Disrupting Nephrology: From Technology to Developing Organs-on-Chips

  • 1 Mukta Baweja is an assistant professor of medicine and nephrology at the Icahn School of Medicine at Mount Sinai in New York City. She serves on the Public Policy and Advocacy Committee of the American Society of Nephrology. She is an advocate for patients and at-risk populations and an agent in optimizing public healthcare delivery.
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Seamlessly carrying on the energy of change and transformation in the kidney sphere captured during plenary sessions at Kidney Week 2019, two sessions brought the potential for such transformation to life: Disruptors on the Move and Organs-on-Chips: Human Kidney Microphysiological Systems.

The panel of innovators and experts in healthcare innovation for the Disruptors on the Move session included current PCORI Interim Executive Director and CJASN Editor-in-Chief Josephine P. Briggs, MD, former Department of Health and Human Services CTO and current Kaiser Permanente VP of Medicaid Transformation Bryan Sivak, CVS Kidney Care CMO Bruce Culleton, MD, Cricket Health CMO Carmen Peralta, MD, FASN, and Outset Medical CEO Leslie Trigg.

Patient centeredness, which took center stage in the discussion on disruption, is important to the disruption of care for at least 3 reasons, Briggs stated:

  • 1) Patients bring a sense of urgency and impatience to the discussion.

  • 2) The questions change when patient centeredness is being evaluated on a continual basis.

  • 3) A patient-centered approach will also bring innovation and better implementation into the process.

These sentiments were echoed by the other panelists.

“Everything comes to your phone—a taxi, food, even your friend. So why can’t the care (sic) come to you?” asked Cricket Health’s Peralta. “It’s not just all about reaching [patients] geographically but also psychologically.”

Meaningful disruption requires three things, according to Outset Medical’s Trigg: 1) an entrepreneurial ecosystem such as that provided by Kidney X, 2) an early adopter environment, and 3) capital flow.

Investors are less excited to provide capital flow if 1) and 2) are not present, she said.

In other fields, particularly with cardiac devices, a crucial ingredient to successful innovation was alleviating practitioners’ sense of fear regarding adoption of a new technology—although it may have flaws and imperfections—in order for users to learn through trial and error what could work, Trigg said.

The need to quell fear among practitioners in adopting new technology also came to mind during the session Organs-on-Chips: Human Kidney Microphysiological Systems.

Jonathan Himmelfarb, MD, FASN, spoke about “A Human Kidney-on-a-Chip for Precision Medicine” and Neil Lin, PhD, spoke on 3D Vascularized Kidney Tissues-on-Chip for Drug Toxicity and Disease Modeling.

The idea of a credit-card–sized chip that could mimic a human organ for use in precision medicine was born out of a partnership of the National Institutes of Health with DARPA and the Food and Drug Administration in 2012. The goal has been for utilization of such a chip for pre-clinical safety and drug testing with the benefit of genetic diversity and for conceivable use in clinical trials.

There is also the amazingly brilliant concept of a kidney organoid, “a multicellular unit in vitro containing nephron-like epithelial structures with podocyte and tubular segments,” and the capabilities are being developed to create human stem cells and organoids from urine samples. The potential for revolutionizing patient care is extraordinary with this technology.

“The tools that are becoming available are now allowing us to combine those technologies [CRISPR] with microfluiditics to allow us to create a field that is personalized,” Himmelfarb said.

Leadership from nephrologists needed

But what ties this basic science revolution with the innovators and industry disruptors in care is that there is a need for leadership from nephrologists and a translation from bench to product that is currently not optimal. Trigg noted that there are currently 7000 medical startups, but less than 20 of these are kidney-based startups.

Our colleagues have developed technologies that years ago were unfathomable—that even may have been considered scientific fiction, as Himmelfarb noted—but perhaps we are not tapping into the full potential of utilizing this knowledge without a willingness to take on the risks of disrupting care and embracing the leadership roles waiting to be seized.

There will be roadblocks and obstacles along the way—we need to address our current barriers in the healthcare system and disparities in care that are community based and find a way to minimize them.

No one said disruption would be easy. But we know this: the technology and science are getting bolder and more exciting, and it is up to us to start somewhere.