What If?

A neurosurgeon dreams of a better device - and invokes an innovative collaboration to help make it a reality

By Mary Hoff

Like other neurosurgeons, Cornelius Lam, treats his patients suffering with excess fluid on the brain (hydrocephalus) by implanting a tube to shunt excess fluid from the brain to the heart or abdomen … but Lam knew there had to be a better way.

“The problem with these shunts is they have a tendency to malfunction— 50 percent fail after two years and have to be revised or replaced,” says Lam. “It’s the best we’ve got. But the technology for them essentially has not changed for 50 years.”

Hydrocephalus is a tragic example of too much of a good thing. Normally, the amount of cerebrospinal fluid, the liquid that circulates through and cushions the brain and spinal cord, exists in a finetuned balance. As fresh CSF is produced in chambers deep within the brain, the old diffuses through tiny projections called arachnoid granulations into veins just beneath the skull. But in some individuals, due to a birth defect, illness, or injury, the arachnoid granulations aren’t able to let the fluid through, and pressure builds up. Hydrocephalus can bcause brain damage and even death.

A couple of years ago, Lam, who is also pursuing a masters degree in biomedical engineering, started thinking about devising a better fix. Why not, he wondered, replace the faulty arachnoid granulations with functioning ones made from a patient’s own cells? Unfortunately, without research funding there wasn’t much he could do but wonder.

Then, in late 2004, the Biomedical Engineering Institute (BMEI) extended an invitation to Medical School faculty to submit proposals to its new “What If” Medical Device Idea Campaign. Top ideas would receive seed funding and technical assistance to help turn vision into reality. Lam put together a proposal to develop a bioartificial arachnoid shunt, and his project was one of seven chosen for the first round of “What If” funding. With an $11,000, one-year start-up grant in hand, he’s now working with BMEI collaborators to develop strategies both for growing arachnoid cells in culture and for convincing the cells to mimic the exquisitely precise semipermeability of the natural blood-brain barrier.

“I’m a neurosurgeon who’s clinically very active,” he says. “The ‘What If’ Campaign really gave me the opportunity to carry out this sort of research. It would be extremely hard to do otherwise.”

BMEI head Jeffrey McCullough, a physician, says Lam’s project was chosen for the “What If” funding because it deals with tissue engineering, one of the strengths of the Academic Health Center and the Institute of Technology (IT). “This is an Important problem for patients, and Dr. Lam is approaching it in a fundamentally different way, sort of a paradigm shift in how one might go about dealing with this situation,” McCullough says. In addition, he says, the project involves collaboration between Medical School and IT faculty members.

Within a year or two Lam hopes to use the progress he makes through the “What If” research to leverage a larger federal grant to continue developing the device. If the device begins to show promise for commercial application, he will have yet more assistance from the Patents and Technology Marketing (PTM) office, part of the University's Office of the Vice President for Research. The PTM staff helps faculty protect inventions through the patent process and finds companies interested in licensing the inventions.

“Our goal is to ensure that inventions are transferred from the lab to application at the bedside,” says PTM senior licensing manager Susan McFadden Patow.

Lam agrees. Improved treatment is ultimately what it’s all about. “I’m on a mission,” he says. “I’m hoping it will make people better.”