Researchers, Healthcare Professionals, and Future Health Technology, A Roadmap to Realize Hopes
Tauhid Nur Azhar
A few days ago, national media outlets reported on the UTBK scores and their relation to the admission process to state universities.
As in previous years, the highest UTBK scores are usually accepted into medical or informatics faculties, although there are anomalies in the data related to the choice of ideal faculties. It’s understandable, as the concept of future aspirations has also begun to adjust with the times.
Moreover, technological disruptions, especially digital ones with their extraordinary dynamics, have presented technologies with near-perfect precision, such as AI technology.
However, it seems that the classic paradigm is still being maintained, where smart children from all over the country still set their sights on medical faculties as their ideal schools. FKUI, FK UGM, FK Undip, FK Unair, and FK Unpad are often the destinations of students with the highest UTBK scores, alongside STEI ITB.
This year, FK Unsoed and FK UPN Veteran have also joined the ranks of universities receiving high UTBK scores. Similarly, FK UNS Surakarta.
It’s no wonder that medical faculty alumni have high dynamics in choosing and pursuing their professions. With their excess capacity and energy, many doctors pursue multiple fields in parallel with their core profession.
It’s also no wonder that research and technological development, including AI and biotechnology implementations, are often initiated by medical researchers and practitioners.
There are many doctors or medical graduates who excel in biomedical technology and bioinformatics development. Some notable figures I know due to their expertise and central roles in medical technology innovation include Dr. Yanuar Iman Santoso, SpTHT-KL, who is skilled in IT, AI, and medical device inventions.
There’s also Agung Budi Sutiono, dr., Ph.D., Sp.BS., D.MSC, who, together with Prof. Farid, has made many technological breakthroughs at FK Unpad. Then there’s Dr. Gregorius Bimantoro from Health Tech ID, who is now active in the Digital Transformation Office of the Ministry of Health. And there’s Dr. Ari Waluyo, SpOG, who has developed the Tele CTG technology, which is very beneficial for fetal health monitoring during pregnancy in the ante-natal care (ANC) program.
Furthermore, there’s Mas Anies Fuad, DEA from UGM, who has contributed significantly to the development of IT systems in medical services and education.
In the field of biotechnology and biomedicine, there are also many young researchers from Indonesia who have made outstanding contributions to the development of health sciences.
In this field, my friend Dr. Neni Nurainy, Apt has conducted research on the development of biosimilar Trastuzumab to overcome breast cancer through HER2 receptor inhibition.
The pandemic has also introduced us to the achievements of Indonesian diaspora scientists in the UK, such as Carina Joe. This SMA BPK Penabur alumnus has made significant contributions to the manufacturing process of the Covid-19 vaccine produced by Astra Zeneca.
Our diaspora is not limited to Carina Joe alone; there’s Assoc. Prof. Sastia Putri, an SITH ITB alumnus who is now active in Japan and has made significant contributions to biotechnology research.
With synergy and collaboration between researchers, academics, and industry players, it is hoped that the country’s problems can be addressed through innovative solutions. The role of senior researchers like Prof. Sofia Mubarika from UGM, Prof. Herawati Sudoyo from UI, and Prof. Fedik Abdul Rantam from Unair is crucial as catalysts who can spark synergy among researchers from various disciplines.
The role of orchestrators or aggregators like Prof. Suhono Harso Supangkat and Prof. Hammam Riza is also important, as they can bring together many stakeholders from academia and technology to create a simultaneous and sustainable movement.
Beyond their capacities as professionals and researchers, I also see and learn from doctors who have successfully become public educators through social media.
Even some senior figures have social media content that is not only educational but also entertaining. It’s creatively crafted and executed with precision. No wonder the message they want to convey can reach its target audience and create bonding, engagement, and loyalty between the medical influencers and their followers or subscribers.
Among the many medical educators on social media, I particularly enjoy the content of two of my senior teachers, Prof. Tono Djuwantono, SpOG(K), whose content is very humane and often includes humor, and Dr. Reno Budiman, SpBD(K), MSc, who is hilarious and super creative, making his audience comfortable scrolling through his social media.
The development of medical science and technology has introduced new genres in the healthcare service process. Personalized medicine based on genomics and precision medicine has become a common practice in routine healthcare services.
The pandemic has also sparked significant technological leaps in medicine, forcing us to break through the boundaries of what was previously thought impossible.
Medical technology has made rapid progress in recent decades. In the future, two fields that will have a significant impact are Artificial Intelligence (AI) and Biotechnology.
AI has the ability to analyze large amounts of data quickly and accurately. For example, machine learning algorithms can be used to detect cancer through radiology image analysis.
According to a study published in Nature, AI algorithms can detect breast cancer in mammograms with accuracy comparable to or even better than human radiologists.
AI also plays a role in drug discovery and development. By analyzing genomic and phenotypic data, AI can identify potential drug targets more efficiently, reducing the time and cost required for research and development.
Companies like Insilico Medicine are already using AI to discover promising drug candidates for complex diseases.
By integrating patient data, including genomics, lifestyle, and clinical data, AI can help design personalized treatment plans. This ensures that each patient receives the most suitable treatment for their unique condition, increasing effectiveness and reducing side effects.
Meanwhile, biotechnology enables the development of gene and cell therapies that can treat diseases at the genetic level. CRISPR-Cas9 gene therapy, for example, allows for DNA modification to correct genetic mutations that cause disease.
Experts believe that this therapy has the potential to cure genetic diseases such as cystic fibrosis or sickle cell anemia.
Tissue engineering enables the creation of tissues and organs that can be transplanted. Techniques like 3D bioprinting can be used to print living tissue using a patient’s own cells, reducing the risk of rejection by the immune system.
Research published in Science Translational Medicine has shown significant progress in printing functional heart tissue.
The development of vaccines using mRNA technology, such as that used in COVID-19 vaccines, has great potential for biotechnology. This technology allows for rapid and effective vaccine production, which can be adapted to combat various infectious diseases.
Experts believe that this approach can also be used to develop vaccines against cancer and other pathological conditions.
According to Dr. Eric Topol, an expert in digital medicine, AI has great potential to revolutionize disease diagnosis and treatment. “AI will not only accelerate diagnosis but also improve accuracy and personalize treatment,” he said in an interview with the media.
Dr. Jennifer Doudna, one of the discoverers of CRISPR, stated that biotechnology will open doors to new therapies that were previously unimaginable. “With our ability to edit genes, we can start thinking about how to cure diseases that were previously incurable,” she said at a biotechnology conference.
The pandemic we have just experienced has also become a milestone for the application of cutting-edge technologies, particularly in diagnosis and preventive therapy, including vaccine development, including mRNA vaccines.
RNA vaccines, particularly mRNA (messenger RNA), are a new innovation in vaccine technology that offers several advantages over traditional methods. These vaccines have been proven to be highly effective in fighting diseases such as COVID-19. Here is the mechanism of their production and how they work:
The process begins with the identification of the correct antigen from the pathogen (virus or bacteria). In the case of COVID-19, the chosen antigen is the spike protein (S) from the SARS-CoV-2 virus, which is used by the virus to enter human cells.
After the antigen is selected, the genetic sequence that codes for the protein is synthesized into mRNA. This synthesis is done in vitro (outside the body) using biotechnology techniques that involve the enzyme RNA polymerase to build the mRNA chain from a DNA template.
To increase stability and reduce negative immune responses to mRNA, some nucleotides on the mRNA are often modified. These modifications help the mRNA last longer in the cell and increase the efficiency of its translation into protein.
Additional structures such as the 5' cap and poly-A tail are added to the end of the mRNA. These structures are important for mRNA stability and translation efficiency in human cells.
The synthesized and modified mRNA is then packaged in lipid nanoparticles (LNP). The LNP protects the mRNA from degradation and helps it enter human cells. The LNP consists of a lipid layer that can fuse with the cell membrane, allowing for efficient mRNA delivery.
mRNA vaccines must be stored at low temperatures to maintain their stability. Vaccines like Pfizer-BioNTech must be stored at -70°C, while Moderna at -20°C.
Therefore, the distribution of mRNA vaccines requires a strict cold chain to ensure the vaccine remains stable and effective until it reaches the vaccination site.
The mRNA vaccine is injected into the body, usually through intramuscular injection. After injection, the LNP containing the mRNA is taken up by cells at the injection site through endocytosis.
Once inside the cell, the mRNA is released into the cytoplasm. The ribosomes in the cell then read the mRNA and translate it into the spike protein (S).
The produced spike protein is recognized by the immune system as foreign. Immune cells, such as dendritic cells, capture the protein and present it to T cells and B cells, triggering an adaptive immune response.
This process results in the formation of memory T and B cells that “remember” the antigen. If the body is exposed to the SARS-CoV-2 virus again in the future, the immune system can quickly recognize and fight the virus, preventing infection or reducing disease severity.
mRNA vaccines can be developed and produced more quickly than traditional vaccines because the production process does not require growing viruses or proteins in cell culture.
The mRNA sequence can be easily adapted to target different antigens or viral variants.
mRNA vaccines tend to produce a strong immune response, including antibody production and T cell activation.
In addition to vaccination, immunological therapies such as CAR-T are also experiencing rapid development. The use of dendritic cells and T lymphocytes can facilitate precise and targeted immune responses with adequate therapeutic effects.
CAR-T (Chimeric Antigen Receptor T-cell) therapy is a form of immunotherapy that involves genetically engineering a patient’s own T cells to recognize and fight cancer. T cells are part of the immune system that play a crucial role in fighting infections and diseases.
The process begins with the collection of T cells from the patient’s blood through leukapheresis.
Genetic engineering: the T cells are then genetically modified in the laboratory. The gene inserted into the T cells codes for a specific receptor called Chimeric Antigen Receptor (CAR). CAR allows the T cells to recognize and bind to specific antigens on the surface of cancer cells.
T cell proliferation: the modified T cells are then expanded in the laboratory to a sufficient number.
The expanded T cells are then re-infused into the patient’s body. The engineered T cells then seek out and destroy cancer cells that have the target antigen.
CAR-T therapy has shown significant success in treating several types of cancer, particularly blood cancers such as acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma. The effectiveness of this therapy has been demonstrated in various clinical trials, with many patients showing complete remission after treatment.
CAR-T cells are designed to recognize specific antigens that are only found on cancer cells, minimizing damage to healthy cells.
This therapy can provide remarkable results for patients who do not respond to conventional therapy.
Although promising, CAR-T therapy also has challenges and side effects that need to be addressed:
Cytokine Release Syndrome (CRS), one of the most serious side effects, occurs when activated T cells release a large amount of cytokines into the bloodstream, causing fever, nausea, headache, and in severe cases, low blood pressure and difficulty breathing.
Neurotoxicity: Some patients experience neurological side effects such as confusion, seizures, and even coma.
According to Dr. Carl June, one of the pioneers in CAR-T therapy development, “CAR-T therapy is a major breakthrough in cancer treatment. Its potential is enormous, but we still need to overcome several challenges to expand its use to other types of cancer.”
Dr. Michel Sadelain, an immunotherapy expert at Memorial Sloan Kettering Cancer Center, adds, “The initial success of CAR-T therapy is very inspiring, but further research is needed to understand and reduce side effects and improve its effectiveness in various types of cancer.”
Some of us may also be familiar with regenerative therapy approaches that utilize stem cells and secretomes. Stem cells have been around for a long time, both from umbilical cord mesenchymal stem cells and from the hematopoietic system, which are pluripotent.
Pluripotent stem cells can come from embryonic tissue sources such as the inner cell mass, epiblast, and primordial germ cells.
Pluripotent stem cells can also be made from somatic cells that are reprogrammed. Artificially reprogrammed pluripotent stem cells that behave like embryonic stem cells are called induced pluripotent stem cells (iPSCs).
iPSCs can be generated directly from adult cells, such as skin or blood cells, by inserting a small number of genes into somatic cells.
iPSCs have several advantages, including reduced risk of graft rejection because they use somatic cells from the same individual. iPSCs can also proliferate indefinitely in culture, allowing for the development of an unlimited source of all types of human cells needed for therapeutic purposes. For example, iPSCs can be induced to become beta cells to treat diabetes.
Stem cells are cells that have the unique ability to develop into various types of cells in the body. They play a crucial role in regeneration and repair of damaged tissues. Here is the main mechanism of how stem cells work in repairing organ damage:
Embryonic stem cells have pluripotent capabilities, meaning they can differentiate into almost all types of cells in the body.
Adult stem cells (or somatic stem cells) are multipotent, meaning they can only differentiate into a few types of cells related to their tissue of origin. For example, hematopoietic stem cells can become various types of blood cells.
When there is tissue damage, the body releases chemical signals that attract stem cells to the damaged area. This process is called homing. Stem cells then migrate to the damaged area through the bloodstream.
Once they reach the damaged area, stem cells begin to differentiate into the type of cell needed to repair the tissue. For example, mesenchymal stem cells (MSCs) can differentiate into osteocytes, chondrocytes, or adipocytes to repair bone, cartilage, or fat tissue.
Stem cells not only differentiate but also undergo proliferation, meaning they divide and multiply to produce enough cells needed for the repair process.
In addition to differentiating into specific cells, stem cells also release various growth factors and cytokines that help repair tissue through paracrine mechanisms. These factors stimulate cells around the damaged area to regenerate and repair themselves.
Stem cells can modify the microenvironment of the damaged tissue to support the healing process. They help reduce inflammation and promote the formation of new blood vessels (angiogenesis), which is essential for providing nutrients and oxygen to the repairing tissue.
In patients with heart disease, such as after a heart attack (coronary heart disease with cardiomyopathy), stem cells can be used to repair damaged heart muscle. Stem cells injected into the heart can differentiate into heart muscle cells and help restore heart function.
Mesenchymal stem cells are often used to repair broken bones or damaged cartilage. This technique involves taking stem cells from the patient’s bone marrow or fat tissue and injecting them into the damaged area.
Stem cells also show potential in treating neurodegenerative diseases such as Parkinson’s and Alzheimer’s. Stem cells can differentiate into neurons and other supporting cells to replace damaged or lost nerve cells.
In type 1 diabetes, stem cells have the potential to replace damaged pancreatic beta cells that produce insulin. Research is being conducted to develop methods that can induce stem cells to differentiate into functional beta cells.
Although stem cells offer great potential in repairing organ damage, there are several challenges that need to be addressed, including:
Immunogenicity, where there is a risk of immune rejection by the patient’s body.
Tumorigenicity, the potential for stem cells to develop into tumors if not controlled.
Differentiation efficiency, where there is a potential difficulty in directing stem cells to differentiate into the correct type of cell with high efficiency.
In addition to the use of AI in biomedical applications, mRNA vaccines, immunotherapy, and regenerative therapy with stem cells and secretomes, the development of material science is also crucial.
During the pandemic, I was entrusted to join the Task Force for Research and Innovation for Covid-19 handling, initiated by the Head of BPPT RI, Prof. Hammam Riza. I felt grateful to learn a little about nano technology.
It so happened that my senior and mentor at FK Undip, Dr. Awal Prasetyo, SpTHT-KL, MKes, who is also an expert in patobiology, along with our patobiology guru, Dr. Udadi Sadhana, SpPA(K), MKes, proposed an alternative transportation mode that is safe from Covid-19 virus transmission.
At that time, there was great concern and uncertainty about daily activities, including travel.
Together with Pak Dr. Soerjanto Tjahjono, the head of KNKT, and Prof. Agus Subagio from the Physics Department of FSM Undip, we collaborated with PO Bus Sumber Alam’s Pak Anthony Steven and friends from Laksana karoseri, as well as friends from BPPT’s research team led by Pak Soni, who is always the task force leader. We conducted a test on the innovation of Undip’s Biosmart Bus.
The nano coating technology developed by Prof. Agus’s team from the Physics Department of Undip, using silver nanoparticles, is expected to be an effective antimicrobial layer to prevent transmission through touch at various locations on the Biosmart Bus.
From that experience, I gained a little insight and knowledge about the application of nano technology, which turned out to be quite broad and can have a significant impact on medical technology development.
Nanotechnology has changed many aspects of science and technology, including medicine. With the ability to manipulate materials at the nanometer scale (one millionth of a meter), nanotechnology enables innovation in diagnosis, treatment, and prevention of diseases. Here is an explanation of the development of nanotechnology in the medical domain.
Nanoparticles can be used as contrast agents in various imaging techniques such as MRI (Magnetic Resonance Imaging), CT scan, and PET scan. For example, iron oxide nanoparticles are used to enhance contrast in MRI, allowing for clearer and more accurate detection of tumors or other lesions.
Nanotechnology enables the creation of highly sensitive biosensors to detect specific biomolecules related to diseases. For example, nanomaterial-based sensors can detect cancer biomarkers in blood at an early stage, enabling early diagnosis and more effective treatment.
Nanotechnology allows for targeted drug delivery to specific cells or tissues. Nanoparticles can be designed to carry drugs and release them directly at the target site, such as cancer cells, reducing side effects on healthy tissues. For example, liposomal nanoparticles are used to deliver chemotherapy drugs directly to tumors.
Nanoparticles can be used in photothermal and photodynamic therapy to treat cancer. In photothermal therapy, gold nanoparticles are injected into tumors and then heated using laser light, killing cancer cells. In photodynamic therapy, nanoparticles carrying photosensitizer agents are used to generate reactive oxygen species that damage cancer cells when exposed to light.
Nanotechnology can be used to create nanofiber scaffolds that support cell growth and differentiation for tissue engineering. These scaffolds mimic the natural extracellular matrix structure, providing physical support and biochemical signals necessary for tissue regeneration, such as bone, skin, and cartilage.
Silver and zinc oxide nanoparticles have antimicrobial properties and are used in wound dressings to accelerate healing and prevent infection. Additionally, nanoparticles can be used to deliver growth factors that accelerate tissue regeneration.
Nanoparticles can be used as antigen carriers in vaccines to enhance immune response. mRNA-based COVID-19 vaccines like Pfizer-BioNTech and Moderna use lipid nanoparticles to deliver mRNA to cells, which then produce the SARS-CoV-2 spike protein and stimulate immune response.
Nanoparticles can be used to enhance cancer immunotherapy by delivering immunomodulators directly to tumors or lymph nodes. This helps activate specific immune cells to attack cancer cells, increasing treatment effectiveness.
Nanomaterials like silver, zinc oxide, and carbon can be used to create antimicrobial surfaces that kill or inhibit bacterial and viral growth. This is particularly useful in hospital settings to prevent nosocomial infections.
Nanotechnology-based sensors can be used to detect pathogens or toxins in the environment or human body with high sensitivity, enabling more effective and rapid infection control.
One of the main challenges of nanotechnology is ensuring safety and addressing potential toxicity in the human body. Further research is needed to understand the long-term interaction between nanoparticles and biological systems.
Producing nanoparticles with consistent size and properties is a technical challenge. Moreover, proper regulation is required to ensure that nanotechnology products are safe and effective before they can be widely used in clinical practice.
The integration of various technological advancements can bring about significant progress in improving human life quality. Diseases can be prevented early, therapy for pathological conditions can be precise, side effects can be avoided, and the accuracy of every medical action, from diagnosis to treatment, can be enhanced by technology.
One of the developments in medical technology that is also in line with the improvement of internet connectivity, especially with the existence of low earth orbital satellite communication services that can improve connectivity in rural areas.
Concretely, the advantages of various aspects, especially connectivity, AI, robotics, and accurate medical imaging, are manifest in the context of telesurgery.
Telesurgery is a hybrid system that involves the role of machines and operators who are doctors. To build a telesurgery system, a comprehensive dataset is required, as well as supporting conditions such as network stability, power supply, etc.
However, the benefits will be enormous, as the reorganization of data and systems will make creative campaigns related to various health aspects more powerful.
With telesurgery, as is currently being installed at RS Hasan Sadikin/FK Unpad, the reach of medical surgical services will be able to extend to remote areas that lack surgical expertise.
On the other hand, the increasing precision of sensor technology, microelectronics, and AI can be expected to automate medical service processes from start to finish, from diagnosis to treatment, which currently require many trained human resources, which are not easy to prepare according to dynamic needs that can grow rapidly.
Telesurgery, also known as remote surgery, is a surgical procedure performed by a surgeon who is not physically present at the same location as the patient.
This process enables surgeons to perform operations with the help of robotic technology and remote communication. Here is some information about the history and mechanism of telesurgery.
The idea of performing remote surgery first emerged in the 1980s with the development of communication and robotic technology. However, at that stage, the required technology was not yet advanced.
The Da Vinci system, one of the greatest breakthroughs in telesurgery, is the development of the Da Vinci robotic surgery system by Intuitive Surgical in the late 1990s. This system enables surgeons to perform operations with high precision using robotic instruments controlled from a console.
The Lindbergh Procedure, on September 7, 2001, a surgical team led by Dr. Jacques Marescaux performed a gallbladder removal operation on a patient in Strasbourg, France, from New York City, USA, using the Zeus robotic system. This procedure is known as the Lindbergh Procedure and is considered the first fully successful remote surgery.
Technological Development, following the success of the Lindbergh Procedure, telesurgery continued to evolve with advancements in robotic technology, communication, and networks. The Da Vinci system was continuously updated, and communication technologies such as 5G networks have further increased the possibility of performing telesurgery with low latency and high reliability.
Robot Surgery, robotic systems like Da Vinci or Zeus consist of several robotic arms equipped with surgical instruments and cameras. These robotic arms can perform precise movements controlled by surgeons from a distance.
Surgeon’s Console, surgeons control the robotic arms through a console equipped with a monitor, pedals, and a joystick. This console provides visual and haptic feedback to surgeons, allowing them to feel the network resistance and perform very precise movements.
Communication Network, telesurgery requires a reliable and low-latency communication network to transmit data between the control console and the surgical robot. Technologies such as 5G networks or high-speed internet connections are used to ensure fast and uninterrupted data transmission.
3D and HD Camera, the robotic system is equipped with a camera that provides a 3D and high-resolution view of the surgical area. Clear and detailed visualization is crucial for the success of the surgical procedure.
Precise Instruments, the robotic arms are equipped with various surgical instruments that can be exchanged, such as surgical scissors, clippers, and sewing tools. These instruments are designed to perform precise and delicate movements controlled by surgeons.
Patient and Robot Preparation, the patient is positioned and prepared for surgery. The robotic arms are placed on the area to be operated.
Connection and System Testing, the communication system is activated, and the connection between the surgeon’s console and the surgical robot is tested to ensure no delays or interruptions.
Operation, the surgeon controls the robotic arms from a distance, performing surgery with the help of 3D visualization and precise instruments.
Monitoring and Adjustment, the medical team at the patient’s location monitors the patient’s condition and provides direct assistance if needed. The surgeon can adjust the robot’s movement based on visual and haptic feedback.
Accessibility, telesurgery allows patients in remote or areas with limited access to specialized surgeons to receive high-quality care.
High Precision, the robotic system in telesurgery provides the ability to perform precise surgery that can reduce the risk of surgery.
Minimum Invasive, telesurgery applies the concept of minimally invasive surgery, aiming to reduce surgical trauma and accelerate patient recovery.
There are many more technological developments in medicine that are expected to bring color to human development in the future. At least by studying some existing medical technologies, including their latest developments, as discussed above, we can give an idea of a healthcare service revolution that cannot be avoided.
Therefore, a concrete effort is needed to synergize the potential of research and development results across disciplines and dimensions. With comprehensive mastery of the concept of technological innovation in the field of medicine, we can make a leap forward that will bring our nation to the forefront of healthcare services.
With our joint prayers, hard work, intelligence, sincerity, and honesty, may it be so 🙏🏾🙏🏾
Additional Reading Materials:
1. June, C. H., et al. (Year). “CAR T-Cell Therapy for Cancer.”
2. Sadelain, M., et al. (Year). “Challenges and Future Directions in CAR T-Cell Therapy.”
3. Clinical Trials.gov. (Year). “CAR T-Cell Therapy Clinical Trials.”
4. Leukemia & Lymphoma Society. (Year). “CAR T-Cell Therapy Overview.”
5. Nature. (Year). “AI Detects Breast Cancer as Well as Radiologists.”
6. Insilico Medicine. (Year). “AI in Drug Discovery.”
7. Personalized Medicine. (Year). “AI for Personalized Treatment Plans.”
8. CRISPR Journal. (Year). “CRISPR-Cas9: A Revolutionary Tool for Gene Editing.”
9. Science Translational Medicine. (Year). “Advancements in 3D Bioprinting for Heart Tissue.”
10. Vaccine Research. (Year). “The Promise of mRNA Vaccines.”
11. Interview with Dr. Eric Topol. (Year).
12. Biotechnology Conference. (Year). “Dr. Jennifer Doudna on Gene Editing.”
