About 30,000 people die each year
from liver cirrhosis in the United States alone. This chronic disease, a
consequence of viral infections (hepatitis C, hepatitis B), obesity or
alcoholism, is characterized by the progressive replacement of healthy liver
tissue by fibrous scar tissue which is unable to fulfill its function.
Extracting a piece of liver to analyze its structure is the most reliable
technique for diagnosing and monitoring the progression of fibrosis. These
biopsies are painful and invasive, and can cause internal bleeding. The current
alternatives to this procedure are expensive or inaccurate. Colombian
biomedical engineer Carolina Amador wanted to find a solution for this issue,
and to do this she has developed a technique that could eradicate biopsies
forever. Based on this innovation Salazar has been chosen as one of Innovators
Under 35 Latin America 2017 winners by the MIT Technology Review, Spanish
Alternatives to biopsy focus on measuring the elastic properties of liver tissue, a technique known as elastography. "By measuring the wave propagation speed, one can determine if the tissue is soft or hard," explains Amador. As the liver becomes more fibrous, its elastic properties change, consequently a non-invasive measurement could end the need for biopsies to confirm the disease.
This can be carried out in two ways: either by the use of ultrasound or by magnetic resonance. Although the second is more accurate, it is also expensive and not widely accessible. Whereas the ultrasonic technique is cheaper and easier to perform, the problem "is that it is very sensitive to variations in the handling of the device," explains the Colombian innovator. Apparatus from different providers, managed by different technicians, or based on different mathematical models, yield different results, even used to test the same patient. "Contradictory results are impeding acceptance of the technique," continues Amador.
To avoid these disparities, Amador’s has worked to establish a standard technique so that the diagnostic results are always reliable. Her endeavor could become a safe, effective and economical alternative to liver biopsies. Her method, Acoustic Radiation Force Induced Creep-Recovery (ARFICR), measures viscosity and elasticity independent of the mathematical model. In addition, the ultrasonic signal used has a greater amplitude and a lower signal-to-noise ratio than other ones, which makes it more accurate. "ARFICR can be implemented simply by modifying the software," adds Amador.
The young woman is convinced that "in ten years we can eliminate liver biopsies." For this reason, in addition to her current position at Philips North America research laboratory, she is continuing her research at the Mayo Clinic. The next steps include demonstrating that her technique offers less variability than alternatives in a clinical trial and convincing the medical community to use it instead of the more expensive magnetic resonance elastography or invasive and dangerous biopsies.
Juan Sebastián Osorio, Director of Education at Gemedco, who in 2012 was a winner of both the global and the regional Colombian edition of 35 Innovators Under 35, highlights Amador’s development trajectory which has included patent grants and several articles published in scientific journals. The Innovators Under 35 Latin America 2017 jury member values the young woman's potential to "translate her research into practice", as well as her relationship with the Mayo Clinic, a pioneer in this area and a global leader in medical research.