UPS’ program on
WakeMed Hospital’s Raleigh campus in N.C. is first drone delivery service
cleared by FAA for commercial purposes
UPS (NYSE:UPS) Chairman and CEO David Abney emphasizes patients, not packages, in the company’s new drive toward drone technology in medical laboratory specimen transport and logistics.
“Healthcare is a strategic imperative for us,” Abney said.
“We deliver a lot of important things, but lab [shipments] are critical, and
they’re very much a part of patient care.”
UPS entered the healthcare sector in 2000 with its acquisition of Livingston HealthCare. In 2016, the company acquired Marken, a move that Abney said, “sent a clear message to our customers that we were taking healthcare and clinical trials very seriously.”
UPS Chairman and CEO David Abney (above) explained the company’s new drive toward drone technology in medical laboratory specimen transport and logistics. Abney closed Day 1 sessions at the 24th Annual Executive War College on Lab and Pathology Management. (Photo copyright: DARK Daily.)
Clinical Laboratory
Specimens Delivered by Drone
With healthcare deliveries already a big part of UPS’ ground
business, the company now moves lab specimens by drone on WakeMed’s hospital campus in
Raleigh, N.C. The effort marks the first commercial daily drone service to be
cleared by the Federal Aviation Administration (FAA) for lab specimen
transport, and it is made possible through UPS’s new partnership with Menlo
Park, Calif.-based Matternet.
Matternet Founder and CEO Andreas Raptopoulos described how the new technology is impacting turnaround time, specimen stability, and viability. The “Future of Lab Logistics” session at EWC, featuring Raptopoulos and Shannon DeMar, Senior Marketing Manager Healthcare Strategy at UPS in Atlanta, Ga., brought questions about FAA regulations, risk mitigation, and more. Laboratory leaders are looking at how to take their logistics to the next level.
On-Demand/Same-Day
Delivery of Medical Lab Samples
The UPS/Matternet program represents a major milestone for
unmanned aviation in the United States, according to UPS, in a recent release.
Currently, the majority of medical samples and specimens are transported across
WakeMed’s expanding health system by courier cars. The addition of drone
transport provides an option for on-demand and same-day delivery, the ability
to avoid roadway delays, increase medical delivery efficiency, lower costs, and
improve the patient experience.
How drones, sensors, and new technologies are poised to
increase the quality and accuracy of specimen transport and logistics
represented just a slice of the first full day of sessions at Executive War
College. UPS is an official partner and sponsor.
Also speaking at the 24th Annual Executive War College on
Lab and Pathology Management:
Evolving market trends are creating both concern and
opportunities for the clinical laboratory industry. New sources of revenue are essential
at a time when fee-for-service prices for lab tests are decreasing.
Early registration is already open for 2020 Executive War College, happening April 28-29, in New Orleans.
Crash into Lake Zurich of American-made drone carrying blood specimens is first setback for pioneering Swiss Post medical drone program
Medical drones shuttling clinical laboratory specimens across open terrain is an exciting reality that Dark Daily has reported on in previous e-briefings. However, the medical drone revolution experienced a setback in January when drone-pioneer Swiss Post (Switzerland’s postal service) saw one of its American-made Matternet drones crash into Lake Zurich, Switzerland.
According to a Swiss Post news release, the drone went down carrying a “non-vital” blood sample (one that had been previously analyzed). The flight was part of a recently launched pilot program transporting blood samples between Zurich’s central laboratory and the Hirslanden Klinik Im Park, a private clinic on the opposite side of Lake Zurich.
A drone can cover the 5.8-kilometres across the water in seven minutes—five times faster than an on-the-road courier, according to Swiss Post.
Zurich city police recovered the drone from the lake on
January 28. However, until the cause of the accident is determined, Swiss Post has
grounded all drone flights, the news release noted.
This was the first accident involving Swiss Post drones,
which have successfully completed more than 3,000 flights in Lugano, Berne, and
Zurich.
A drone from California-based Matternet (shown above) flies toward the opposite side of Lake Zurich in Switzerland. Swiss Post, Switzerland’s postal service, is using drones to quickly transport clinical laboratory samples between hospitals in urban areas (Photo copyright: Swiss Post.)
Christian Hegner, Director General of Switzerland’s Federal Office of Civil Aviation, is proud of his country’s contribution to the development of performance-based regulatory models for the drone industry, which are detailed in the World Economic Forum (WEF) Advanced Drone Operations Toolkit. “The goal of this toolkit is to enable regulators to learn from the innovative policy experiments occurring around the world and empower them to adopt these governance models that accelerate the promise of drones for all,” he states in the toolkit.
“We have learned a lot in the last few years,” Hegner told SWI swissinfo.ch (SWI), the international reporting service of the Swiss Broadcasting Corporation (SBC). “Sharing our expertise and learning from other countries will help speed up and extend drone security around the world.”
Timothy Reuter, Head of Drones and Tomorrow’s Airspace at the World Economic Forum, and co-author of the Advanced Drone Operations Toolkit, believes it is only a matter of time before ecommerce and medical drones rule the skies. “We are witnessing the beginning of a logistics revolution; one that will redefine the way goods and people are moved around the world, and one that will drive social change alongside societal impact,” he states in the Advanced Drone Operation Toolkit. (Photo copyright: Quartz.]
Might Medical Drones
in the US Carry Clinical Laboratory Samples?
Now that the World Economic Forum has issued its “toolkit,” which is aimed at helping countries replicate the pioneering success of Switzerland and Rwanda in transporting blood and other medical specimens using unmanned aerial vehicles (drones), could the use of medical transport drones to deliver clinical laboratory specimens throughout the US could take off as well?
Maybe. Creation of such a medical transport network using
drones faces headwinds from aviation industry regulators.
“We haven’t seen the [FAA] be interested in a one-off approach,” Susan Roberts, PhD, told NPR. Roberts is Global Commercial Head of Innovation and Sales Excellence for Panasonic Avionics, and founder and former policy leader at AiRXOS, a General Electric subsidiary focused on drone infrastructure technology. “It doesn’t do anybody any good for a delivery company to be able to fly from two specific points if they can’t then scale that over and over again,” she noted.
Nevertheless, in its Advanced Drone Operations Toolkit, the WEF
argues a “unique opportunity exists today to harness the revolutionary power of
drones and autonomous aerial mobility,” and it provides a regulatory framework
to do so.
The crash of the Swiss Post drone carrying clinical
laboratory samples is a setback. However, it is also a learning experience. As Swiss
Post and other nations gain experience, and as regulatory models become established,
anatomic pathology groups and medical laboratories worldwide may finally have a
solution for delivering specimens over long distances while maintaining the
integrity of samples.
Onboard cooling system ensures samples remain viable for medical laboratory analysis after three-hour flight across Arizona desert
Clinical laboratories and anatomic pathology groups could soon be receiving blood samples and tissue specimens through the air by medical drone. The technology has been tested successfully in Europe, which Dark Daily reported in July. Now, Johns Hopkins University Medicine (JHUM) has set a record in America for the longest distance drone delivery of viable medical specimens.
In a project to demonstrate the viability of using drones to transport medical laboratory specimens, the Johns Hopkins University team flew a drone with specimens more than 161 miles across the Arizona desert. The goal is to bring autonomous medical delivery drones a step closer to transforming how specimens get transported across long distances, according to a Johns Hopkins press release.
A previous Johns Hopkins study in 2015 proved common and routine blood tests were not affected when medical laboratory specimens were transported in up to 40-minute flights on hobby-sized drones. This latest research provides evidence that unmanned aircraft may be able to successfully and quickly shuttle medical specimens even longer distances between remote hospitals and medical laboratories.
Transporting Clinical Laboratory Samples by Air Can Save Lives
In conducting its most recent study, Johns Hopkins researchers obtained paired chemistry and hematology samples from 21 adults (84 samples in total). One sample from each pair was held at a drone test range in a car with active cooling. Remaining samples were flown for three hours in a drone with a Johns Hopkins-designed onboard payload-cooling system to maintain temperature control in the hot desert environment.
A temperature-controlled specimen transport container (above) designed by the Johns Hopkins University research team ensured the blood samples remained cooled and were viable for testing after the three-hour drone flight in the Arizona heat. The project demonstrated the viability of using drones to transport medical laboratory specimens. (Photo copyright: Johns Hopkins Medicine.)
After the 161-mile flight, all samples were transported 62 miles by car to the Mayo Clinic in Scottsdale, Ariz., for testing. Flown and not-flown paired samples showed similar results for red blood cell, white blood cell and platelet counts, and sodium levels, among other results. Only glucose and potassium levels revealed minor but statistically significant differences in results.
Pathologist Timothy Amukele, MD, PhD (above), led a team of researchers at Johns Hopkins University School of Medicine that set a new distance delivery record for medical drones after successfully transporting human blood samples 161 miles across the Arizona desert. The test flight adds to the growing evidence that unmanned aircraft may be the most effective way to quickly transport blood and other medical samples to clinical laboratories. (Photo copyright: Johns Hopkins Medicine.)
In a report of the findings published in the American Journal of Clinical Pathology (AJCP), the research team concludes that long drone flights at high temperature “do not appear to affect the accuracy of 17 of the 19 test types in this study.” However, they note, “Time- and temperature-sensitive analytes such as glucose and potassium will require good pre-planning and stringent environmental controls to ensure reliable results.”
The John Hopkins team believes their achievement adds to mounting evidence that drone transportation can transform the delivery of clinical laboratory specimens.
“We expect that in many cases, drone transport will be the quickest, safest, and most efficient option to deliver some biological samples to a laboratory from rural or urban settings,” stated Timothy Kien Amukele, MD, PhD, Assistant Professor of Pathology at Johns Hopkins University School of Medicine and the paper’s senior author, in a Johns Hopkins Magazine article.
“Getting diagnostic results far more quickly under difficult conditions will almost certainly improve care and save more lives,” Amukele added.
Full Drone Delivery Network Operating Over Switzerland
Medical drones are rapidly moving from demonstration projects to active use. As Dark Daily previously reported, Switzerland is establishing a delivery network of medical drones in the city of Lugano. In March 2017, drone logistics system developer Matternet, based in Menlo Park, Calif., received authorization from the Swiss Federal Office for Civil Aviation (FOCO) for full operation of drone logistics networks over densely populated areas in Switzerland. Working in partnership with Swiss Post (Switzerland’s postal service) and the Ticino EOC hospital group, Matternet successfully completed roughly 100 drone transport test flights between two of Ticino EOC’s hospitals in Lugano.
Another major player in medical drone delivery is Zipline, a Silicon Valley-based drone delivery company that since October 2016 has flown more than 14,000 flights in Rwanda, delivering 2,600 units of blood. The company’s foothold in Africa expanded in August when Tanzania announced it was partnering with Zipline to launch the “world’s largest drone delivery service to provide emergency on-demand access to critical and life-saving medicines.” Tanzania will establish four distribution centers that will use more than 100 drones to make up to 2,000 flights a day.
The emergence of medical drones not only could speed up diagnoses for patients in remote regions of the world and rural communities, but also could revolutionize anatomic pathology specimen deliveries to clinical laboratories in urban areas by providing a faster, more reliable and lower-cost delivery option than third-party couriers using ground transportation.
Demonstration project to move lab specimens by drone was successfully conducted in this alpine nation by Swiss Post and an eight-hospital health system
Delivering clinical laboratory specimens from point A to point B while maintaining the quality and integrity of critical samples is an ongoing issue for medical laboratories and pathology groups worldwide. This is especially true in countries prone to long winters and large amounts of snow. Ground transportation in those areas often experience delays, which can prevent hospitals from receiving needed test results and progressing with treatments that could save lives.
Switzerland is now taking the lead in using drones to transport medical laboratory specimens. In what is believed to be a global first, Ticino EOC, an eight-hospital medical group in Lugano, Switzerland, partnered with Swiss Post (Switzerland’s postal service) and transportation technology manufacturer Matternet of Menlo Park, Calif., to successfully transported laboratory samples between two of Ticino EOC’s hospitals by air using unmanned aerial vehicles (UAVs), commonly called drones. The samples arrived in good conditions after sailing high above blocked roadways. This demonstration project showed that drones can be used to safely deliver much needed lab specimens in both urban and remote rural medical settings.
Drones Present Opportunities for Medical Providers
The Ticino EOC group consists of eight hospital locations:
Lugano Regional Hospital;
Three locations of the Regional Hospital of Bellinzona and Valli (Bellinzona, Faido and Acquarossa);
Mendrisio Regional Hospital;
Locarno Regional Hospital;
Novation Rehabilitation Clinic; and
Oncological Institute of Italian Switzerland.
Matternet’s M2 drone is a quadcopter that travels up to 12 miles on a single battery charge. At just over 2.5 feet in diameter, the M2 can transport parcels up to 4.4 pounds. It cruises at about 22 miles/hour at an altitude of approximately164 to 328 feet above the ground.
According to Matternet’s website, the M2 is “engineered with encrypted communications, a parachute, precision landing, and a host of other safety features” and is “designed to be safe around people and infrastructure.”
Matternet received certification from the Swiss Federal Office for Civil Aviation (FOCA) to fly the drones at any time of the day. FOCA, along with Swiss Post, handle any regulatory issues involved in transporting human blood tissue and other medical laboratory specimens by drone and over public spaces.
“This is a big milestone for us. It means we can operate our technology throughout Switzerland. This will open a big opportunity in medical and e-commerce,” stated Andreas Raptopoulos, Matternet’s cofounder and CEO, in a TechCrunch article.
Matternet’s M2 drone (above) has been used to deliver biological samples between two hospitals in the town of Lugano, Switzerland. (Photo copyrights: Matternet/Swiss Post.)
An additional safety certification is still needed before Swiss Post adds medical drone deliveries to their official services. The packaging that will contain blood samples or any other biohazard materials still requires approval. Swiss Post hopes to be using the drone service regularly for the transportation of lab samples by 2018.
Each drone can be launched using a smartphone application. The launching and landing sites transmit an infrared signal that the drone homes in on. It then delivers the specimens to their predetermined destinations. In the event of an in-flight failure, the drone discharges a parachute and lands.
Delivery by UAV Not New to Healthcare
This is not the first venture to use drones in the field of healthcare. Zipline, a logistics company based in Silicon Valley, is working with the Rwandan government to deliver blood supplies to rural clinics by drone. The company’s website states that, as of May 2017, they have completed over 350 deliveries of blood products to hospitals in Rwanda.
An article appearing in the scientific journal PLOS ONE, highlighted how important drones can be in serving people in rural and economically impoverished areas. Drones can provide healthcare workers with fast access to lab specimens for diagnosis and treatment in areas where roads are impassable or do not exist.
Researchers for that study proved that the movement of the drones does not have any effect on blood samples, which is a crucial element in transporting medical laboratory specimens.
“Such movements could have destroyed blood cells or prompted blood to coagulate and I thought all kinds of blood tests might be affected. But our study shows they weren’t, so that was cool,” Amukele stated.
Pathologist Timothy Amukele, MD, PhD (above left), teamed with engineers at Johns Hopkins to develop a drone courier system capable of transporting blood to clinical laboratories. (Photo copyright: Johns Hopkins Medicine.)
For the study, Amukele and his team collected blood samples from 56 healthy volunteers and drove the samples to a drone launching field. Half of the samples were then driven to a clinical laboratory for processing and the other half were placed on the drones for flights lasting from six to 38 minutes.
Comparison of Clinical Lab Specimens Transported by Ground and by Drone
Both the flown and the non-flown samples underwent 33 common medical laboratory tests. The test results showed almost no difference between the two groups of samples. A test for carbon dioxide was the only one that generated different results, but the team did not know if that was due to the movement of the drones or the fact that the samples sat for up to eight hours before being tested.
Amukele is taking part in a collaboration between Johns Hopkins and Makerere University in Uganda. He noted that they would like to perform a study in a more remote location, possibly in Africa, where clinical laboratories can sometimes be more than 60-miles from clinics.
“A drone could go 100 km [approximately 62 miles] in 40 minutes,” noted Amukele in the Johns Hopkins news release. “They’re less expensive than motorcycles, are not subject to traffic delays, and the technology already exists for the drone to be programmed to ‘home’ to certain GPS coordinates, like a carrier pigeon.”
Opportunities for Clinical Laboratories
Use of drones is subject to each country’s laws and regulations. In the US, drone use is regulated by guidelines established by the Federal Aviation Administration (FAA). In some cases, the drone must be registered with the FAA and the operator must have a remote pilot certificate to legally fly a drone.
These projects highlight the critical need for cost-effective, safe, dependable transportation of biological materials in a timely manner. For pathologists and clinical laboratories, drones could prove to be another opportunity to provide high-quality, value- added services to healthcare consumers and other medical professionals.
Clinical laboratories involved in genetic testing may find this welcomed news, after a pair of studies conducted in 2019 raised concerns about CRISPR base editing. The researchers of those studies observed that it “causes a high number of unpredictable mutations in mouse embryos and rice,” Chemical and Engineering News (C&EN) reported, adding, “Other groups have raised concerns about off-target mutations caused when the traditional CRISPR-Cas9 form of gene editing cuts DNA at a location that it wasn’t supposed to touch. The results of the new studies are surprising, however, because scientists have lauded base editors as one of the most precise forms of gene editing yet.”
Nevertheless, UC Berkeley’s latest breakthrough is expected to drive development of new and more accurate CRISPR-Cas genome-editing tools, which consist of base editors as well as nucleases, transposases, recombinases, and prime editors.
Understanding CRISPR Base Editors At a ‘Deeper Level’
Harvard University Chemistry and Chemical Biology Professor David Liu, PhD, who co-authored the study, explained the significance of this latest discovery.
“While base editors are now widely used to introduce precise changes in organisms ranging from bacteria to plants to primates, no one has previously observed the three-dimensional molecular structure of a base editor,” he said in a UC Berkeley news release. “This collaborative project reveals the beautiful molecular structure of a state-of-the-art highly-active base editor—ABE8e—caught in the act of engaging a target DNA site.”
UC Berkeley Professor Jennifer Doudna, PhD (above), who served as senior author of the study, says scientists may now have the information necessary to refine base editors and improve their precision and genome-targeting ability. “This structure helps us understand base editors at a much deeper level,” she said in the UC Berkeley statement. “Now that we can see what we’re working with, we can develop informed strategies to improve the system.” (Photo copyright: UC Berkeley.)
Jennifer Doudna, PhD, UC Berkeley Professor, Howard Hughes Medical Institute Investigator, and senior author of the study, has been a leading figure in the development of CRISPR-Cas9 gene editing. In 2012, Doudna and Emmanuelle Charpentier, PhD, Founding, Scientific and Managing Director at Max Planck Unit for the Science of Pathogens in Berlin, led a team of researchers who “determined how a bacterial immune system known as CRISPR-Cas9 is able to cut DNA, and then engineered CRISPR-Cas9 to be used as a powerful gene editing technology.” In a 2017 news release, UC Berkeley noted that the work has been described as the “scientific breakthrough of the century.”
Viewing the Base Editor’s 3D Shape
CRISPR-Cas9 gene editing allows scientists to permanently edit the genetic information of any organism, including human cells, and has been used in agriculture as well as medicine. A base editor is a tool that manipulates a gene by binding to DNA and replacing one nucleotide with another.
According to the recent UC Berkeley news release, the research team used a “high-powered imaging technique called cryo-electron microscopy” to reveal the base editor’s 3D shape.
Genetic Engineering and Biotechnology News notes that, “The high-resolution structure is of ABE8e bound to DNA, in which the target adenine is replaced with an analog designed to trap the catalytic conformation. The structure, together with kinetic data comparing ABE8e to earlier ABEs [adenine base editors], explains how ABE8e edits DNA bases and could inform future base-editor design.”
The graphic above, taken from the UC Berkeley news release, shows the “3D structure of a base editor, comprised of the Cas9 protein (white and gray), which binds to a DNA target (teal and blue helix) complementary to the RNA guide (purple), and the deaminase proteins (red and pink), which switch out one nucleotide for another.” (Image and caption copyright: UC Berkeley.)
Knowing the Cas9 fusion protein’s 3D structure may help eliminate unintended off-target effects on RNA, extending beyond the targeted DNA. However, until now, scientists have been hampered by their inability to understand the base editor’s structure.
“If you really want to design truly specific fusion protein, you have to find a way to make the catalytic domain more a part of Cas9, so that it would sense when Cas9 is on the correct target and only then get activated, instead of being active all the time,” study co-first author Audrone Lapinaite, PhD, said in the news release. At the time of the study, Lapinaite was a postdoctoral fellow at UC Berkeley. She is now an assistant professor at Arizona State University.
“As a structural biologist, I really want to look at a molecule and think about ways to rationally improve it. This structure and accompanying biochemistry really give us that power,” added UC Berkeley postdoctoral fellow Gavin Knott, PhD, another study co-author. “We can now make rational predications for how this system will behave in a cell, because we can see it and predict how it’s going to break or predict ways to make it better.”
Clinical laboratory leaders and pathologists will want to monitor these new advances in CRISPR technology. Each breakthrough has the power to fuel development of cost-effective, rapid point-of-care diagnostics.
