Our latest interview is with Luca Marciani, Professor of Gastrointestinal Imaging at the University of Nottingham. Luca chatted about the mechanical colon he has been using in his studies into the human gut and his thoughts on the future of medical technology and data in research.
A physicist by background, Luca studied in Italy and joined the University of Nottingham twenty six years ago. He specialises in magnetic resonance imaging (or MRI) of the gastrointestinal tract.
Working with the mechanical colon
The dynamic colon model or DCM is a really interesting project. It was invented at the University of Birmingham by my colleague Konstantinos Stamatopoulos and the team in Chemical Engineering.
The concept is that the ascending colon is one of the most inaccessible parts of the gut. It’s hard to reach it and study it. For example, if you want to know something like the impact of fluid volumes in the colon or the motion or fluid flow, it’s very difficult. You can make assumptions and work on those assumptions, or you can use this model.
The colon is a dynamic thing. It moves continuously, so whilst using a static model could help you understand the physics, it’s not representative of the real thing.
My colleagues in Birmingham came up with this fantastic idea of building a hydraulic and dynamic colon. It has little compartments that are computer-controlled and can move independently as much as you want. That means they can generate sequences of movement that look like the ones that we think are actually happening inside the body.
Having a model on the bench means you can do whatever you want with it – you can change the contents, you can drop drugs inside and look at how they are dissolved, you can digitally model different flows and conditions.
It has been created to be MRI compatible, as you can’t have something with metal parts inside an MRI scanner. That means we can put the DCM inside the scanner and from the outside, using pipes, we can generate different motions that are picked up by the imaging. That’s where I come in, along with some of my colleagues in Nottingham. We can image the DCM and relate it to the situation in vivo, comparing the images we take of the DCM to the images of patients.
It’s been really useful for our work. So far we’ve done two or three publications exploring the link to physiology. As the colon is so difficult to reach and study, not much is known about what drug tablets will do when they get to the colon. The DCM allows us to explore that.
We then opened up a digital branch to our studies and produced a digital version of the colon on the computer. We experiment on the computer with that digital version, based on what we’ve seen in the bench model, and then those experiments are compared to what we see in physiology.
That’s the idea – exploring the imaging of the gut in vitro, in silico and in vivo, and looking at the link between them.
I think the main challenge was to make the DCM completely MRI compatible as every metal component and substitute it with something else. We had to extend the leads of the piping for the hydraulic system, because the machine that drives the model is metallic too and it would have spoiled the imaging. We had to plug the machine in outside the room and pass the pipes through a hole in the wall.
In terms of the future, we are thinking of changing the conditions inside the DCM. Different people will have different volumes and viscosity of the biomass inside the colon, for example if they have been taking drugs such as laxatives. The physics inside the colon would change dramatically; how does this affect drug dissolution, distribution and absorption? This is one of the steps in which the research is going.
Developing a capsule
Another project I’m working on involves developing a capsule device that is the MRI equivalent of the old-fashioned x-ray radiopaque markers.
The radiopaque markers are lots of little plastics pellets that patients swallow. These pellets were designed to be seen on x-rays, so after a while you could see how far – or not far – they had progressed in the gut. You could make clinical decisions based on that.
Obviously, the radiation was an issue, particularly for children. We were privileged to get funding from the National Institute for Health and Care Research (NIHR) to develop a device which works like the radiopaque markers did but for an MRI scanner. There’s a little bit of a plastic shell, filled with an MRI visible liquid. The children swallow a number of these mini capsules and after a while we take our MRI images and track the capsules as they move through their gut.
We have teamed up with a medical technology SME called JEB Technologies Ltd and they’re making our capsules. We’ve got a few patents for our device and a trademark so they’re called TransiCap now.
We are on the verge of getting regulatory approvals and trying to prove the clinical efficacy; we’ve already proven safety and intended purpose and showed that they’re OK to use, now we want to demonstrate that it’s actually good for a clinician to have access to this information.
Medical technology and data in research
I’m in a privileged position here – I sit on one of the Invention for Innovation funding panels for NIHR. I sit on the product development award panel within that.
I see all these grant applications coming in, trying to find funding for all sorts of exciting medical technology from apps to surgical devices – it gives me a great view of all the cool things that are happening in this country.
The ideas are absolutely brilliant and they cover so many things. I see ideas to make improvements to help diagnostics, to shorten the length of stay for a patient in hospital just a little, to make it easier for patients to monitor themselves from home. There are incredible benefits to be found, whether it’s delivering a better patient experience or reducing costs.
On the panel, we look at these innovations coming from all sorts of directions. It’s clear that the future of medical technology is huge.
As someone who works in imaging, whilst I don’t personally think digital technology such as machine learning or artificial intelligence can replace the human brain of the professionals, they can speed up the process massively. They are very useful for screening and looking at features such as texture and the size of organs within the body, and extraction of data – it’s fabulous.
We don’t know where the funding will go, on the panel; we can’t predict it. Every year, something magical happens. It’s hard work, we read every single application in great detail, and making decisions is hard because in all honesty, they’re all very good. But we have to decide which ones are the most exciting and can provide the largest benefit.
Many thanks to Luca for taking the time to join us.
