Margot Damaser: Well, thank you for the invitation, Alan, and thank you for that wonderful generous introduction. This brief slide talk is adapted from the talk I gave at SUFU. For this one, I wanted to look forward to the future of urology research. I always have disclosures. I always show my disclosures. I work with a lot of companies, as you know, Alan. This is actually how I think we translate our research in the lab, is to work with companies who can create a commercial product and do the commercialization and advertising. Most of these are not relevant to the talk today, but a couple of them are to slides I will show later in the talk.
I do like to show this figure. I love this figure to give a sense of the abyss intellectually between our bench research in the lab and getting things to the bedside. This is not trivial. Translating things. And this year happens to be the 75th year of NIDDK, the primary NIH Institute responsible for funding non-cancer urology research. NIDDK has been there with us researchers for 75 years trying to do the very best basic science research we can and to translate it to the bench and to learn, translate it to the bedside, and to learn from physicians and patients and bring that back to the bench and the research.
And so right there with NIDDK, there's been a lower urinary tract research for a very long time, and I did some deep digging in the NIH Reporter website to find out what NIDDK has been funding. The NIH Reporter website only goes back to 1986, and so that's as early as I could dig up. But there's just some amazing researchers. I'm sure Alan knows everyone on this list of some examples that I pulled. I was really fortunate to be able to work with Bob Levin and Penny Longhurst at Penn and Alan. And this is the basic science research that all of our bench-to-bedside research is built, on all of our practical translation, anything we get to patients is really built on the basic science research done 20, 30 years ago. And so we are really standing on the shoulders of giants and I want to give credit to all these amazing researchers who not only taught us literally, but did the research that our research can build upon.
So what research is NIDDK funding now more in the basic science realm that I believe will impact the future of urologic care in our field? And I came up with three examples. This is not to exclude others. These are just ones that I felt were particularly exciting. The first one is effective stress and inflammation on lower urinary tract. And these three projects recently funded by NIDDK are really exciting. Looking at, for example, early life inflammatory events and its effects on lower urinary tract dysfunction in adulthood, nerve inflammation and its effect on bladder and erectile dysfunction, and then the top one, Dr. Vizzard's research on effective stress and inflammation on central nervous system nutrition circuits and molecular signaling.
I think these are really important. When I was at Penn 30 years ago, there was IC research being done and it was important, don't get me wrong, but the disease was not as well-defined and we've sort of over the years been honing in on some causes and some etiology that I think is going to be really important in terms of developing therapies. Second idea is mechanisms of recurrent UTI, an area again, of long-time research and very few treatments. And I think what's newly funded by NIH is really exciting. Looking at the urobiome, so the bacteria in the urine and its role in recurrent UTI susceptibility. And then in terms of translation, there's a group from Watershed Medical working on an intravesical device that will deliver intravesical antibiotic for recurrent urinary tract infections. If we can identify what bacteria lead to recurrent UTIs from one person's research and then deliver the appropriate treatment to get rid of them, then working together, we can really advance the field.
And the last NIDDK-funded project I wanted to focus on is one that I'm involved in. It's a bit more technology-oriented because that's the realm where I work. And I'm working with a colleague at Cleveland State University who has developed this piezoelectric electrode. Piezoelectric platforms generate electricity by bending or pressing or movement or stretching of the electronics itself. And so it doesn't need an attached stimulator, it doesn't need a wireless stimulator, it doesn't need a battery. So if we put the piezo part in the pelvic floor muscles, when a woman does Kegels, she could be also delivering a very, very small signal to the pudendal nerve to help pudendal nerve regeneration. And then his whole system is biodegradable, so there's no need to go in and take it back out. And we're running a rat experiment now. And the rats, I've tried, they won't do Kegels.
So we're putting the piezo part near the quadriceps and putting them on running leads to see if we can get the whole system working. So I think that's exciting and holds a lot of potential for the future. And then I have one last area, which is a little bit different, talking about digital phenotyping. And this is an area where cardiovascular and other areas of medicine are ahead of us, but I think urology really needs to catch up. So the idea behind digital phenotyping is health monitoring during normal activities using smart devices. Think a Fitbit or an Apple Watch, you could also use environmental sensors, wearable devices, medical monitors to get data about people's daily activities. And then we need some algorithms to extract the data and then use this to help treat their conditions. So it enables early detection of changes to health, personalized medicine, chronic disease management, rehabilitation monitoring and more. All of these aspects of digital phenotyping could be applied to our field.
Potentially a value for improving diagnosis and treatment of nocturia, erectile dysfunction, incontinence, voiding dysfunction and more. And so we think of it as a digital repository of data similar to what you might've heard about a biorepository where blood samples and biopsies would be held. So we can do physiological phenotyping with wearable medical devices or smartwatches, behavioral, psychological phenotyping, environmental phenotyping with travel bath patterns or bathroom usage, social phenotyping with call logs and text messages. And of course there are concerns when this kind of data is being collected of privacy. So all those things also need to be addressed. And medical phenotyping, medication adherence from smart pill bottles. And the interesting thing is that these different aspects of digital phenotyping can be done in conjunction with each other. So the trick is to choose the right things to monitor for the right condition.
So we've been working on a indwelling bladder device. I've kind of nicknamed a Fitbit for the bladder. We're now calling it the Urodynamics monitor. This device, the blue device being held in the hand in the picture straightens out to be inserted transurethrally and then bounces around in the bladder lumen. It's very lightweight. People tolerate it really easily. And then it transmits out bladder pressure and it can be used at home, overnight or in the clinic, whatever's best for the condition being monitored. And if we think of it as a tool for digital phenotyping, it could be paired with a home EEG system to diagnose or monitor nocturia at night. It could be paired with a smart watch and movement tracking to diagnose incontinence versus mobility. Why is it that somebody can't get to the bathroom? It could be paired with uroflow to diagnose incontinence and voiding dysfunction.
And these are just a few examples. And it could provide feedback for behavioral modification. And it is just worth pointing out that ours is a homemade device, but it has been translated and commercialized as the Glean Urodynamic System. And they have gone with the idea for an initial product of pairing it with uroflow to diagnose incontinence. So they have a Uroflow meter on the right that is synchronized with their Glean system. So I think there's a lot more we can do with this technology that's yet to be done. And I think it's also a great research tool for learning about what is the bladder doing at home, so more research is needed. There are challenges like I mentioned with the digital phenotyping and digital repositories. We could work with, see how biorepositories have addressed these challenges. And I'm sure all of you have ideas of what might need to be monitored at home if you could monitor anything. I think the future is great. In 10 years, I think we'll see a very different urology practice. Thank you.
Alan Wein: Thank you. That was terrific. What's the usual transit time from inception of an idea, the research that it takes to let's say, prove a hypothesis, getting it to a company that's willing to produce it, doing the clinical trials and getting it on the market?
Margot Damaser: There is no usual transit time.
Alan Wein: I mean ballpark, let's say for your piezoelectric system for re-innovation.
Margot Damaser: So that one is going to have a longer commercialization time because it's implantable. And also it's going to have to have some serious safety studies done because it's bioresorbable. So what happens to it in the body systemically as it resorbs? It doesn't stay put in one place. It gets excreted. And so I would say from the stage we're at now, at least 15 years. The Urodynamics monitor, as an example, had a faster pipeline to commercialization because we were able to do IRB studies in people as a non-significant risk device, so we did not have to go to the FDA. Because it's not resorbable, it can be pulled out at any time via the string that's attached. It has a bunch of other things that make it a non-significant risk device.
Alan Wein: The digital phenotyping, where does all that data go? In other words, to whom or to what does it go to and what's the information that comes out? Is it just raw data that comes out or does artificial intelligence interpret that and say, "Oh, this person has a risk for whatever. You better do this or you better do that."?
Margot Damaser: Right, right, exactly. We're not there yet, but that's exactly where we need to go with artificial intelligence assessment. Nobody is going to sit there and scroll through days and days of data.
Alan Wein: Exactly.
Margot Damaser: So along with device development, we have to have algorithm development or train artificial networks as soon as we get some data to train them with.
Alan Wein: I mean, are there people who are being trained to do that now? In other words, is the current generation, let's say, of graduate students or whatever, I mean, are they being trained to be able to do this when these actually become available?
Margot Damaser: Absolutely, yes. And whenever we have the money, we peel one off of the cardiovascular realm.
Alan Wein: Gotcha.
Margot Damaser: That's where they're being trained. And we say, "Okay, lots of cardiovascular people. You want to be different. You want to do something really interesting, come work with me on bladder data." For sure. They are being trained to do it. They're very, very good. Postdocs these days. Yeah.
Alan Wein: So in the area of functional urology, which is meaning absolutely not cancer, and whatever else you'd describe as functional urology, I mean, what do you see are the most significant things coming down the pike in terms of basic research that'll be translatable to a clinical situation? Or what would you like to be funded that maybe is not funded now?
That's probably a better question.
Margot Damaser: I think particularly women's health is always chronically underfunded. Although that has improved, I think we could do a better job. We as a society, as a field, could do a better job of funding the bridges between the basic science and say the bridges between the urobiome research for recurrent urinary tract infections and the manufacturing of a device. There's SBIR grants, right, for the companies. But there's this middle stage between where it's really hard to get funding because it's not necessarily hypothesis driven. It's more milestone driven of prototype a device, come up with an idea, troubleshoot the device, try it on the bench, try it in animals, try it in people short term. And I think it's just really hard to get funding in that translational window area. And that's where I'd like to see more funding.
Alan Wein: Great. Well, thank you so much for your time. That was really very illuminating. I mean, it's great to see all the stuff that has resulted from basic research because so many people say, "Ah, what do we need that for?" And it's great to see what's coming down the pike and what your views about that have been and continue to be. So please stay working.
Thank you.
Margot Damaser: All right. Well thank you for this opportunity.