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Annual Review of Biomedical Engineering - Early Publication
Reviews in Advance appear online ahead of the full published volume. View expected publication dates for upcoming volumes.
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Leveraging Preclinical Modeling for Clinical Advancements in Single Ventricle Physiology: Spotlight on the Fontan Circulation
First published online: 03 March 2025More LessPreclinical modeling of human circulation has been instrumental in advancing cardiovascular medicine. Alongside clinical research, the armamentarium of computational (e.g., lumped parameter or computational fluid dynamics) and experimental (e.g., benchtop or animal) models have substantially enhanced our understanding of risk factors and root causes for circulatory diseases. Recent innovations are further disrupting the boundaries of these preclinical models toward patient-specific simulations, surgical planning, and postoperative outcome prediction. This fast-paced progress empowers preclinical modeling to increasingly delve into the intricacies of single ventricle physiology, a rare and heterogeneous congenital heart disease that remains inadequately understood. Here, we review the current landscape of preclinical modeling (computational and experimental) proposed to advance clinical management of a prominent yet complex subset of single ventricle physiology: patients who have undergone Fontan-type surgical corrections. Further, we explore recent innovations and emerging technologies that are poised to bridge the gap between preclinical Fontan modeling and clinical implementation.
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The Evolution of Systems Biology and Systems Medicine: From Mechanistic Models to Uncertainty Quantification
First published online: 19 February 2025More LessUnderstanding interaction mechanisms within cells, tissues, and organisms is crucial for driving developments across biology and medicine. Mathematical modeling is an essential tool for simulating such biological systems. Building on experiments, mechanistic models are widely used to describe small-scale intracellular networks. The development of sequencing techniques and computational tools has recently enabled multiscale models. Combining such larger scale network modeling with mechanistic modeling provides us with an opportunity to reveal previously unknown disease mechanisms and pharmacological interventions. Here, we review systems biology models from mechanistic models to multiscale models that integrate multiple layers of cellular networks and discuss how they can be used to shed light on disease states and even wellness-related states. Additionally, we introduce several methods that increase the certainty and accuracy of model predictions. Thus, combining mechanistic models with emerging mathematical and computational techniques can provide us with increasingly powerful tools to understand disease states and inspire drug discoveries.
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Therapeutic Ultrasound for Multimodal Cancer Treatment: A Spotlight on Breast Cancer
First published online: 19 February 2025More LessCancer remains a leading cause of mortality worldwide, and the demand for improved efficacy, precision, and safety of management options has never been greater. Focused ultrasound (FUS) is a rapidly emerging strategy for nonionizing, noninvasive intervention that holds promise for the multimodal treatment of solid cancers. Owing to its versatile array of bioeffects, this technology is now being evaluated across preclinical and clinical oncology trials for tumor ablation, therapeutic delivery, radiosensitization, sonodynamic therapy, and enhancement of tumor-specific immune responses. Given the breadth of this burgeoning domain, this review places a spotlight on recent advancements in breast cancer care to exemplify the multifaceted role of FUS technology for oncology indications—outlining physical principles of FUS-mediated thermal and mechanical bioeffects, giving an overview of results from recent preclinical and clinical studies investigating FUS with and without adjunct therapeutics in primary or disseminated breast cancer settings, and offering perspectives on the future of the field.
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Replicating Host–Microbiome Interactions: Harnessing Organ-on-a-Chip and Organoid Technologies to Model Vaginal and Lung Physiology
First published online: 19 February 2025More LessOrgan-on-a-chip (OOC) and organoid technologies are at the forefront of developing sophisticated in vitro systems that replicate complex host–microbiome interactions, including those associated with vaginal health and lung infection. We explore how these technologies provide insights into host–microbiome and host–pathogen interactions and the associated immune responses. Integrating omics data and high-resolution imaging in analyzing these models enhances our understanding of host–microbiome interactions' temporal and spatial aspects, paving the way for new diagnostic and treatment strategies. This review underscores the potential of OOC and organoid technologies in elucidating the complexities of vaginal health and lung disease, which have received less attention than other organ systems in recent organoid and OCC studies. Yet, each system presents notable characteristics, rendering them ideal candidates for these designs. Additionally, this review describes the key factors associated with each organ system and how to choose the technology setup to replicate human physiology.
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A Theoretical Approach in Applying High-Frequency Acoustic and Elasticity Microscopy to Assess Cells and Tissues
First published online: 19 February 2025More LessMedical ultrasound is a diagnostic imaging modality used for visualizing internal organs; the frequencies typically used are 2–10 MHz. Scanning acoustic microscopy (SAM) is a form of ultrasound where frequencies typically exceed 50 MHz. Increasing the acoustic frequency increases the specimen's spatial resolution but reduces the imaging depth. The advantages of using SAM over conventional light and electron microscopy include the ability to image cells and tissues without any preparation that could kill or alter them, providing a more accurate representation of the specimen. After scanning the specimen, acoustic signals are merged into an image on the basis of changes in the impedance mismatch between the immersion fluid and the specimens. The acoustic parameters determining the image quality are absorption and scattering. Surface scans can assess surface characteristics of the specimen. SAM is also capable of elastography, that is, studying elastic properties to discern differences between healthy and affected tissues. SAM has significant potential for detection/analysis in research and clinical studies.
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Supracortical Microstimulation: Advances in Microelectrode Design and In Vivo Validation
First published online: 06 February 2025More LessElectrical stimulation of the brain is being developed as a treatment for an increasing number of neurological disorders. Technologies for delivering electrical stimulation are advancing rapidly and vary in specificity, coverage, and invasiveness. Supracortical microstimulation (SCMS), characterized by microelectrode contacts placed on the epidural or subdural cortical surface, achieves a balance between the advantages and limitations of other electrical stimulation technologies by delivering spatially precise activation without disrupting the integrity of the cortex. However, in vivo experiments involving SCMS have not been comprehensively summarized. Here, we review the field of SCMS, focusing on recent advances, to guide the development of clinically translatable supracortical microelectrodes. We also highlight the gaps in our understanding of the biophysical effects of this technology. Future work investigating the unique electrochemical properties of supracortical microelectrodes and validating SCMS in nonhuman primate preclinical studies can enable rapid clinical translation of innovative treatments for humans with neurological disorders.
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Lessons Learned and Challenges Ahead in the Translation of Implantable Microscale Sensors and Actuators
First published online: 06 February 2025More LessMicroscale sensors and actuators have been widely explored by the scientific community to augment the functionality of conventional medical implants. However, despite the many innovative concepts proposed, a negligible fraction has successfully made the leap from concept to clinical translation. This shortfall is primarily due to the considerable disparity between academic research prototypes and market-ready products. As such, it is critically important to examine the lessons learned in successful commercialization efforts to inform early-stage translational research efforts. Here, we review the regulatory prerequisites for market approval and provide a comprehensive analysis of commercially available microimplants from a device design perspective. Our objective is to illuminate both the technological advances underlying successfully commercialized devices and the key takeaways from the commercialization process, thereby facilitating a smoother pathway from academic research to clinical impact.
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Designer Organs: Ethical Genetic Modifications in the Era of Machine Perfusion
First published online: 28 January 2025More LessGene therapy is a rapidly developing field, finally yielding clinical benefits. Genetic engineering of organs for transplantation may soon be an option, thanks to convergence with another breakthrough technology, ex vivo machine perfusion (EVMP). EVMP allows access to the functioning organ for genetic manipulation prior to transplant. EVMP has the potential to enhance genetic engineering efficiency, improve graft survival, and reduce posttransplant complications. This will enable genetic modifications with a vast variety of applications, while raising questions on the ethics and regulation of this emerging technology. This review provides an in-depth discussion of current methodologies for delivering genetic vectors to transplantable organs, particularly focusing on the enabling role of EVMP. Organ-by-organ analysis and key characteristics of various vector and treatment options are assessed. We offer a road map for research and clinical translation, arguing that achieving scientific benchmarks while creating anticipatory governance is necessary to secure societal benefit from this technology.
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Emerging Technologies for Multiphoton Writing and Reading of Polymeric Architectures for Biomedical Applications
First published online: 28 January 2025More LessThe rise in popularity of two-photon polymerization (TPP) as an additive manufacturing technique has impacted many areas of science and engineering, particularly those related to biomedical applications. Compared with other fabrication methods used for biomedical applications, TPP offers 3D, nanometer-scale fabrication dexterity (free-form). Moreover, the existence of turnkey commercial systems has increased accessibility. In this review, we discuss the diversity of biomedical applications that have benefited from the unique features of TPP. We also present the state of the art in approaches for patterning/writing and reading 3D TPP-fabricated structures. The reading process influences the fidelity for both in situ and ex situ characterization methods. We also review efforts to leverage machine learning to facilitate process control for TPP. Finally, we conclude with a discussion of both the current challenges and exciting opportunities for biomedical applications that lie ahead for this intriguing and emerging technology.
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Cell-Instructive Biomaterials with Native-Like Biochemical Complexity
First published online: 28 January 2025More LessBiochemical signals in native tissue microenvironments instruct cell behavior during many biological processes ranging from developmental morphogenesis and tissue regeneration to tumor metastasis and disease progression. The detection and characterization of these signals using spatial and highly resolved quantitative methods have revealed their existence as matricellular proteins in the matrisome, some of which are bound to the extracellular matrix while others are freely diffusing. Including these biochemical signals in engineered biomaterials can impart enhanced functionality and native-like complexity, ultimately benefiting efforts to understand, model, and treat various diseases. In this review, we discuss advances in characterizing, mimicking, and harnessing biochemical signals in developing advanced engineered biomaterials. An overview of the diverse forms in which these biochemical signals exist and their effects on intracellular signal transduction is also provided. Finally, we highlight the application of biochemically complex biomaterials in the three broadly defined areas of tissue regeneration, immunoengineering, and organoid morphogenesis.
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Understanding the Lymphatic System: Tissue-on-Chip Modeling
First published online: 22 January 2025More LessThe lymphatic vasculature plays critical roles in maintaining fluid homeostasis, transporting lipid, and facilitating immune surveillance. A growing body of work has identified lymphatic dysfunction as contributing to the severity of myriad diseases and to systemic inflammation, as well as modulating drug responses. Here, we review efforts to reconstruct lymphatic vessels in vitro toward establishing humanized, functional models to advance understanding of lymphatic biology and pathophysiology. We first review lymphatic endothelial cell biology and the biophysical lymphatic microenvironment, with a focus on features that are unique to the lymphatics and that have been used as design parameters for lymphatic-on-chip devices. We then discuss the state of the art for recapitulating lymphatic function in vitro, and we acknowledge limitations and challenges to current approaches. Finally, we discuss opportunities and the need for further development of microphysiological lymphatic systems to bridge the gap in model systems between lymphatic cell culture and animal physiology.
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Neurons as Immunomodulators: From Rapid Neural Activity to Prolonged Regulation of Cytokines and Microglia
First published online: 13 January 2025More LessRegulation of the brain's neuroimmune system is central to development, normal function, and disease. Neuronal communication to microglia, the primary immune cells of the brain, is well known to involve purinergic signaling mediated via ATP secretion and the cytokine fractalkine. Recent evidence shows that neurons release multiple cytokines beyond fractalkine, yet these are less studied and poorly understood. In contrast to ATP, cytokines are a class of signaling molecule that are much larger, with longer signaling and farther diffusion. We posit that neuron-expressed cytokines are an essential mechanism of neuron–microglia communication that arises as part of both normal learning and memory and in response to tissue pathology. Thus, neurons are underappreciated immunomodulatory cells that express diverse immunomodulatory signals. While neuronally sourced cytokines have been understudied, new technical advances make this a timely topic. The goal of this review is to define what is known about the cytokines expressed from neurons, how they are regulated, and the effects of these cytokines on microglia. We delineate key knowledge gaps and needs for new tools to define and analyze neuronal roles in immunomodulation. Given that cytokines are central regulators of microglial function, a broad new body of work is required to illuminate functional links between these neuronally expressed cytokines and sustained and transient microglial function.
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Restoring Speech Using Brain–Computer Interfaces
First published online: 02 January 2025More LessPeople who have lost the ability to speak due to neurological injuries would greatly benefit from assistive technology that provides a fast, intuitive, and naturalistic means of communication. This need can be met with brain–computer interfaces (BCIs): medical devices that bypass injured parts of the nervous system and directly transform neural activity into outputs such as text or sound. BCIs for restoring movement and typing have progressed rapidly in recent clinical trials; speech BCIs are the next frontier. This review covers the clinical need for speech BCIs, surveys foundational studies that point to where and how speech can be decoded in the brain, describes recent progress in both discrete and continuous speech decoding and closed-loop speech BCIs, provides metrics for assessing these systems’ performance, and highlights key remaining challenges on the road toward clinically useful speech neuroprostheses.
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Systems Biology of the Cancer Cell
First published online: 17 December 2024More LessQuestions in cancer have engaged systems biologists for decades. During that time, the quantity of molecular data has exploded, but the need for abstractions, formal models, and simplifying insights has remained the same. This review brings together classic breakthroughs and recent findings in the field of cancer systems biology, focusing on cancer-cell pathways for tumorigenesis and therapeutic response. Cancer cells mutate and transduce information from their environment to alter gene expression, metabolism, and phenotypic states. Understanding the molecular architectures that make each of these steps possible is a long-term goal of cancer systems biology pursued by iterating between quantitative models and experiments. We argue that such iteration is the best path to deploying targeted therapies intelligently so that each patient receives the maximum benefit for their cancer.
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