Starting a biomedical revolution

Engineering is making important advances in medicine

Richard Cairney - 1 September 2010

Robert Burrell was touring burn units at Australian hospitals in October 2002 when victims of the Bali terrorist bombings began to arrive in emergency rooms. Harried medical personnel invited Burrell into operating theatres at the Royal Brisbane Hospital to provide technical advice on the use of Acticoat, a silver-based wound dressing he invented. Used in burn units and in neonatal care centres around the world, Acticoat has antimicrobial properties and speeds healing. The revolutionary dressing is considered one of the most radical advances in wound-care history.

"It was almost overwhelming to see the dressing being used under such tragic conditions, but there was a tremendous satisfaction in seeing the results of its use," says Burrell. "Many people can alter the bottom line for a company, but very few people can alter the outcomes of people's lives-I am lucky to be one of the few."

A chemical and materials engineering professor, Canada Research Chair in Nanostructured Biomaterials, and chair of the Department of Biomedical Engineering at the University of Alberta, Burrell invented Acticoat in 1995 while working for Westaim Corporation's Nucryst Pharmaceuticals. He is nationally and internationally recognized for his work and has received numerous awards including the 2009 ENCANA Principal Innovation Award from The Ernest C. Manning Awards Foundation for the development of Acticoat, the 2009 ASM International - ASM Engineering Materials Achievement Award for the development of technology and manufacturing methods for silver based nano-structured antimicrobial and anti-inflammatory coatings with significant and wide ranging clinical and patient benefits; and the 2008 World Union of Wound Healing Society Lifetime Achievement Award for contributions to wound healing around the world. Acticoat uses nanocrystalline silver technology to deliver unique silver moieties to wound sites-speeding healing remarkably and fighting off infections. The dressing was the first commercial therapeutic application of nanotechnology in the world. Today, Burrell is researching ways to deliver nanostructured metal therapeutics, known to reduce inflammation, without the side effects that accompany some existing treatments. And as chair of Biomedical Engineering, he's overseeing a new wave in engineering and medicine.

Burrell describes biomedical engineering as the application of engineering principles to the development of medical solutions ranging from assistive medical technologies through to new surgical procedures and the development of devices and drugs. It is interdisciplinary by its very nature, bringing together the complicated worlds of medicine and mechanics, microbiology and materials engineering, and leading-edge technology like MRIs with the human body. As well as administering the department-which is run jointly by the Faculty of Medicine and Dentistry and the Faculty of Engineering-Burrell also finds himself building bridges across academic disciplines and professions.

It's a daunting challenge, but one Burrell has met head on. One method of bringing the two professions together that Burrell initiated is presentations by doctors to engineers. A doctor will present a room full of engineering professors with a medical challenge and ask them to view the problem with a fresh perspective. In one such meeting, for example, neonatologist Dr. Bernard Thebaud spoke to engineering professors and graduate students about a problem that plagues premature babies in neonatal intensive care units: there is no way to monitor the amount of CO2 in the blood of the tiny patients without drawing blood either through a catheter line or by puncturing the skin of a frail newborn-some of which are up to 24 weeks premature.

Monitoring the infants' exhaled breath isn't always reliable, says Thebaud. "So we end up drawing blood anyway and it is a big issue-it means we have to open a line it takes blood away from a baby that needs it and we many end up having to transfuse the baby and that means there are opportunities for infection."

In a presentation Burrell set up, Thebaud asked engineering professors and graduate students if they could come up with some way to read CO2 blood content externally. Questions and ideas began to fly around the room and the end of the meeting seemed to come too soon-the engineering professors were beginning to run with some ideas. No solution is immediately forthcoming but important connections were formed that day.

Burrell takes satisfaction in that.

"You can't force people to work together so what we are doing is creating an environment that facilitates the collaboration between care givers and engineers," says Burrell. After that, it's up to the researchers to find common ground-but that isn't always easy. Even the languages of the two fields of study are radically different.

"To engineers, plasma is a charged gas mass and to a physician or caregiver it is something that is in your bloodstream. We use different words differently so in biomedical engineering we also have to train people to become translators so they can bridge the language gap," says Burrell.

"Historically what academia has been good at is building silos and they are very well built. You have your own jargon inside the silo-the very purpose of the silo was to isolate people. So we have to stick our heads in the engineers' silo and equally engineers have to stick their heads into the medicine silo and talk to clinicians to make sense of problems."

Burrell himself is a prime example of this kind of interdisciplinary thinking. His undergraduate degree was in zoology, his master's degree dealt with microbial toxicity and his PhD examined ecotoxicology. "My whole professional career has been spent working in engineering environments as the only life scientist working with different groups of engineers," he says.

"Rob is not an engineer" says Dr. Rick Snyder, a professor emeritus and one of the department of biomedical engineering's longest-serving academics and researchers. "But he knew what engineering had to bring to his research and he has saved God knows how many lives with his dressing . . . and that is what matters to the people in this area: our mandate is to improve health care through engineering. Those five words say it all."

Mechanical engineering professor Warren Findlay is another example, Snyder adds. Findlay, an internationally recognized educator and researcher who specializes in the delivery of aerosolized and inhalable drugs-like those delivered by asthma inhalers-has developed a mouth-throat geometry that has been adopted worldwide by companies testing inhaler prototypes. He is also working with Richard Thompson, an MRI researcher in the department of biomedical engineering, to further develop an understanding of physiology and the way different inhaled drugs are delivered.

Snyder himself is similarly inclined. He arrived at the U of A with a PhD in physics in 1968 and began working on early versions of positron imaging and later moved into magnetic resonance imaging.

A staunch proponent of interdisciplinary work, Snyder estimates there are at least 60 researchers at the U of A involved in biomedical engineering-not all of them are housed within the faculties of Medicine and Dentistry and Engineering, either. Snyder would like to see even more silos torn down, but is nonetheless impressed with recent developments, such as the merger of the department of biomedical engineering with both faculties in July of 2009, and with new programs engineering students are taking.

"The important thing to remember about biomedical engineering is it has changed and evolved dramatically. At one time engineers were doing what we commonly associated with engineering work. Today, you find biological labs over in engineering buildings, and people in biomedical engineering know molecules-they know the basic biology, and all of the engineering departments have people doing biomedical engineering research and there are undergraduate programs now," he says. "It has evolved and is evolving very rapidly."

Snyder says the modern era of biomedical engineering really began to take shape when electrical engineers began working with physiologists to measure physical functions. The electrocardiogram (ECG) is one such device; another is the pulse oximeter, the tiny clamp patients wear on their fingers that uses light to measure oxygen content into the blood.

"This device was a major breakthrough. You used to have to take blood samples constantly and send them to the lab for analysis but now we have constant monitoring of the amount of oxygen in the blood," he says.

Which brings us back to the matter of providing care for premature babies. Thebaud is hopeful that there may be an engineered solution to the problem.

"Now, they will try to use their engineering expertise to solve a medical problem," says Thebaud. "So, there is work going on now. I can't predict how long it might take but they are working on this biotechnological challenge."