27 May 2016

Cyborgs are among us

Anna Petrenko, "Biomolecule"

Thanks to science fiction films and books, humanity seems to have got used to the idea that cyborgs will live among us in the future. However, it's hard to believe that the future is already here, and real cyborgs have been living next to us for many decades. These are ordinary people – but with pacemakers, prosthetic limbs, biosensors or hearing implants. So what are "cybernetic tissues", who competes in a Cybathlon and what ethical questions arise in this regard?

Technically modified and improved creatures without emotions and feelings – such associations with the word "cyborg" usually pop up in the head thanks to modern mass culture. In fact, "cybernetic organism" – which is exactly how the uncorrected version of the term sounds – means only the union of a biological organism and some kind of mechanism. Cyborgs living among us do not always look like iron-patched robots: these are people with pacemakers, insulin pumps, biosensors in tumors. Many of them cannot even be detected "by eye" – except by the signal of a metal detector frame in a public place.

Now implantation of medical devices is one of the most profitable types of business in the USA. Such devices are used to restore body functions, to improve life, and to conduct invasive tests.

Implanted technology: from traditional devices to the latest developments

It's hard to believe, but the tandem of scientists and doctors has been successfully creating cyborgs for several decades. It all started with the cardiovascular system. More than 50 years ago, the first completely under–the-skin pacemaker was created - a device that supports and/or regulates the patient's heart rate. Nowadays, more than 500,000 such devices are implanted annually. New technologies have also appeared: for example, there is an implantable cardioverter-defibrillator for the treatment of life-threatening tachycardia and fibrillation.

But the most striking thing is that in a couple of years it is planned to test the artificial BiVACOR heart on humans (Fig. 1) – experiments on sheep have already been successful. It does not pump blood like a pump, but simply "moves" – therefore, there will be no pulse in future patients with such a cardioprosthesis. The device can completely replace the patient's own heart and last up to 10 years, according to the developers [1]. In addition, it is small (to suit both a child and a woman), but powerful (to work successfully in the body of an adult man). In the modern world, where donor organs are constantly sorely lacking, this device would be simply irreplaceable. The power supply of the device is external – with the help of a percutaneous transmission. The design using magnetic levitation and rotating discs prevents wear of parts – one of the problems of other developments that mimic the structure of a real heart. "Smart" sensors help to adjust the blood flow rate of BiVACOR to the physical and emotional activity of the user.


Figure 1. It is expected that testing of the artificial heart in humans will begin in 2018. Drawing from the website obninskchess-ru.livejournal.com .

In addition to the heart, traditionally devices are integrated into the body for the delivery of drugs for chronic diseases – as does, for example, an insulin pump for diabetes mellitus (Fig. 2). Now the same devices are used to deliver drugs during chemotherapy or treatment of chronic pain.


Figure 2. Implantable insulin pump for people with diabetes mellitus is a classic example of human cybernization. Figure from [5].

Implantable neurostimulators – deivas that stimulate certain nerves in the human body are becoming increasingly popular. They are being developed for use in epilepsy, Parkinson's disease, chronic pain (see video), urinary incontinence, obesity, arthritis, hypertension [2] and many other disorders.

Implantable devices for improving vision and hearing have reached a completely new level [3, 4].

How Spinal Cord Stimulation Changes Pain signals before they enter the brain

Measure everything: biosensors

All the mentioned developments are designed to restore the lost or missing function of the body. But another direction of technology development has also appeared – miniature implantable biosensors that register changes in the physiological parameters of the body [5]. The implantation of such a device also makes a cyborg out of a patient – although in a slightly unusual sense of the word, because the body does not have any superpowers.

A biosensor is a device consisting of a sensitive element – a bioreceptor that recognizes the desired substance – a signal converter that translates this information into a signal for transmission, and a signal processor. There are a lot of such biosensors: immunobiosensors, enzymatic biosensors, genobiosensors... With the help of new technologies, hypersensitive bioreceptors are able to "detect" glucose, cholesterol, E. coli, influenza viruses and human papilloma, cell components, certain DNA sequences, acetylcholine, dopamine, cortisol, glutamic, ascorbic and uric acids, immunoglobulins (IgG and IgE) and many other molecules [6].

The use of biosensors in oncology is considered one of the most promising areas [7]. By tracking changes in specific parameters directly in the tumor, it is possible to make a verdict on the effectiveness of treatment and attack the cancer at the very moment when it is most sensitive to a particular effect. Such targeted planned therapy can, for example, reduce the side effects of radiation or suggest whether it is worth changing the main medicine. In addition, by measuring the concentrations of various cancer biomarkers, it is sometimes possible to diagnose the neoplasm itself and determine its malignancy, but the main thing is to detect a relapse in time.

Some people have a question: how do the patients themselves react to the fact that devices have been implanted in their body and thereby turned into some kind of cyborgs? There are few studies on this topic so far. However, it has already been shown that at least men with prostate cancer have a positive attitude to the implantation of biosensors: the idea of becoming a cyborg scares them much less than the likelihood of losing their masculinity due to prostate cancer [8].

Progress in technology

The widespread use of implantable devices is closely related to technical improvements. For example, the first implanted pacemakers were the size of a hockey puck, and they could be used for less than three years. Now such devices have become much more compact and work from 6 to 10 years [4]. In addition, batteries are being actively developed that could use the user's own body energy – thermal, kinetic, electrical or chemical.

Another area of engineering is the development of a special coating of devices that would facilitate the integration of the device into the body and not cause an inflammatory response. Similar developments already exist [9].

There is another way to combine the sensor and living tissue. Researchers from Harvard University have developed so-called cybernetic tissues that are not rejected by the body, but at the same time read the necessary characteristics by sensors [10]. Their basis is a flexible polymer mesh with attached nanoelectrodes or transistors [11]. Due to the large number of pores, it mimics the natural supporting structures of the tissue. It can be populated with cells: neurons, cardiomyocytes, smooth muscle cells. In addition, the soft frame reads the physiological parameters of its environment in volume and in real time.

Now a Harvard team of scientists has successfully implanted such a grid into the rat brain to study the activity and stimulation of individual neurons (Fig. 3) [12]. The scaffold integrated into the tissue and did not cause an immune response during five weeks of observation. Charles Lieber, the head of the laboratory and the main author of publications [11, 12], believes that the "mesh" can even help in the treatment of Parkinson's disease.

In the future, the development can be used in regenerative medicine, transplantology, and cellular biophysics. It will also be useful in the development of new drugs: the reaction of cells to the substance can be observed in volume.


Figure 3. A folded "mesh" is injected into the brain with a syringe, then straightened out and monitors the activity of individual neurons using embedded sensors. Figure from [11].

Scientists have also proposed another fascinating way out of the catastrophic situation with the transplantation of scarce organs. The so–called cardiac cybernetic patch is a combination of organics and technology: living cardiomyocytes, polymers and a complex 3D nanoelectronic system [13]. The created fabric with embedded electronics is capable of stretching, recording the state of the microenvironment and heart rate, and even conducting electrical stimulation. The "patch" can be applied to a damaged area of the heart – for example, to the necrosis zone after a heart attack. In addition, it releases growth factors and medicinal substances such as dexamethasone to involve stem cells in the recovery processes and reduce inflammation, for example, after transplantation (Fig. 4). The device is still in the earliest stages of development, but it is planned that the doctor will be able to monitor the patient's condition from his computer in real time. For tissue regeneration in emergency conditions, the "patch" will be able to launch the release of therapeutic molecules that are enclosed in electroactive polymers, and positively and negatively charged molecules release different polymers.

According to Professor Dvir (Tal Dvir), the head of the study from Tel Aviv University, in the future such a device will be able to regulate its own state. For example, when inflammation is detected in its environment, an anti–inflammatory drug is released, and when oxygen is insufficient, molecules recruiting vascular-forming cells to the heart. By the way, now a group of researchers is studying whether such a cyberplast can be used in the brain and spinal cord for the treatment of neurological diseases.


Figure 4. An example of "cybernetic tissue" is a cardiac "patch" made of living heart cells with embedded nanoelectronics. It transmits information about the environment and heart rate in real time to the attending physician, and if necessary, he can use a patch to stimulate the heart or start the release of active molecules. Figure from [13].

Brain Prosthesis

Neuroprosthetics is perhaps the most promising and desirable area of development of implanted technologies. Implantation of the brain-machine interface directly into the nervous system for direct physical contact of the device with nerve cells not only helps to expand our knowledge about the work of the brain, but also allows us to control prostheses and perform complex movements with their help [14]. American scientists have just been able to restore the ability of movement to a paralyzed person – after a neck fracture a few years ago [15].

Ian Burkhart is the first paralyzed person to be able to move his arm again thanks to developing technologies

Previously, it was believed that after injury, neurons are strongly reorganized and create new connections. However, a new study has shown that the degree of reorganization of nerve cells is not so high.

Ian Burkhart broke his neck at the age of 19 while diving into waves on vacation. Now he is paralyzed below the shoulders and therefore decided to volunteer in an experiment of the Chad Bouton research group. Scientists took an fMRI (functional magnetic resonance imaging) of the subject's brain while he was focusing on a video with hand movements, and identified the part of the motor cortex responsible for this. A chip was implanted into it that reads the electrical activity of this area of the brain when the patient imagines the movements of his hand. The chip converts and transmits a signal via a cable to a computer, and then this information goes in the form of an electrical signal to the flexible sleeve around the right arm of the subject and stimulates the muscles (Fig. 5; video).


Figure 5. The signal from the chip implanted in the motor cortex goes through the cable to the computer, and then, being transformed, gets on the "flexible sleeve" and stimulates the muscles. Drawing from the website knews.kg .

After training, Ian can move his fingers separately and perform six different wrist and hand movements. It would seem that it is not much yet, but it already allows you to raise a glass of water and play a video game depicting the performance of music on an electric guitar. When asked what it's like to live with an implanted device, the first paralyzed person who has been given the opportunity to move answers that he has already got used to it and does not notice it – moreover, it's like an extension of his body.

Cyber Community

People with prosthetics, perhaps, fit best into the standard perception of a human machine. However, it is much more difficult for such cyborgs to live in reality than for similar book and movie characters. The statistics on global disability are amazing. According to WHO, about 15% of the world's population has physical disabilities of varying degrees, and from 110 to 190 million people experience significant difficulties with the functioning of the body. The vast majority of people with disabilities have to use conventional bulky strollers or uncomfortable and expensive prostheses. However, now it is possible to quickly, efficiently and cheaply create the necessary prosthesis using 3D printing. According to scientists, this is the way to help primarily children from developing countries and all those who have limited access to medical services [16].

Some active cyborgs do not waste time and take part in various open meetings. For example, last year's Geek Picnic festival, held in Moscow and St. Petersburg, was dedicated specifically to people-cars. There you could see a giant robot arm, chat with people whose body has been improved by technology, and visit virtual reality.

In October 2016, Zurich will host the world's first Olympiad for people with disabilities – Cybathlon (Cybathlon). At this competition, you can use those devices that were excluded from the program of the Paralympic Games. Some have already dubbed this event the "Cyborg Olympiad", since technical devices will make a significant contribution to the victory (Fig. 6). Participants will compete in six disciplines using electric wheelchairs, prostheses and exoskeletons, devices for electrical muscle stimulation and even a brain-computer interface.


Figure 6. Cybathlon is the first Olympiad in which people with disabilities compete with each other with the help of technical innovations. When winning, one medal is awarded to the athlete, the second to the developer of the mechanism. Drawing from the website bbc.co.uk .

Athletes driving cars will be dubbed "pilots". In each discipline, two medals are awarded: one to the person controlling the device, the second to the company or laboratory that developed the "champion" mechanism. According to the organizers, the main goal of the competition is not only to show new assistive technologies for everyday life, but also to remove the boundaries between people with disabilities and the general public. In addition, as Professor Robert Riener from the University of Switzerland told the BBC in an interview, the Olympiad will be able to bring together developers and direct users of new devices, which is simply necessary to improve technologies: "Some of the modern developments look very cool, but to become practical and easy to use, they have a long way to go the way." It remains to be hoped that the human component will not be lost during the competition, and the Cybathlon will not turn into an advertising race of equipment from different companies.

Posthumans: Cyborgs and Bioethics

New implantable technologies are generally perceived positively by society. This is not surprising: after all, they maintain, restore and improve health, facilitate access to medical services, while they are safe and in the future can significantly reduce healthcare costs on a global scale. However, it is worth talking about such patients as cyborgs, as connotations from science fiction immediately pop up (Fig. 7). The main concerns are related to the fear for human humanity [17]: what if machines change a person and he loses his human essence? Where is the boundary between the artificial and the natural for a person and is it worth using such a separation to evaluate any phenomenon? Is it possible to divide a cyborg patient with an implanted device into two separate components - a person and a machine – or is it already a whole new organism?

In addition, sometimes even in normal hospital conditions it is impossible to separate patients and devices for their maintenance [18]. Medical staff need to take care of the technique as if it were not just an extension of the patient's body, but also by themselves.


Figure 7. Robocop – cyborg, a character in a series of fantastic films. Drawing from the website myconfinedspace.com .

The difference between therapy and improvement of the body is also actively discussed: therapy vs. enhancement [19, 20]. For example, how would you feel about a competition between a drummer who masterfully wields two of his hands, and a drummer with one of his hands and a prosthetic arm? And if you found out that two drumsticks are built into the prosthesis, one of which is controlled by a sensor reading an electromyogram from the muscles, and the second is not controlled by a person and "improvises", adjusting to the first stick? By the way, such a prosthesis is not a fiction at all, but a reality: drummer Jason Barnes lost his right arm below the elbow a few years ago and now uses just such a device. "I bet a lot of metal drummers would be jealous of what I can do. Speed is good. Always the faster the better," says the cyborg drummer.

Cyborg drummer Jason Barnes had no need to say goodbye to his musical career after losing part of his arm: with a special prosthesis, he will give odds to most of his colleagues

Interestingly, the debate is not only about technology, but also about new drugs that improve brain function. There was even a special term – neuroethics – to discuss various aspects of the existence of people "improved" with the help of neuroimplants [21]. And if we operate with the concept of progressive technologies more broadly, then cyborgs can also include people with biotechnological "improvements": for example, recipients of organs created from induced pluripotent cells.

A kind of response to such discussions was the London Superhuman exhibition at the Wellcome Collection [22]. It featured exhibits reflecting a person's ideas about improving their body: images of flying Icarus, the first glasses, "Viagra", photos of the first "test tube baby", cochlear implants... Maybe it is the craving for improvements and new developments that is the most natural thing for a person?

For many reasons, it is not possible to come to a consensus on what makes a person human and radically distinguishes him, on the one hand, from other living beings, and on the other – from robots.

Finally, there is another issue that has not been thought about much yet – the problem of security and controllability. How to make such devices resistant to hacker attacks? After all, the insecurity of such developments can be extremely dangerous not only for the user himself, but also for others. Perhaps this is the question that the next generation of users will be most concerned about (Fig. 8).


Figure 8. The rich imagination of Japanese screenwriters has already brought the topic of hacking to life: what if in the future cyborgs will have to investigate murders committed by hacked robots?.. A frame from the cartoon "Ghost in Armor 2: Innocence".

Perhaps, cyborgs controlled from the outside are the most terrible thing. At least for today. However, with simpler nervous systems, this is actively practiced. For example, biobot insects are successfully used for search and rescue purposes – for example, Madagascar cockroaches (fig. 9) [23-25]. In addition, such modernized simply arranged beings are also excellent experimental objects for neuroscience.


Figure 9. A biobot is a creature with a simple nervous system that can be controlled by implanted technology. It is unlikely to be possible to repeat this for the human brain because of the complex structure of the organ. Figure from [25].


Cyborgs are already living among us – whether individual members of the public like it or not. Technical boundaries are being pushed, and for sure new developments will improve the quality of life for many people with disabilities and help in medical practice.

"I think the future of the fight against chronic diseases is implantable devices," says Sadie Creese from the Martin School at Oxford University. "They will measure vital signs and send them to the health care provider, whoever it is and wherever he is." Thus, according to Sadie, one can imagine consultants and doctors all over the world: ideally, any local doctor could receive alerts about the patient's health using a single application. Indeed, it is possible that the entire system of patient management will change in the very near future. It is worth taking a look at the rapidly developing field of implanted devices – and such an algorithm no longer seems impossible. And mobile applications and their use in healthcare will be discussed in the next article.


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