MD, Professor of Medicine, Associate Dean, Director of the Dialysis Program at the David Geffen School of Medicine at UCLA in Los Angeles, California on the novel us of bottom-up nanotechnology to engineer ion-selective membranes and how this aids in the management of patients with end-stage renal disease.
    Dr. Nissenson: This commentary is really a summary of some work that's been going on for the past 5 years on what we call the human nephron filter, which is an application of nanotechnology to the field of renal substitution therapy. We really got into this project because of the well-known concern about the current state of technology for the treatment of end-stage renal disease. In addition to the technology being somewhat stagnant over the past two and half decades, there is increasing demand for renal replacement therapy or as it's increasingly being called renal substitution therapy because none of these artificial techniques really replace kidney function entirely. We understand the epidemic of chronic kidney disease, which is now affecting more than 26 million people in the United States with a very high mortality from cardiovascular disease, and the continued growth of the dialysis population projected to be over 500,000 in this country just by 2010, and we were trying to look for a way to really leapfrog from a technology point of view how patients are treated.
    Part of the concern when we began the project was that current dialysis therapy "really" only delivers about 10 to 15% of equivalent GFR (glomerular filtration rate). And I say that "really" in quotation marks because generally this is primarily small solute removal -- the amount of larger solute removal is probably even less than this. In addition, current dialysis therapy is proinflammatory. It exacerbates the underlying inflammatory process that patients have. It's very intrusive on patient lifestyles and very disruptive to patients coming to dialysis units 3 times a week to get treatment and there are still lots of complications that occur during and in between the treatments. The bottom line is we still have over 20% annual gross mortality, high morbidity with over 2 hospitalizations on average per patient per year, 17 days in the hospital per patient, and quality of life that's really not optimal, so we applied nanotechnology. And when thinking about nanotechnology, it's looked at as either top-down or bottom-up. Top-down is really taking what currently exists and just miniaturizing it.
    What we did was bottom-up nanotechnology, which is the assembly of new molecules or taking molecules and assembling them into new machines. The basic concept of the device that we've been working on is one that contains 2 membranes in an attempt to emulate the normal nephron so the way it works is blood first flows over the first membrane, which we call the G membrane and is configured to reflect the function of the glomerular basement membrane so it's a fully porous membrane removing solute up to the molecular weight of albumin. The ultrafiltrate that's produced by blood passing over this membrane then passes over a second membrane we call the T membrane, which is probably the critical part of the device. This is meant to emulate the tubular membrane in the renal tubules. The ultrafiltrate passes over the tubular membrane and again this ultrafiltrate contains all of the toxins as well as the solutes that we want to retain. The tubular membrane, the T membrane, has been developed so that it will reabsorb all of those substances we want to retain, some sodium, some potassium, calcium, a little bit of phosphorous, and so on. Everything else remains and the ultrafiltering goes down the drain.
    So one of the thought processes behind this was since there are hundreds of uremic toxins and it would be impossible to identify them individually so the best approach would be to just get rid of all of them but then retain those things that we know are important and maintain body homeostasis from a biochemical point of view. That is the basic concept. To do this, the T membrane, the tubular membrane, is manufactured using nanotechnology and contains specially developed pores that are very tiny. The distance between the pores is about 1 to 5 nanometers and the length of the pore is only about 1 nanometer so these are very, very thin membranes that are created with these very, very thin pores. The pores are created in a way that they differentially permit movement of solute through independent of molecular weight so as 2 substances of an identical molecular weight are trying to get through a pore, one can be permitted to go through and one can be blocked. Therefore, you might have a pore that will allow sodium through but not potassium and that's really the critical technology piece of this -- that these nano pores can be engineered to selectively permit the movement of particular solutes. The result of this would be because of the tiny size of the pores and the thinness of the membranes, we can produce a membrane sandwich structure that's sufficient to provide 30 cc a minute of glomerular filtration operating 12 hours a day that is roughly the size of a quarter. That's how tiny we can make the cartridges that contain the membrane for a device of this sort.
    We have done some computer modeling to look at how well this device would function and have a whole series of assumptions when we went into the modeling that are typical for these sorts of studies. We compared our device operating 12 hours a day 7 days a week to a conventional hemodialysis system and what we find when we do that intermittently 3 times a week with 4-hour dialysis with a typical dialyzer, we get the expected sawtooth pattern with the blood urea nitrogen at the highest of the start of dialysis falling rapidly and then slowly going up again between dialyses and a time average urea concentration of about 67 mg/dL. With our device operating 12 hours a day 7 days a week, we have a time average urea concentration of about 27 mg/dL, and if we operate the device 24 hours 7 days a week, the time average urea drops to normal. We've also done computer simulations of larger solute removal, beta-2 microglobulin molecular weight a little over 11,000, and find that with our device operating 18 hours a day 7 days a week, the time average beta-2 microglobulin level drops to near normal and operating 24 hours a day, it drops into the normal range as well. So the device is capable of restoring, at least the biochemical, the levels of key solutes both small and middle molecules back to normal. Now the entire system we're envisioning in the initial iteration will be using a commercial G membrane rather than manufacturing the G membrane using nanotechnology, and because the commercial G membrane is thicker than we will use ultimately when we nano-fabricate that membrane, we're going to need a blood pump for the initial version. To have a blood pump, we're going to also need a battery. So, the whole device is going to be a little bit larger, but a small battery that can be worn on a waistband and then the device itself in a wearable holster and a waste bag would be the entire system that we would have for this device to start with.



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    Re: Nano Treatment

    We have made considerable progress, although it's been slow, over the past 2-3 years. We have synthesized pores for in vitro testing; we fabricated a membrane with the pores in it; and we're in the process of working on the scale of methodology to produce a device. So, just to summarize at least the conceptual advantages of this approach, one is the ability to miniaturize the components of the device including the membranes that will permit this to be wearable and ultimately implantable so that it will be transparent to the patient. Using a nano thickness G membrane, we'll be able to eliminate the blood pump and run off the patient's own blood pressure. In addition, we can nano-manufacture the G membrane and engineer it in a way to make it completely biocompatible so the interaction of blood with this membrane will be such that we hope to obviate the need for anticoagulation and also eliminate membrane-induced inflammation. In addition, by using this very open G membrane, we should be able to remove all of the important uremic toxins without regard to molecular weight at least up to the molecular weight of albumin. We can manufacture using nanotechnology the T membrane to make sure we reabsorb necessary substances and if we start seeing depletion syndromes, we can reengineer the pores to eliminate that problem. We hopefully can produce about 60 cc a minute of glomerular filtration, which would restore patients up to early stage 3 chronic kidney disease and hopefully this would be a cost-saving approach. And finally, there are a number of challenges to actually successfully complete this project. One is we still have to demonstrate that the membrane functions in vitro the way we modeled it on a computer. We need to fabricate the complete device. Then we need to show in animal models that the device operates safely and effectively in the way we think it will. We also need to continue to work on the manufacturing scalability. And a few of the logistical issues, like possible need for anticoagulation, the type of vascular access, the need to customize the filters, evaluation for depletion syndromes, all are going to need to be evaluated as we get into clinical trials. Then finally if we're successful, this has the potential for being truly transformational or disruptive technology because it will permit patients to move out of the dialysis center into an ambulatory or home setting and that's something that we need to consider as well.


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