Five Grand Challenges for the Future at the Interface of Engineering and Medicine

Jianyi "Jay" Zhang, M.D., Ph.D.,Just imagine this, the creation of:

• An artificially intelligent machine that acts as a human exocortex, a system that will interface with and make an old brain tick normally.
• Human cells that can sense metastatic cancer or the boundaries of solid tumors and respond with killing of tumor cells, release of inflammatory payloads or bioluminescence to help guide surgical removal.
• Manufactured vaccines that prevent or impede a cancer, block opioid action or reverse autoimmune diseases like multiple sclerosis.

These are a few of the far-reaching ideas put forward by 50 international biomedical engineering experts in a new white paper — “Grand challenges at the interface of engineering and medicine,” published in the IEEE Open Journal of Engineering in Medicine and Biology.

Jianyi “Jay” Zhang, M.D., Ph.D., chair of the Department of Biomedical Engineering and a leader in heart tissue engineering at the University of Alabama at Birmingham, is one of the co-authors who devoted a two-day workshop and months of in-depth discussions to identify five grand challenges as the research areas with the greatest potential of achieving tremendous impact on the field of medicine in the next decades or century.

The grand challenges presented in the study are:

• A new discipline called “Accumedicine,” through creation of avatars of cells, tissues, organs and whole humans. These can be tissue avatars or digital computer avatars.
• Development of smart and responsive devices for human function augmentation.
• Exocortical technologies to understand brain function and treat neuropathologies.
• Development of approaches to harness the human immune system for health and wellness.
• New strategies to engineer genomes and cells. 

As the authors write, “The 21st century is witnessing a paradigm shift in human health and medicine. Engineering of entirely unforeseen devices, sensors and technologies have given rise to a deeper understanding of human physiology and pathophysiology. We are in the unprecedented position to translate the knowledge from multiscale myriad measurements into actionable outcomes, and the Grand Challenges outlined here provide a road map for this future.”

“This Grand Challenge paper is an example of both the ‘Convergence Revolution’ in biology and the ‘Fourth Industrial Revolution,’” said Zhang, who helped write and revise the manuscript. 

The Convergence Revolution, as outlined in a Massachusetts Institute of Technology white paper in 2011, is where the “tools, methods and concepts and processes of chemistry, physics, engineering, computer science, material sciences and engineering are increasingly used in biological research — and in which, conversely, life scientists’ understanding of complex evolutionary systems is influencing physical science and engineering.” 

These research areas — part of the Convergence Revolution — have the greatest potential of achieving tremendous impact on the field of medicine in the coming decades or century.The Convergence Revolution is the third revolution in biology since the mid-20th century, an MIT timeline reports. The first revolution was molecular and cellular biology, beginning with the 1953 description of the structure of DNA by Watson and Crick. The second revolution was genomics, the drive to study an organism’s entire genome, including DNA sequencing of the entire human genome. The third revolution evolved in the first decade of the 21st century as academic sectors began to explore Convergence, including the 2009 National Academy of Sciences report, “A new biology for the 21st Century.”

“The Grand Challenges paper presents high-level perspectives from leaders in the Convergence Revolution and the Fourth Industrial Revolution, which have impacted and will continue to impact every perspective of society and life,” Zhang said. “I think — and am very hopeful — that new and younger and stronger leaders will emerge naturally as these revolutions continue.”

The Fourth Industrial Revolution, as described by Klaus Schwab, founder of the World Economic Forum, is “a fusion of technologies that is blurring the lines between the physical, digital, and biological spheres,” 

Schwab says that the First Industrial Revolution, beginning in 1784, used water and steam power to mechanize production. The Second, beginning in 1870, used electric power to create mass production. The Third, beginning in 1969, used electronics and information technology to automate production. 

Notably, the cyber-physical systems of the Fourth are distinct from the Third in velocity, scope and systems impact, Schwab says. “The speed of current breakthroughs has no historical precedent,” Schwab wrote. “When compared with previous industrial revolutions, the Fourth is evolving at an exponential rather than a linear pace. Moreover, it is disrupting almost every industry in every country.”

That includes biomedical research, Zhang says. “UAB — as, evidenced by establishing the new joint Department of Biomedical Engineering in 2015 under the UAB’s School of Engineering and the Marnix E. Heersink School of Medicine — will continue grow strongly as an engaged leader and contributor to the Convergence Revolution and the Fourth Industrial Revolution.”

In the IEEE Open Journal of Engineering in Medicine and Biology Grand Challenges paper, each challenge is framed into five topics to explain the current needs and existing gaps that will help guide future work. The topics are social needs, challenges, enabling technologies, multidisciplinary teams and core competencies.

Each of the five Grand Challenges, the authors say, will need interdisciplinary collaborations between life-science-based and engineering disciplines, as well as next-generation training of doctors and clinicians in technologically and quantitatively driven sciences.

Corresponding authors of the study are Shankar Subramaniam, Ph.D., University of California, San Diego; Paolo Bonato, Ph.D., Harvard Medical School, Boston, Massachusetts; and Michael Miller, Ph.D., Johns Hopkins School of Medicine and Whiting School of Engineering, Baltimore, Maryland.

The IEEE is a community of more than 450,000 technology and engineering professionals and a trusted international voice for engineering, computing and technology. Funding for the study came from the IEEE Engineering in Medicine and Biology Society, Johns Hopkins University and UC San Diego.

At UAB, Zhang holds the T. Michael and Gillian Goodrich Endowed Chair of Engineering Leadership.