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High-tech implant could ease harmful effects of brain ailment

March 13, 2020

Hydrocephalus is among the neurological disorders for which modern medical science remains stymied in the search for a cure. Even treatment for what is commonly called “water on the brain” is looked upon as antiquated in an age of expanding technological innovation.

Characterized by an abnormal buildup of cerebrospinal fluid in the brain, untreated hydrocephalus can trigger swelling, headaches and convulsions, impair cognitive functions and walking and even cause death.

The condition affects people of all ages, including infants — an average of one of every 500 newborns in the United States alone — as well as older children and adults, who can develop hydrocephalus from many conditions. It also affects people with post-traumatic stress disorder, or PTSD, many of whom are current or retired members of the military.

The current treatment process, called shunting, involves diverting the excess fluid from the brain using catheters. The tubing is routed from inside the skull and then underneath the skin to another cavity in the body, such as the abdominal cavity or the heart, where it is absorbed back into the body.

Shunting, however, has a failure rate of about 40% within two years after the procedure is performed and more than 95% within a decade.

But hope for a considerably less invasive and more resilient treatment may lie in advances in one especially fast-growing sphere of technology: micro-electro-mechanical systems, called MEMS.

These miniaturized electrical and mechanical devices are used mostly in semiconductor manufacturing, cell phones, digital displays, wireless communications, aerospace and automotive technologies, but their capabilities are being more fully explored beyond those applications.

Junseok Chae, a professor of electrical engineering in the Ira A. Fulton Schools of Engineering at Arizona State University, has been honing his expertise in the use of MEMS technology to develop medical devices.

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In his research laboratory at Arizona State University’s Tempe campus, Professor Junseok Chae talks about progress he has been making through a collaboration with neurosurgical experts at the Barrow Neurological Institute to develop a more effective and less invasive treatment for hydrocephalus. Photo by Connor McKee/ASU

Progress on that endeavor recently helped earn two grants totaling $2 million from the U.S. Army’s Congressionally Directed Medical Research Programs. The funding supports an ongoing collaboration to develop brain implants that treat hydrocephalus. The work involves Chae and neurosurgical experts at Barrow Neurological Institute in Phoenix, one of the premier neurosurgery centers in the United States, and at Phoenix Children’s Hospital.

The partnership began in 2006, when Dr. Ruth Bristol, a pediatric neurosurgeon at Phoenix Children’s Hospital who has been treating patients with hydrocephalus for almost 20 years, asked Chae to work on a more effective treatment. That request has led to more than 12 years of multidisciplinary collaboration that also involves Dr. Mark Preul, a neurosurgeon and director of neurosurgery research at the Barrow Neurological Institute. Bristol is also with the institute.

Preul’s expertise includes the development and testing of advanced technologies for neurosurgery. One of the Army medical research program’s grants went to ASU to support Chae’s efforts. The other grant went to the Barrow Neurological Institute to fund work led by Preul at Barrow’s neurosurgery laboratory.

“We want to implant a device manufactured from MEMS technology that will drain the cerebral spinal fluid just like the way the body does it naturally when there is no hydrocephalus,” said Chae, who teaches in the School of Electrical, Computer and Energy Engineering, one of the six Fulton Schools.

Cerebrospinal fluid, which is a watery fluid produced by special cells in the brain, surrounds and bathes the brain and the spinal cord. Almost a pint of it is produced every day in the brain’s cavities, called ventricles.

The fluid flows around the brain and spinal cord through the spaces between the brain’s membranes before it is absorbed into the bloodstream. Along the way, cerebrospinal fluid performs critical functions such as protecting the brain by acting as a shock absorber, bringing nutrients to the brain and taking waste out.

In a healthy brain, Chae explained, the fluid circulates through the brain and then flows through tissue structures called arachnoid granulations — projections of the arachnoid membrane — which rest on one of the brain’s meningeal layers that support the framework for cerebral and cranial blood vessels.

“What we want to do is implant our MEMS device onto the meningeal layer to act like natural arachnoid granulation,” Chae said.

The arachnoid granulations regulate the flow of cerebrospinal fluid from the subarachnoid space to the sinus space where it is absorbed back into the body’s blood stream.

In cases of hydrocephalus, the flow, drainage and absorption process gets blocked, causing the troublesome cerebrospinal fluid buildup in the brain.

Chae’s team describes its brain implant as an artificial arachnoid granulation that will “emulate the body’s arachnoid granulation valve system and restore brain fluid flow to its natural pathway by mimicking the body’s natural process,” he said.

To do this, the researchers are using MEMS technology to manufacture the tiny device that regulates the fluid flow through the properties of a hydrogel made of a biocompatible polymer, which has a unique swelling feature enabling it to regulate the flow of cerebrospinal fluid between the subarachnoid and sinus spaces.

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Electrical engineering doctoral student Seunghyun Lee examines one of the small implantable devices designed to help prevent the debilitating effects of hydrocephalus. Photo by Connor McKee/ASU

“This will be a hydrocephalus treatment that is a minimally invasive procedure compared to the current bulky shunt treatment system. It won’t require any catheters, which are currently the biggest cause of the failure of the shunt system,” Chae said.

The new treatment “will have no implanted batteries or electronics but will operate with a fully passive artificial valve to mimic the body’s natural regulation of brain fluid,” Chae said. “The fluid will flow into an outer layer of the brain (the superior sagittal sinus), where it can be reabsorbed into the blood stream.”

Chae, Bristol and Preul are among the co-authors of three articles published in research journals that report on recent technical advances related to the new treatment — in IEEE Transactions on Biomedical Engineering; the  Annals of Biomedical Engineering, part of the Springer Nature Journal, and in the current edition of the American Chemical Society’s ACS Sensors journal.

Despite the promise of the new treatment, Chae cautions against expectations for it to be put into practice in the near future.

“Good things are happening in our research, but this is still a long-term exploratory project,” he said. “We have to go through the Food and Drug Administration’s process and many other validations before we are certain we can could deploy this treatment in a completely safe manner.”

Success in the endeavor, however, would “translate into dramatically improved quality of life for hydrocephalus patients,” Chae said.

Chae credits some of the progress on the project to his student lab assistants.

Electrical engineering doctoral student Seunghyun Lee has contributed to development of a MEMS device, including testing it in the lab, collecting testing data and analyzing the data using advanced statistical methods.

Daniel Beltran, an electrical engineering undergraduate student, has been helping to manufacture the MEMS device, as well as develop the lab setup to test multiple devices simultaneously. 

Top photo: Researchers are using advanced micro-electro-mechanical systems, or MEMS, technology to manufacture small implants that will restore the normal flow of cerebrospinal fluid through the brain to relieve pressure resulting from hydrocephalus. Photo by Connor McKee/ASU

Joe Kullman

Science writer , Ira A. Fulton Schools of Engineering


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How to act cooperatively in the face of a pandemic

March 13, 2020

ASU psychologist Athena Aktipis and collaborators weigh in

Cooperation is essential during a pandemic. As societies deal with the rise of disease in different ways, a consistent theme is that knowing how diseases spread and evolve can put you in a much better position to evaluate what is or isn’t a real threat.

We asked Arizona State University’s resident expert on cooperation, Athena Aktipis, and some of her collaborators about how to encourage cooperation during a pandemic. Aktipis is an assistant professor of psychology in the ASU Department of Psychology who studies cooperation and cheating and co-directs the Human Generosity Project

“Researchers who study cooperation span many different disciplines, approaches and backgrounds, making it possible for us to learn from one another and leverage lots of different knowledge bases to triangulate on problems and think about how we can better survive and thrive in challenging situations, both as individuals and as a society,” Aktipis said. She assembled a diverse team that is collaborating on an interdisciplinary project to study cooperation and interdependence during the pandemic.

We spoke with Lee Cronk, who co-directs the Human Generosity Project with Aktipis and is an anthropologist at Rutgers University; Emily Zarka, of ASU’s English Department, who studies representations of the undead in literature as a method to understand history; Geoffrey Miller, an evolutionary psychologist at the University of New Mexico who has worked on reducing the risks associated with global catastrophes like pandemics; Keith Tidball, an anthroecologist from Cornell University, who studies natural resource management in times of disasters and war; and Joe Alcock, an emergency physician at the University of New Mexico Hospital who has been deployed on the New Mexico Disaster Medical Assistance team, which handles the worst-case scenarios involving patients and the general population.

Question: During a pandemic, do you expect for people to act cooperatively or selfishly?

Aktipis: I have an optimistic view because often during disaster situations people come together to share resources, information and help. However, if people expect others to be selfish this can make everybody more fearful and lead to a downward spiral. We have 10 field sites in small-scale societies around the world in the Human Generosity Project, and among the people we study, we see a lot of cooperation and sharing when people are most hungry and in need. It is important for us to think about ways to keep building societal trust during times of uncertainty so that we can keep cooperating to solve the problems we are facing.

Cronk: People will be both cooperative and uncooperative in different contexts. In the case of COVID-19, we already see uncooperative behavior in the hoarding of face masks, disposable gloves, sanitizing gel and so on. But those who suffer as a result of such behavior are strangers to the hoarders, and the hoarders can use the items they have hoarded to help people they know. This example shows how cooperation is relatively easy to accomplish on small scales and with small numbers of people but is difficult to achieve on large scales and with large numbers of people. The fact that we’re dealing with a contagious disease will also have an impact on levels of cooperation. Much, though not all, of cooperation involves being in proximity to other people, which is exactly what one wants to avoid during an epidemic.

Alcock: During epidemics and times of great stress it will become even more difficult to coordinate and mobilize people to act cooperatively. There are always individuals and groups who are willing to help out, often at great cost to themselves. We need look no further than the “dirty teams” of medical volunteers during the SARS outbreak in Hong Kong who risked their lives to care for victims of that epidemic. On the other hand, self-interested hoarding has led to the disappearance of basic supplies and personal protective equipment in affected hospitals in Washington state, in one of the wealthiest communities on the planet. Currently, the tension between altruism and selfishness driven by desperation and panic will come into sharp relief.

Q: What can people do to prepare now for COVID-19 or to be better prepared for future issues?

Zarka: Always vet your information. Make sure you are getting accurate information from unbiased, knowledgeable resources like the Centers for Disease Control and Prevention or the World Health Organization. ASU has a centralized information hub that can provide information about travel restrictions and general instructions for prevention.

Tidball: Use trusted resources like to put together an emergency preparedness plan, which outlines an approach that is endorsed and used by the Federal Emergency Management Agency.

As you prepare your emergency plan, match your plans and supplies to your specific daily living needs and responsibilities. Discuss your needs and responsibilities and how you and friends and family can assist each other with communication, care of children, business, pets or specific medical needs. Create your own personal network for the specific areas where you need assistance.

Q: What should we be doing on a societal or community level?

Aktipis: Many of the small scale societies that we study in the Human Generosity Project have systems of helping one another in times of need that they can call upon during disasters. We should be thinking about building and supporting informal networks that can help buffer us from risks as well as thinking about how we can expand systems of helping to larger and larger scales without losing their effectiveness.

Miller: For society to function through future crises, it needs to create an effective, evidence-based, well-funded, well-staffed global system for reducing pandemic risks, costs and disruptions. The current spread of COVID-19 is a wake-up call that in a world tightly connected by international air travel, we cannot be complacent about these risks. Humanity is divided into many nations, religions, races and ideologies — but we all share the same biology that is vulnerable to the same infectious diseases. We have to tackle pandemic risks as a unified species.

Q: What should scientists do to help with the current crisis and in the future?

Miller: During times of crisis, we have at least three moral duties as citizen-scientists. We have to pay attention to the news, keep up with emerging data and take serious global threats seriously. We should offer our expertise to help other citizens find the middle ground between oblivious business-as-usual denialism — “COVID-19 is no worse than the flu” — and end-of-the-world catastrophism — “COVID-19 is an existential threat to humanity.” We should also work together in interdisciplinary teams to learn as much as we can, as fast as we can, about how people respond to the virus. This way we can help manage future pandemics better than we’ve managed this one.

Alcock: Even if the spread of the virus ended today, it would already yield enough surprises to fuel the careers of countless epidemiologists, physicians and social scientists. We are only in the earliest stages of this public health disaster, which has the potential to transform economies, medical systems and politics. In confronting this threat, we have an opportunity to be our best selves. Grave threats can re-focus our efforts on what is important: 1) promoting cooperation between scientists, physicians and political leaders, 2) making our public health system stronger and more agile, and 3) ensuring that accurate and useful knowledge is conveyed to the public.  

Aktipis: As scientists studying topics that are relevant to the present issues, we have a moral obligation to share our knowledge both with the public and with each other. We have to share knowledge across disciplines and be open to working with people from different fields who bring different information and skills to the table. A big part of why I started the Zombie Apocalypse Medicine Alliance and the Zombified podcast is to avoid becoming overwhelmed with feelings of fear or uncertainty when talking about issues like what we’re currently facing.

We use the zombie apocalypse as a lens through which we can talk about potentially frightening aspects of our present and future with imagination and creativity instead of fear. Framing the conversations this way is not about just dealing with the present threat from COVID-19, but rather about how we increase our readiness for the challenges humanity will likely face in the future.

Research opportunity: If you would like to participate in the research study that this interdisciplinary team is running, "Preparing and assessing risk in unfamiliar situations," go here.

Top photo by Ashley Gerlach via Unsplash

Robert Ewing

Marketing and Communications Manager , Department of Psychology