Really really small, big time life savers

Whenever someone in real life uses the term “nanoparticles”, it really sounds as if they are trying to impress their (Geek?) girlfriend. Nanoparticles are all the rage on TV and in movies, and seem to be the magic elixir that fixes everything that needs to be fixed. And of course, they are totally programmable so that they can dissolve a blood clot (as they did for the “ATOM” on the TV show ARROW) or rearrange themselves into a chess board and then play with you.

In a recent research article, it seems that once again, life is as techified as fiction. In the animal study described in this article, the researchers subjected rats to the equivalent of a major blast injury, similar to what a soldier could experience on the battlefield. There are a number of technologies presently available for helping to stop isolated severe injuries with excessive bleeding. If for example, a soldier is injured in the thigh, such hemostatic technologies can prevent the soldier from bleeding out from an injury to the major artery to the leg. In blast injuries, there is major internal trauma that is not focused in one place. If the lungs are involved in such an injury, the soldier can die from lung [i.e. pulmonary] failure.

The nanoparticles that were studied in this research have two functions. Firstly, they help to control internal bleeding. Secondly, these nanoparticles carry a medication called dexamethasone. Dexamethasone is effectively cortisone, the kind that you shmere on a rash or that people with asthma will use to control an attack. When used for relatively short periods of time, cortisone is magical.  It can control complicated medical situations that no other medication can deal with. The long-term use of cortisone [many months and beyond] has very significant side effects. But in the short term, it is a tremendously powerful, effective and, yes, cheap medication.

The dexamethasone that is bound to these nanoparticles helps control inflammation and damage to the lungs. The immediate injection of these nanoparticles right after the blast injury, dramatically improved the outcomes of the treated rats. This kind of treatment could stabilize an injured soldier long enough to get that soldier to a full trauma service hospital. In Israel, we have the unfortunate luck of fighting wars that are never very far from our regular, highly effective trauma centers. A soldier injured in Gaza or on the Lebanese border could be treated on-site with these nanoparticles and then be flown to a trauma center within minutes to tens of minutes.

I should add one general point of information about the management of trauma. A few decades ago, it was recognized that amongst survivors of major trauma, there is a one hour window, the golden hour, during which appropriate management can save the patient. This concept of the golden hour is constantly referred to when speaking about solutions for major trauma. These kinds of nano particle treatments can extend the golden hour, allowing the physicians and surgeons in the trauma center more time to test and treat/operate on the patient. In these situations, minutes make the difference. That is why these kinds of technologies are so critical.

Small particles that are bound to various molecules are being studied in other areas of medicine. In the past, I’ve referred to oncology treatments that are targeted at a cancer via special proteins that guide nanoparticles, with cancer killing medications attached, to the growths. Even in the world of infections, nano particle technology may be the future for targeting antibiotics at specific bacteria, thereby sparing the patient side effects and toxicity from aggressive antibiotics. In the past, this group of technologies was referred to as “magic bullets” for obvious reasons. When it becomes possible to focus in on, only the pathological entity, it is even possible to use medications that are highly toxic to normal tissue. Because the toxic particles are bound to the nanoparticles and are never released except when interacting with the diseased tissue, there is no risk to the patient’s overall health.

Part of the success of this technology will be dependent on the improvement in the devices that create the nanoparticles. When it gets to a point that generating nanoparticles with almost any attached molecule requires nothing more than the click of a button, opportunities for treating a whole variety of diseases will arise. While these technologies may now be in the lab and are presently very expensive, it is only a matter of 1 to 2 decades before they are as commonplace as a simple blood test.

The time will definitely come, as described in science fiction books, TV shows and movies, when each nano particle is a programmable computer. Provide the nano particle literally with microscopic legs, and this tiny supercomputer will walk over to where ever it needs to be and perform whatever function it was programmed to do. It would probably be possible to reprogram these future nanoparticles even after they are injected into the body. In the future, it might be that everyone walks around with a totally internal collection of nanoparticles that are constantly on the watch for any pathology. And, the moment the nano computers identify a danger, they will spring into action and destroy the threat to the person’s health. I would actually be surprised if such technology is more than 30 to 40 years away.

Chemotherapy and antibiotic therapies save lives every day. But these are blunt instruments which negatively affect patients, sometimes to the extreme. The future of nanoparticles is to create totally specific treatments that, for all intents and purposes, should never cause side effects. Like so many other technologies I have discussed in the past, this too will be a revolution in healthcare, and will fundamentally change the practice of medicine.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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