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Innovative home testing platform offers new hope in sleep apnoea diagnosis

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A North American digital health company is looking to extend the commercial reach for its pioneering diagnostic platform, developed to identify patients suffering from a potentially fatal sleep disorder common among older adults.

Chicago-headquartered Sibel Health received US Food and Drug Administration clearance in July 2022 for its ANNE Sleep tool created to help doctors detect patients suspected of having moderate to severe cases of obstructive sleep apnoea.

The team behind the wearable appliance then launched it with select commercial partners, following clinical research that showed ANNE Sleep could single out most moderate to severe sleep apnoea cases with a lower number of false positives compared to the current gold standard polysomnography (PSG) test.

Now Northwestern University spinout Sibel Health is planning to make the technology more widely available as a way for clinicians to monitor patients’ vital signs in real-time.

Obstructive sleep apnoea affects more than a billion people worldwide and can happen to anyone from children to adults. However, it is a significant issue among older adults with up to 32% of over 65s thought to have some form of sleep apnoea, according to the European Respiratory Society.

The condition results from the upper airways becoming blocked while a person sleeps, which can reduce or stop airflow. As a result, people with obstructed airways can wake up multiple times throughout the night, leading to them feeling excessively tired during the day and suffering from headaches.

Sibel Health’s ANNE Sleep tool created to help doctors detect patients suspected of having moderate to severe cases of obstructive sleep apnoea.

But undiagnosed and untreated obstructive sleep apnoea can have far more serious implications, including the risk of developing high blood pressure, type 2 diabetes, strokes, and heart attacks, and in the worst cases a shortened lifespan.

Whilst anyone can develop obstructive sleep apnoea, being overweight, having high blood pressure, chronic nasal congestion, a naturally narrowed airway, smoking, asthma or diabetes, may put someone more at risk.

Men are two to three times more likely than premenopausal women to have obstructive sleep apnoea. However, the chance of contracting it increases in women after menopause.

The risk of obstructive sleep apnoea also grows with age, although it appears to level off after your 60s and 70s. A family history of sleep apnoea may also play a part.

Yet around 90% of cases remain undiagnosed.

As Ha Uk Chung, vice president of research and development and a co-founder of Sibel Health, explained, obstructive sleep apnoea isn’t just a disorder, it is a “silent health crisis. Most people don’t know they have it.”

ANNE Sleep has originated from prior FDA-endorsed devices Sibel Health created for tracking a person’s cardiorespiratory metrics, including their heart and breathing rate, body temperature, and oxygen saturation levels for premature babies.

Dr Chung revealed they had a specific vision in mind. Since at-home tests for sleep apnoea can include multiple wires, chest bands, and breathing tubes, which can be both cumbersome and uncomfortable when you’re trying to get a good night’s rest, the award-winning medical technology company set out to create a flexible, wearable system.

Ha Uk Chung, vice president of research and development and a co-founder of Sibel Health.

He revealed they wanted something that would easily attach to the skin, collect a wide range of data, be easy to use, not interfere with a person’s natural sleep, could be used for multiple nights if required, and be cost-effective.

ANNE Sleep uses two wireless sensors to track a person’s sleep patterns. One attaches to the skin on the chest, the other clips onto the index finger.

A person wears both sensors before they go to sleep. The sensors then measure their total sleep time through an artificial intelligence (AI) algorithm. The sensors also measure their heart rate, snoring, blood oxygen saturation, and body position among other factors.

After the person wakes, they charge the sensors, which upload the collected data into a secure hub.

A qualified physician can then assess the patient’s sleep patterns based on one or multiple nights.

If a person has at least five breathing interruptions during an hour of sleep due to fully or partially blocked airways, then they are classed as having mild obstructive sleep apnoea.

Moderate forms occur when the airways are blocked at least 15 times. Severe forms start at 30.

An adult needs at least seven hours of sleep each night to support the body’s many functions. If a person is constantly waking up due to interrupted breathing, the ensuing sleep deficit can significantly impact their health.

So, the earlier an individual can be screened, diagnosed, and treated for obstructive sleep apnoea, the better.

The methods for treating obstructive sleep apnoea vary but may include mouthguards or devices such as continuous positive airway pressure machines, which deliver just enough air pressure to a mask to keep the upper airway passages open, preventing snoring and sleep apnoea.

A total of 225 adults suspected of having moderate to severe obtrusive sleep apnoea, took part in clinical research to see if the wearable system could accurately diagnose the disorder.

The team at Sibel Health wanted to see how close the ANNE Sleep device came to the polysomnography test, which records a patient’s brain waves, oxygen levels in the blood, and heart rate and breathing during sleep. It also measures eye and leg movements.

PSG is an overnight sleep assessment but is only conducted at either a laboratory or an accredited sleep centre. Its electric sensors attach to a person’s chest, eyelids, head, and chin so that researchers can make the necessary observations.

For the ANNE Sleep trial participants completed an overnight sleep assessment at one of four sites in Illinois in the midwestern United States. During the visit, each participant’s sleep was assessed by PSG while they wore the ANNE Sleep sensors.

Both PSG and ANNE Sleep identified about one-third of adults with moderate to severe forms of obtrusive sleep apnoea. The results showed the wearable device could identify most moderate to severe sleep apnoea cases with a low number of false positives compared to PSG.

After the trial, the participants completed a post-study survey. Most reported the system was easy to use and comfortable, and that they could see themselves using it again.

Dr Chung said: “User feedback is what motivates us.” He elaborated that thinking about how patients are using the system to support their health is what drives Sibel Health’s researchers to scale the technology.

The system is said to be suitable for all adults, but Dr Chung envisioned it would appeal to those with increased risks for obstructive sleep apnoea who would prefer to conduct overnight sleep assessments from the comfort of their own homes.

This might include adults aged 65 and older.

Stephanie Davis, a small business programme coordinator within the Division of Extramural Research Activities at the United States’ National Heart, Lung, and Blood Institute, which gave a grant to Sibel Health to support its work, said: “With obstructive sleep apnoea being a significant issue among older adults and for so many people in our population, it’s encouraging to see new devices for diagnosing and treating sleep apnoea

“It’s a great way to bring in new technologies that focus on an important unmet clinical need.”

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Gut microbes from aged mice induce inflammation in young mice

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Findings from a new study suggest that changes to the gut microbiome play a role in the systemwide inflammation that often occurs with ageing.

When scientists transplanted the gut microbes of aged mice into young “germ-free” mice — raised to have no gut microbes of their own — the recipient mice experienced an increase in inflammation that parallels inflammatory processes associated with ageing in humans. Young germ-free mice transplanted with microbes from other young mice had no such increase.

Published in Aging Cell, the study also found that antibiotics caused longer-lasting disruptions in the gut microbiomes of aged mice than in young mice.

“There’s been a growing consensus that ageing is associated with a progressive increase in chronic low-grade inflammation,” said Jacob Allen, a professor of kinesiology and community health at the University of Illinois Urbana-Champaign who led the new research with Thomas Buford, a professor of medicine at the University of Alabama at Birmingham.

“And there’s a kind of debate as to what drives this, what is the major cause of the ageing-induced inflammatory state. We wanted to understand if the functional capacity of the microbiome was changing in a way that might contribute to some of the inflammation that we see with ageing.”

Previous studies have found associations between age-related changes in the microbial composition of the gut and chronic inflammatory diseases such as Parkinson’s disease and Alzheimer’s disease. Some studies have linked microbial metabolism to an individual’s susceptibility to other health conditions, including obesity, irritable bowel syndrome and heart disease. Age-related changes in the gut microbiome also may contribute to the so-called leaky gut problem, the researchers said.

“Microbiome patterns in aged mice are strongly associated with signs of bacterial-induced barrier disruption and immune infiltration,” they wrote.

“The things that are in our gut are supposed to be kept separate from the rest of our system,” Buford said. “If they leak out, our immune system is going to recognize them. And so then the question was: ‘Is that a source of inflammation?’”

Many studies have compared the relative abundance and diversity of species of microbes in the gut, offering insight into some of the major groups that contribute to health or disease. But sequencing even a portion of the microbes in the gut is expensive and the results can be difficult to interpret, Allen said. That is why he and his colleagues focused on microbial function — specifically, how the gut microbiomes of ageing mice might spur an immune response.

The team focused on toll-like receptors, molecules that mediate inflammatory processes throughout the body. TLRs sit in cellular membranes and sample the extracellular environment for signs of tissue damage or infection. If a TLR encounters a molecule associated with a potential pathogen — for example, a lipopolysaccharide component of a gram-negative bacterium — it activates an innate immune response, calling in pro-inflammatory agents and other molecules to fight the infection.

The researchers first evaluated whether the colonic contents of young and aged mice were likely to promote TLR signalling. They found that microbes from aged mice were more likely than those from young mice to activate TLR4, which can sense lipopolysaccharide components of bacterial cell walls. A different receptor, TLR5, was not affected differently in aged or young mice. TLR5 senses a different bacterial component, known as flagellin.

Young germ-free mice transplanted with the microbes of aged mice also experienced higher inflammatory signalling and increased levels of lipopolysaccharides in the blood after the transplants, the team found.

This finding provides “a direct link between ageing-induced shifts in microbiota immunogenicity and host inflammation,” the researchers wrote.

In other experiments, the team treated mice with broad-spectrum antibiotics and tracked changes in the microbiomes during treatment and for seven days afterward.

“One of the most interesting questions for me was what microbes come back immediately after the treatment with antibiotics ends,” Buford said. And in the mice with aged microbiota in their guts, “these opportunistic pathogens were the most quick to come back.”

“It appears that as we age our microbiome might be less resilient to antibiotic challenges,” Allen said. “This is important because we know that in the U.S. and other Western societies, we’re increasingly exposed to more antibiotics as we age.”

The study is an important step toward understanding how age-related microbial changes in the gut may affect long-term health and inflammation, the researchers said.

Co-authors of the study also included Illinois postdoctoral researcher Elisa Caetano-Silva; U. of I. Ph.D. student Akriti Shrestha; National Children’s Hospital research scientist Michael Bailey; and Jeffrey Woods, the director of the Center on Health, Aging and Disability at Illinois.

Allen also is a professor of nutritional sciences at Illinois and an affiliate of the Carl R. Woese Institute for Genomic Biology at the U. of I.

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Evening exercise benefits elderly hypertensives

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Evening exercise benefits elderly hypertensives

A study conducted at the University of São Paulo with 23 volunteers found that aerobic exercise performed in the evening benefits elderly hypertensives more than morning exercise.

Aerobic training is known to regulate blood pressure more effectively when practiced in the evening than in the morning.

Researchers who conducted a study of elderly patients at the University of São Paulo’s School of Physical Education and Sports (EEFE-USP) in Brazil concluded that evening exercise is better for blood pressure regulation thanks to improved cardiovascular control by the autonomic nervous system via a mechanism known as baroreflex sensitivity.

Leandro Campos de Brito, first author of the article, commented: “There are multiple mechanisms to regulate blood pressure, and although morning training was beneficial, only evening training improved short-term control of blood pressure by enhancing baroreflex sensitivity.

“This is important because baroreflex control has a positive effect on blood pressure regulation, and there aren’t any medications to modulate the mechanism.”

In the study, 23 elderly patients diagnosed and treated for hypertension were randomly allocated into two groups: morning training and evening training. Both groups trained for ten weeks on a stationary bicycle at moderate intensity, with three 45-minute sessions per week.

Key cardiovascular parameters were analysed, such as systolic and diastolic blood pressure, and heart rate after ten minutes’ rest. The data was collected before and at least three days after the volunteers completed the ten weeks of training.

The researchers also monitored mechanisms pertaining to the autonomic nervous system, which controls breathing, heart rate, blood pressure, digestion, and other involuntary bodily functions, such as muscle sympathetic nerve activity, which regulates peripheral blood flow via contraction and relaxation of blood vessels in muscle tissue, and sympathetic baroreflex sensitivity, assessing control of blood pressure via alterations to muscle sympathetic nerve activity.

In the evening training group, all four parameters analysed were found to improve: systolic and diastolic blood pressure, sympathetic baroreflex sensitivity, and muscle sympathetic nerve activity. In the morning training group, no improvements were detected in muscle sympathetic nerve activity, systolic blood pressure or sympathetic baroreflex sensitivity.

“Evening training was more effective in terms of improving cardiovascular autonomic regulation and lowering blood pressure. This can be partly explained as due to an improvement in baroreflex sensitivity and a reduction of muscle sympathetic nerve activity, which increased in the evening. For now, all we know is that baroreflex control is the decisive factor, from the cardiovascular standpoint at least, to make evening training more beneficial than morning training, since it induces the other benefits analysed. However, much remains to be done in this regard in order to obtain a better understanding of the mechanisms involved,” said Brito, who is currently a professor at Oregon Health & Science University’s Oregon Institute of Occupational Health Sciences in the United States, and continues to investigate the topic via circadian rhythm studies.

Baroreflex sensitivity regulates each heartbeat interval and controls autonomic activity throughout the organism.

“It’s a mechanism that involves sensitive fibres and deformations in the walls of arteries in specific places, such as the aortic arch and carotid body. When blood pressure falls, this region warns the brain region that controls the autonomic nervous system, which in turn signals the heart to beat faster and tells the arteries to contract more strongly. If blood pressure rises, it warns the heart to beat more slowly and tells the arteries to contract less. In other words, it modulates arterial pressure beat by beat,” Brito explained.

In previous studies, the EEFE-USP research group showed that evening aerobic training reduced blood pressure more effectively than morning training in hypertensive men (read more at: agencia.fapesp.br/34194), and that the more effective response to evening training in terms of blood pressure control was accompanied by a greater reduction in systemic vascular resistance and systolic pressure variability (read more at: agencia.fapesp.br/37432).

“Replication of the results obtained in previous studies and in different groups of hypertensive patients, associated with the use of more precise techniques to evaluate the main outcomes, has strengthened our conclusion that aerobic exercise performed in the evening is more beneficial to the autonomic nervous system in patients with hypertension. This can be especially important for those with resistance to treatment with medication,” Brito said.

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Revolutionising cancer treatment: intracellular protein delivery using hybrid nanotubes

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Revolutionising cancer treatment: intracellular protein delivery using hybrid nanotubes

A new hybrid nanotube stamp system has been developed which revolutionises precision medicine with high efficiency and cell viability rates for cancer treatment.

Precision medicine and targeted therapies are gaining traction for their ability to tailor treatments to individual patients while minimising adverse effects. Conventional methods, such as gene transfer techniques, show promise in delivering therapeutic genes directly to cells to address various diseases.

However, these methods face significant drawbacks, hindering their efficacy and safety. Intracellular protein delivery offers a promising approach for developing safer, more targeted, and effective therapies. By directly transferring proteins into target cells, this method circumvents issues such as silencing during transcription and translation and the risk of undesirable mutations from DNA insertion. Additionally, intracellular protein delivery allows for precise distribution of therapeutic proteins within target cells without causing toxicity.

A group of researchers led by Professor Takeo Miyake at Waseda University, Japan in collaboration with the Mikawa Group at the RIKEN Institute have now developed a hybrid nanotube stamp system for intracellular delivery of proteins. This innovative technique enables the simultaneous delivery of diverse cargoes, including calcein dye, lactate oxidase (LOx) enzyme, and ubiquitin (UQ) protein, directly into adhesive cells for cancer treatment.

The researchers explored the therapeutic potential of delivering LOx enzyme for cancer treatment. “Through our innovative stamp system, we successfully delivered LOx into both healthy mesenchymal stem cells (MSC) and cancerous HeLa cells. While MSC cells remained unaffected, we observed significant cell death in HeLa cancer cells following LOx treatment with viabilities decreasing over time. Our findings highlight the promising efficacy of intracellularly delivered LOx in selectively targeting and killing cancer cells, while sparing healthy cells, offering a targeted therapeutic strategy for cancer treatment,” explains Miyake.

Finally, the team successfully delivered 15N isotope-labeled UQ proteins into HeLa cells using the HyNT stamp system. This delivery allowed for the analysis of complex protein structures and interactions within the cells. In addition, optical and fluorescence imaging confirmed the presence of delivered UQ in HeLa cells, and nuclear magnetic resonance spectroscopy matched the intracellular UQ protein concentration with that of a solution containing 15N-labeled UQ. These results demonstrate the effectiveness of the stamp system in delivering target proteins for subsequent analysis.

The results demonstrate the remarkable capability of the HyNT stamp system in delivering LOx and UQ into a substantial number of adhesive cells, as required for regenerative medicine applications. The system achieved a notably high delivery efficiency of 89.9%, indicating its effectiveness in transporting therapeutic proteins into the target cells with precision. Moreover, the cell viability rate of 97.1% highlights the system’s ability to maintain the health and integrity of the treated cells throughout the delivery process.

The HyNT stamp system offers transformative potential in intracellular protein delivery, with applications spanning from cancer treatment to molecular analysis. Beyond medicine, its versatility extends to agriculture and food industries, promising advancements in crop production and food product development. With precise cell manipulation and efficient delivery, the HyNT stamp system is poised to revolutionize biomedical research, clinical practice, and diverse industries, paving the way for personalized interventions and shaping the future of modern medicine.

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