By David Templeton

Under each research rock in Pittsburgh’s medical garden lie possible advances for 2017 in cancer treatments, cardiovascular care, prosthetic limbs, organ transplantation for children and health technology.

National and online publications annually provide lists of anticipated medical breakthroughs, with this year focused on artificial pancreases for diabetes, immunotherapy treatments for cancer and the use of big data to advance individualized health care.

Pittsburgh can provide its own impressive can-do list of potential advances from UPMC, the University of Pittsburgh and its School of Medicine, Allegheny Health Network and Carnegie Mellon University with but one caution: These are goals, no guarantees.

We didn’t rank them and it’s not comprehensive, but herein lie examples of what local research stands to accomplish in 2017.

The heart beat

Cutting open the chest to reach a damaged heart always is a serious matter. But Srinivas Murali, medical director of AHN’s Cardiovascular Institute, said 2016 advances that will become even more important in 2017 include minimally invasive replacement of transaortic and mitral valves, some involving surgical robotics, and wearable sensor technology to monitor patients before and after procedures.

“We can use these less invasive procedures in patients who are very ill and too high risk for conventional surgery, and we do it in patients who are low risk with the goal of a speedier recovery,” Dr. Murali said.

He also reported progress in personalized care for heart health, with expanded understanding of the disparities in response to treatment among ethnic groups and men and women. “That’s led to a better understanding of how precision in treatment using genotype information can help us tailor treatment recommendations to maximize patient benefits.”

Cancer on the run

Immunotherapy that harnesses the immune system to attack cancer is the greatest new development in cancer treatment, said Stanley Marks, chairman of the UPMC CancerCenter.

He expects that trend to continue this year with drugs known as checkpoint inhibitors and CAR (chimeric antigen receptors) T-cell therapies being used to activate an immune response against blood cancers. Researchers now are addressing how to prevent an autoimmune response and other serious side effects the drugs can cause.

Four checkpoint drugs now are approved as treatments for melanoma, lung, head and neck, bladder and kidney cancers and Hodgkin lymphoma, with good rates of success. In other approaches, dendritic cells are being used as messengers to help the CAR T cells fight cancer.

“Many of the immunotherapy trials have been initiated right here at UPMC CancerCenter and remain a very active part of our clinical research,” Dr. Marks said. “Other clinical trials at UPMC are using combinations of immunotherapy agents. This is where the excitement is.”

David S. Parda, chairman of the AHN Cancer Institute, noted the newly discovered benefits of combining immunotherapy treatments with targeted surgery, radiation and chemotherapy based on a person’s genetic profile.

“It really is a function of bringing them all together for the individual patient” to produce optimal treatments, he said, noting that AHN has 150-200 human clinical trials open along with 300 to 350 trials open at Johns Hopkins University, its university partner. That means AHN cancer patients have access to about 500 clinical trials.

Ngoc Thai, chief of transplantation at AHN and interim chairman of its department of surgery, said development of stereotactic body radiotherapy by AHN radiologist Alexander Kirichenko and Dr. Thai has brought gamma knife-type precision in treating brain cancers to the treatment of liver tumors. The procedure overcomes issues involving liver movement due to patient breathing.

“It can pinpoint the delivery of high-dose radiation to the liver, providing a killing dose,” Dr. Thai said. “This is available at AHN, and [Dr. Kirichenko] has made us far and away the most robust program in the country” in treating liver cancers with this method.

Health technology

“One of my favorite tasks is to gaze into the crystal ball and decide what’s coming down the pike,” said Rasu Shrestha, UPMC’s chief innovation officer.

He said remote health monitoring is emerging. Soon patients discharged from hospitals will wear sensors and other technology that monitor their health automatically, allowing doctors to intervene at the earliest stage possible to reduce the risk of complications and prevent hospital re-admissions.

“This already is underway, and we’re making great advances in pilot projects with patients with congestive heart failure and patients who need advanced care. This is going to be real, for sure, in 2017.”

Meanwhile, UPMC, Pitt and CMU continue making progress through the Pittsburgh Health Data Alliance — a big data initiative — which analyzes patient health data to improve precision care and reduce costs.

“We’re already doing this at multiple levels,” including studying patients with breast cancer and at-risk children to determine the best individualized treatment for the person’s genotype and how it interacts with environmental factors, Dr. Shrestha said.

Robots with feeling

Michael L. Boninger, UPMC endowed vice chairman for research in Pitt’s department of physical medicine and rehabilitation, is part of a team that enabled people with paralysis to control a robotic arm with brain power. More recently the same team showed that it was possible to restore sensation by stimulating the brain.

Now comes the next phase he said he hopes can be accomplished in 2017 or early 2018 involving using these sensations to improve movement and therefore functionality. “We’re hoping that we’ll be able to make a connection to close the loop,” Dr. Boninger said.

In addition to stimulating the brain directly, the team is working on stimulating near the spinal cord. This approach takes advantage of the normal wiring in the brain that is so important to the control of movement. In this new approach the team might first focus on people with amputation whose nervous systems aren’t otherwise impaired. “We hope we can show that this is a meaningful way to restore sensation — and we’re hopeful it could come out in 2017,” he said.

Ending the AIDS epidemic

It won’t occur in 2017, but Chiu-Bin Hsiao, medical director of the Allegheny Health Network Positive Health Clinic, said there’s still opportunity to reduce AIDS cases in Pittsburgh to zero by decade’s end.

People still will be infected with HIV, but the medical cocktail of drugs, which has been reduced to as little as one pill a day, will help reduce the viral load below contagious levels. That raises hope of achieving the goal of eliminating AIDS, the viral disease HIV can progress to if untreated.

Clinical trials for vaccines also are underway in Canada and the United States with some level of success to date. Dr. Hsiao said an Emory University team of scientists is using a monoclonal antibody to control SIV, the chimpanzee form of HIV. It’s showing promise, with the antibody already a treatment for ulcerative colitis and Crohn’s disease.

“By 2020, we do not want to see any new HIV patients sick with AIDS in Pittsburgh,” he said.

Sharing one’s liver

When it comes to childhood liver transplants, the trend to watch is live donations, mostly from family members willing to provide a portion of their own livers.

“Obviously there is a shortage of available life-saving organs to meet the need, and living donors offer great advantages,” said George V. Mazariegos, chief of pediatric transplantation at Children’s Hospital of Pittsburgh of UPMC.

Live donor liver transplants have been available since 1997 at Children’s, but the hospital now is educating patients and families on their long-term success.

Personalized medicine also is improving outcomes by better determining individual patient need for anti-rejection drugs. Research also continues in making donated organs more readily acceptable to the body, with another line of research focused on repairing genetic mutations to prevent problems that could prompt the need for a transplant, Dr. Mazariegos said.