Bioengineering: The Future of Biology and Medicine NIH SymposiumOn 27-28 February, 1998 the United States National Institutes of Health (NIH) sponsored a two-day symposium on biomedical engineering research titled "Bioengineering: The Future of Biology and Medicine". The symposium was held on the NIH campus in Bethesda. Dr. Dov Jaron, President-elect of the IFMBE headed the planning of the symposium. This was the first time in its history that the NIH held such a major symposium on bioengineering. Over 750 participants, from academia, industry, regulatory agencies, and the NIH institutes attended. They represented leaders in biomedical engineering research and education from across the country and NIH program managers and scientists. Two NIH representatives and two individuals from the research community co-chaired the symposium program.The NIH was represented by Dr. Jaron who is now Associate Director of NIH's National Center for Research Resources and by Dr. John Watson who is Deputy Director of the National Heart, Lung and Blood Institute. The biomedical engineering research community was represented by Dr. Doug Lauffenburger from the Massachusetts Institute of Technology and Dianne Rekow from the University of Medicine and Dentistry of New Jersey. BECON, NIH "Bioengineering Consortium"The overall planning for the symposium was carried out by the NIH "Bioengineering Consortium" (BECON). BECON was established in early 1997 by the Director of NIH, Dr. Harold Varmus. BECON comprises a representative from each NIH Institute and Center. In a memorandum to the NIH Institute Directors, Dr. Varmus, a Noble Laureate, wrote:
The first action item for BECON was to formulate a definition of bioengineering that reads as follows:
Definition: Bioengineering integrates physical, chemical, or mathematical sciences and engineering principles for the study of biology, medicine, behaviour, or health. It advances fundamental concepts, creates knowledge from the molecular to the organ systems level, and develops innovative biologics, materials, processes, implants, devices, and informatics approaches for the prevention, diagnosis, and treatment of disease, for patient rehabilitation, and for improving health. Symposium Bioengineering: The Future of Biology and MedicineThe purpose of the symposium was to focus on future vision for biomedical engineering, identify grand challenges and barriers to success and develop general research themes that would guide the NIH in future research areas. The symposium included plenary speakers, panel discussions, posters and exhibits. Plenary speakers identified future grand challenges in biomedical research. Panels discussed the role of biomedical engineering in addressing these challenges and proposed recommendations for future NIH activities. Accomplishments made possible through NIH funding of biomedical engineering-related projects were showcased using posters and exhibits. These projects included results of research and development made possible by NIH awards to academic investigators, collaborations with industry, and awards to small businesses through the NIH Small Business Research Innovation Programs. Centre for Bioengineering Research at the NIH?Harold Varmus, MD opened the symposium and introduced the featured keynote speaker: Bill Frist, M.D, a US Senator from the state of Tennessee. Dr. Frist who is a practising heart surgeon and a medical researcher spoke about the importance of biomedical engineering to the development of diagnostic and therapeutic devices and to advances in health care. He emphasised the importance of increased funding by the NIH for bioengineering and discussed the pending congressional bill to establish a Center for Bioengineering Research at the NIH. The plenary speakers addressed six areas in which challenges to the biomedical engineering profession are most critical. Dr. Scott Fraser spoke on "Imaging and Measurements from Molecule to Function"; Buddy Ratner discussed "Materials for Understanding and Controlling Biological Processes"; Leroy Hood gave a presentation on "Functional Genomics: From the Genome to the Physiome"; Patricia Brennan presented a talk on the topic "Informatics: Now and Beyond"; Rakesh Jain spoke on "Delivery of Molecular and Cellular Therapeutics"; and O. Howard Frazier M.D. discussed challenges on designing "Next Generation Devices and Methodologies." Future research needsThe plenary talks set the stage for many of the panel discussions. Panels, dealing with a broad range of biomedical engineering research areas discussed the obstacles to addressing future research needs and made recommendations for areas of investment and for means to implement the recommendations. A total of 16 panels were convened. The topics covered and a vision statement that resulted from the deliberation of each panel follows. Functional Genomics: From the genome to the physiomeBioengineering should play a key integrative role in functional genomics, including the integration of research and education, across disciplines, and among academia, industry, and society. Bioengineering principles should be applied to the characterisation of genetic and physical-chemical properties of components of biological systems at various levels and to the understanding of function in terms of the regulation and interaction of these components. Imaging at the molecular and cellular levelsNew developments in microscopies are providing crucial information and essential approaches for understanding the structure and function of cells and molecules. Molecular and cellular bioengineering is a rapidly evolving multidisciplinary area capitalising on these technologies to create advances in research in many vital areas. The emergent microscopies are particularly critical in research on mechanical modelling of cells and tissues, interactions of implanted devices with host tissues, biosensors that monitor physiological processes, and prosthetics to augment deficient sensory systems. Imaging at the tissue and organ levelsDiagnostic imaging of tissues and organs, especially in the modalities of ultrasound, nuclear medicine, nuclear magnetic resonance and spectroscopy, and X-ray computed tomography, has been a field of rapid advances. Integration of the information content from the diverse imaging methods (Table 1) is required to reap the benefits of these advances. Emphasis must be continued on minimising invasiveness, imaging and processing time, costs, and patient discomfort, as well as maximising resolution and ease of use of data display. Bioengineering can play a crucial role in future improvements in each of the components of imaging research and development from image acquisition to clinical decision making. Functional biomaterialsThe panel envisions harnessing the knowledge of all relevant disciplines to design functional biomaterials (including device components) that will guide specific tissue/organ structure and function. This process will incorporate knowledge of tissue structure, material properties, cell function and protein/cell-material interaction guided by clinical relevance and ethics, as well as acceptable cost and manufacturing requirements. Instruments and devicesThe development of instruments and devices that augment or replace damaged organs or diseased tissues, thus restoring patients to health and independence, will occur by means of technological advances that combine principles of engineering, physics, mathematics, and chemistry with an in-depth knowledge of biology. The NIH can facilitate achievement of this goal by supporting the multidisciplinary research necessary to develop instruments and devices for the next century. Bioengineering in clinical medicineImprovements in preventive, diagnostic, and therapeutic medicine require the ongoing infusion of new technologies (drugs, devices, equipment and procedures) evolving from discovery and knowledge gained through basic biomedical research. In turn, challenges in clinical medicine help focus basic research efforts on the search for improved ways to meet clinical needs. The dual-pathway migration of knowledge between basic research and clinical evaluation and use is defined as translational research. Nurturing this migration to stimulate productive research and improve clinical medicine is an ever-present challenge for the NIH. Today this challenge is accentuated by external forces such as managed care and a regulatory environment. Education and trainingIn recent years our understanding of the fundamental mechanisms of disease has improved enormously with commensurate changes in the practice of medicine. These changes have driven an exponential growth in the potential for engineering to contribute to medicine through increased biomedical understanding, innovative diagnostics and therapeutics, and improved healthcare delivery. For this potential to be realised, however, we must focus on the educational infrastructure expected to produce the biomedical engineering leaders of the next century. In considering the educational infrastructure, interdisciplinary and integrated are keywords that emerge from any perspective. From the perspective of career paths, biomedical engineering education must provide a foundation for industry, academic science, and medicine. Each path provides enormous opportunities to improve the social, economic, and health status of the United States: a cadre of bioengineers is necessary to translate our country's lead in biomedical science into industrial opportunities and economic development, to increase the scope and speed of scientific advances in biomedical science, and to bring an increased analytical perspective to the practice of medicine. From the disciplinary perspective, many problems in medical science respond only to the combined contributions of engineering, science, and medicine. Thus, the educational infrastructure must provide a mechanism for students to integrate across multiple disciplines. From a more general perspective, biomedical engineers must be able to adapt to a changing science base and to the internationalisation of the work place and be able to appreciate the ethical and political implications of research. As the number of educational programs begins to grow in response to these opportunities, bioengineers have focused intensely - and led the way - on establishing innovative organisational structures and teaching paradigms for integrated, interdisciplinary education. NanobiotechnologyNanobiotechnology will generate new capabilities, facilities, and approaches for investigating and understanding cellular and molecular processes. These advances would not be possible using macroscopic technologies. Nanobiotechnology will allow for a dramatic miniaturisation and integration of complex functionality for a new class of biomedical devices and micro systems and will lead to development of improved device-tissue interfaces to permit their long-term use in vivo. Beyond Informatics: The Future of ComputationBioinformatic databases must be transformed into functional models of cell and tissue processes. Accomplishing this requires harnessing the knowledge of all relevant disciplines, including computer science, mathematics, bioengineering, and biological sciences. The models will range from empirical correlation of databases to mechanistic and systemic descriptions of complex biological processes. Comprehensive informatic-based descriptions of model organisms and organs need to be developed and tested in concert with basic biological research to uncover the rules of non-linear cellular and systemic regulation. Algorithms and other computational tools for predicting and exploring intrinsic and emergent properties of these modelled processes will be needed. New approaches to therapeuticsIn the future, the field of therapeutics should advance drug delivery, tissue engineering, and genetic engineering by integrating the expertise of cell biologists, bioengineers, and medical scientists to develop tools to better assess the physiological barriers to entry of therapeutic agents, the directed delivery of those agents, and the persistence of the physiological effect. Combinatorial approaches in biologyWe envision the development of generally valid paradigms and techniques based on combinatorial approaches for the design, synthesis, characterisation, assaying, and end-use evaluation of complex, novel molecular entities and interactions. We expect that within five to ten years, combinatorial paradigms will become an engine of innovation in a variety of fields with particular emphasis on pharmaceutical sciences and drug delivery, medical device development, and materials design and engineering. Mathematical modellingThe success of reductionist and molecular approaches in modern medical science has led to an explosion of information, but progress in integrating information has lagged. We need to make connections among facts, but this is hampered by inherent biological complexities and problems of translating information between different experimental spaces e.g., structural, spatial, and temporal. Mathematical models provide a rational approach for integrating this ocean of data, as well as providing deep insight into biological processes. The integrative capacity of models will be needed in translation efforts to bring knowledge gained from molecular studies to the physiological level needed for treatment of disease. Modelling should not be seen as an afterthought, but as a critical component of multidisciplinary projects. To foster such recognition, we need improved communication between modellers and biological scientists and improved educational opportunities for those involved in multidisciplinary projects. We should raise the bar for what is expected from hypothesis-driven science. Mathematical modelling is a glue holding together various experimental and interpretative modalities. Medical informaticsMedical informatics and bioengineering have potentially symbiotic capabilities, which require integration and recognition of complementary strengths. Both fields involve acquiring, processing, and analysing information. They share the need to manage massive, distributed, networked data sets that are compiled from heterogeneous sources. These databases serve a heterogeneous set of users, with roles in research, patient care, and education. Methodologies for addressing clinical issues and educational materials may be productively applied to biological and genomic information. Medical records are required to assess the capabilities of medical devices and to design bioengineering experiments. Information obtained by sensors and imaging, and assay methods can contribute to the detail and richness of the data set for a patient. As we advance the ability to describe a person's genomic profile, genomic and medical records databases converge. This convergence will improve care by increasing understanding of diseases that might develop and responses to specific therapies and by answering questions about patient populations. Role of biomedical engineering in rehabilitation and assistive technologiesBiomedical engineering plays a pivotal role in the rehabilitation process by assisting with restoration and substitution of functional loss. By virtue of their dual training in biology and engineering, biomedical engineers draw from the knowledge base of many of the life and physical sciences and apply this knowledge to develop meaningful applications that improve a person's body, mind, and contribution to society. The recent Institute of Medicine report, Enabling America, classifies disabilities broadly into four areas: pathophysiology, impairment, functional limitation, disability, and societal/environmental limitations. Disability emerges from the interaction between impairment and societal or environmental barriers. While many areas of science and engineering contribute to the resolution of organ system pathology and impairment, biomedical engineering is uniquely qualified to develop and implement substitutions for organ function and to reduce the adverse effects of societal and environmental barriers on the lives of disabled people. Biomedical engineers can help compensate for functional limitations and reduce the impact of societal and environmental barriers. They emphasise the overriding need to maintain and restore functional capacity to optimise quality of life. Biomechanical solutionsBiomechanics is a branch of engineering science dealing with the involvement of force, deformation and motion in biology, from molecules to whole individuals. Biomechanics impacts every area of medical disease. No disease will ever be fully understood unless it undergoes a complete stress analysis. All cells in the body-stem cells, endothelial cells, embryonic cells, etc. are strongly impacted by the geometry and stress factors in their environment, factors that influence key functions such as gene expression, growth and development etc. Biomechanics has contributed to the understanding of physiology and pathology, development of medical diagnostic and treatment procedures, design and manufacture of prostheses, improvement of human performance in the workplace and sports and automobile safety, injury prevention, protection of the aged, handicapped, sick and injured. Biomechanics has strength in problems of blood circulation, musculo skeletal systems, ultrasound imaging, tissue remodelling, mass transport as in kidney dialysis and in cancer drug delivery, development of artificial internal organs and joints, automated gait analysis, human tolerance and tissue engineering. It is relevant to treatment strategies for many diseases, from gene therapy to surgery. In vigorous development for the future are the biomechanics of biomolecules, DNA, genes, genetic circuits, cells, extracellular matrix and tissues, and the integration of molecular biomechanics with the physiology of the organs and the whole individual. As an engineering discipline, biomechanics is uniquely qualified to address these broad issues. Biomechanics must be an integral part of a solution to the grand challenge of integrating bioengineering with biological research of the next two decades. Bioelectric/biomagnetic phenomena: ion channels to organ functionDiseases involving electrical dysfunction in the heart, brain, and skeletal muscles are major health problems. Future advances may depend on improved methods for the detection of electric and magnetic signals, innovative combining of bioelectric phenomena with chemical, acoustic, optic, and motion information, and development of mathematics to analyse non-linear processes more accurately. The technology-development and integrative systems skills of biomedical engineers will play a major role in future studies of bioelectric and biomagnetic phenomena, including applications to diagnosis and therapy. Poster presentationsExamples of poster presentations included research projects on topics such as:
Commercial products through NIH supportExamples of commercial products developed with support from the NIH, either through initial funding by regular investigator-initiated grants or through the Small Business Innovation Research program that were displayed during the symposium include products such as:
Watershed in the history of biomedical engineeringThe symposium highlighted the dynamic nature of biomedical engineering research and the major changes that the field is undergoing. It reinforced the need for universities to examine their educational and research programs, prepare to meet new challenges and establish innovative paradigms in biomedical engineering research and education for the 21st century. It emphasised the importance of biomedical engineering for the future of basic, applied and translational research. Just as important,was the preparation for the symposium that involved top program managers from the NIH institutes, and the event itself. The event attracted a large fraction of top NIH management and started a major transformation in the attitude of the agency toward basic engineering research. The symposium enormously increased the visibility of the profession within the NIH community. It enhanced the appreciation of NIH leadership to the importance of biomedical engineering contributions. It also improved the agency's understanding of the major role biomedical engineering will have to play in order to enable critical breakthroughs and advance future biomedical research. The major conclusions from the symposium emphasised the unique nature of biomedical engineering in its system and integrative approach to problem solving, its ability to carry the results of basic research into the commercial and clinical setting and its ability to function in a multidisciplinary environment. Among the most important recommendations were the establishment of biomedical engineering research and development centres, examining and revising the educational paradigm for the profession and increasing the interaction between the engineering and the medical disciplines. The symposium generated tremendous excitement within the biomedical engineering community and among NIH management. It has been labelled as a "watershed" in the history of biomedical engineering. The full report of the symposium will be available in a couple of months on the web at: http://www.nih.gov/grants/becon/symposium.htm Dov Jaron PhD Associate Director, National Center for Research Resources Director, Biomedical Technology, National Institutes of Health, 6705 Rockledge Drive, Room 6160 Bethesda, MD 20892-7965, USA Tel: 301-435-0755; Fax: 301-480-3659 Email:dov.jaron@nih.gov | ||