REVOLUTIONARY DEVICE FOUND TO LOWER BLOOD PRESSURE

A revolutionary device has been shown to significantly lower blood pressure among patients with uncontrolled high blood pressure, compared to those treated with usual drug measures -- according to research from Queen Mary University of London and published in The Lancet.

 The device -- developed by ROX Medical and named the 'Coupler' -- is a paper clip sized implant which is inserted between the artery and vein in the upper thigh, in a procedure lasting around 40 minutes under local anaesthetic.

Researchers led a randomised, blinded endpoint clinical trial with patients from multiple European Centres of Hypertension Excellence -- including the Barts Blood Pressure Clinic at Barts Health NHS Trust in east London -- all of whom had resistant high blood pressure and had not responded to at least three types of drug treatment.

The team compared the effects of the Coupler versus usual medical treatment in 83 patients of whom 44 received the ROX Coupler therapy. Patients who received the Coupler experienced a significant and durable reduction in blood pressure. There was also a reduced number of hypertensive complications and hospital admissions for high blood pressure crises.

The Coupler also worked well among patients who had failed to respond to renal denervation (another new approach to treating high blood pressure), suggesting the Coupler targets different mechanisms of blood pressure control. However, patients who had not previously been treated with renal denervation experienced the same level or more of blood pressure reduction. In addition, unlike renal denervation, this new device-based treatment is fully reversible, immediate and pain-free.

Dr Melvin Lobo, Lead Author and Principal Investigator of the study at Queen Mary University of London, and Director of the Barts Blood Pressure Clinic at Barts Health NHS Trust, comments: "This is an entirely new and highly promising concept in high blood pressure treatment. Existing drugs focus on hormonal or neurological regulation of blood pressure, and newer treatments such as renal denervation are uniquely centred on the renal nervous system. The Coupler effectively targets the mechanical aspects of how blood circulation works -- so it's a totally new approach to controlling blood pressure. The Coupler also highlights the importance of arterial stiffness as a major cause of resistant high blood pressure and it targets this issue both safely and successfully. Once the Coupler is placed, the results are also immediate, which again is unique to this treatment."

The study findings show that blood pressure treatment with the ROX Coupler can give both patients and doctors an alternative option for treating high blood pressure in the future -- particularly when standard therapies have failed.

The study has also put the spotlight on how dangerous uncontrolled high blood pressure truly is. During the study there were five hospital admissions for hypertensive crises among the control group and none in the Coupler group.

However, the Coupler, like all therapies, did have a side effect. Around 29 percent of patients who received the Coupler did go on to develop leg swelling which meant another short procedure was needed to deal with this (usually a stent in the vein).

Dr Lobo concludes: "High blood pressure is very dangerous and leads to hospital treatment, stroke, heart attack and chronic kidney disease. We must find better means of treating high blood pressure as drugs do not work for everyone and the Coupler is a big step forward in our search for alternative treatment.

"It's a little too early to begin applying these findings to routine clinical care at this stage. We need more research to explore the long-term effects of the Coupler, better understand its safety and understand more about how it works within the body. However, an International Registry is commencing early this year which means we will be able to continue offering patients with uncontrolled high blood pressure the option of Coupler treatment, as long as conventional measures to get their blood pressure down to target have failed."

CANCER NEW DEVICE YIELDS CLOSE UP LOOK AT METASTASIS

Johns Hopkins engineers have invented a lab device to give cancer researchers an unprecedented microscopic look at metastasis, the complex way that tumor cells spread through the body, causing more than 90 percent of cancer-related deaths. By shedding light on precisely how tumor cells travel, the device could uncover new ways to keep cancer in check

The inventors, from the university's Whiting School of Engineering and its Institute for NanoBioTechnology (INBT), published details and images from their new system recently in the journal Cancer Research. Their article reported on successful tests that captured video of human breast cancer cells as they burrowed through reconstituted body tissue material and made their way into an artificial blood vessel.

"There's still so much we don't know about exactly how tumor cells migrate through the body, partly because, even using our best imaging technology, we haven't been able to see precisely how these individual cells move into blood vessels," said Andrew D. Wong, a Department of Materials Science and Engineering doctoral student who was lead author of the journal article. "Our new tool gives us a clearer, close-up look at this process."

With this novel lab platform, Wong said, the researchers were able to record video of the movement of individual cancer cells as they crawled through a three-dimensional collagen matrix. This material resembles the human tissue that surrounds tumors when cancer cells break away and try to relocate elsewhere in the body. This process is called invasion.

Wong also collected video of single cancer cells prying and pushing their way through the wall of an artificial vessel lined with human endothelial cells, the same kind that line human blood vessels. By entering the bloodstream through this process, called intravasion, cancer cells are able to hitch a ride to other parts of the body and begin to form deadly new tumors.

To view these important early stages of metastasis, Wong replicated these processes in a small transparent chip that incorporates the artificial blood vessel and the surrounding tissue material. A nutrient-rich solution flows through the artificial vessel, mimicking the properties of blood. The breast cancer cells, inserted individually and in clusters in the tissue near the vessel, are labeled with fluorescent tags, enabling their behavior to be seen, tracked and recorded via a microscopic viewing system.

Wong's doctoral advisor, Peter Searson, the Joseph R. and Lynn C. Reynolds Professor of Materials Science and Engineering and director of the INBT, said his graduate student took on this challenging project nearly five years ago -- and ultimately produced impressive results.

"Andrew was able to build a functional artificial blood vessel and a microenvironment that lets us capture the details of the metastatic process," said Searson, who was the corresponding author of the Cancer Research article. "In the past, it's been virtually impossible to see the steps involved in this process with this level of clarity. We've taken a significant leap forward."

This improved view should give cancer researchers a much clearer look at the complex physical and biochemical interplay that takes place when cells leave a tumor, move through the surrounding tissue and approach a blood vessel. For example, the new lab device enabled the inventors to see detailed images of a cancer cell as it found a weak spot in the vessel wall, exerted pressure on it and squeezed through far enough so that the force of the passing current swept it into the circulating fluid.

"Cancer cells would have a tough time leaving the original tumor site if it weren't for their ability to enter our bloodstream and gain access to distant sites," Wong said. "So it's actually the entry of cancer cells into the bloodstream that allows the cancer to spread very quickly."

Knowing more about this process could unearth a key to thwarting metastasis.

"This device allows us to look at the major steps of metastasis as well as to test different treatment strategies at a relatively fast pace," Wong said. "If we can find a way to stop one of these steps in the metastatic cascade, we may be able to find a new strategy to slow down or even stop the spread of cancer."

Next, the researchers plan to use the device to try out various cancer-fighting drugs within this device to get a better look at how the medications perform and how they might be improved.