Filtration & fluid control
“The geometry is about fluid flow,” he adds. “Place it in one way to encourage flow out, and reverse it for flow in. The liquid infusion solves the problem of bacterial accretion. A biofilm that is hard to clear with antibiotics can sometimes build up, so we need to replace tubes when there is repeated infection, but with iTTs, cells have a hard time adhering to the tube, so a build up is less likely, and iTTs don’t work their way out.”
In six months of preclinical studies, no iTTs were extruded from the ear, suggesting they can dramatically reduce the need for tube replacement procedures. “An ear tube is mainly just there to let air into the ear to clear fluid, but I think about other uses including drug delivery to the middle ear,” Remenschneider continues. “Some conditions need the direct application of steroids, which normally requires a syringe, anaesthetic and repeat visits. An implanted tube could allow patients to self-medicate.”
From iTTs to next-gen IMCs The new design approach that created iTTs results in predictable and effective uni and bi-directional fluid transport at the millimetre scale and can resist contaminations, and could define how other IMCs are made. Indeed, the research team envisages the design methodology ultimately being applied to many different
IMCs. At MEE, an aqueous shunt to decrease pressure in the eye is an obvious application, though the excellent safety and efficacy results in the ear lay the ground for shunts for the brain, bile duct, or for draining spinal fluid, and also suggest new designs for urinary catheters. “We have been able to really define the materials and the performance in a preclinical model, so a human subject study is next in order to compare iTTs to standard-of-care tubes and assess the risk of biofilm formation over a longer duration of action,” Remenschneider explains.
“The materials are all commonly used and are known to be human-friendly, but any new device takes time, resources and data to reach the market,” he notes. “This could be transformative for our field, as preclinical data suggests that it could significantly reduce many of the complications we see with TTs. More exciting is that it could represent a new way to treat inner or middle ear conditions that have previously required invasive procedures.” With new therapies developing fast, including gene therapies that could treat nerve-related hearing loss, the ability to get those medications into the inner ear is vital. Even without the potential applications elsewhere in the body, iTTs represent game-changing technology for millions of people. ●
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