When Davide Paparo and Ian Häusler, two engineering students from the Zurich University of Applied Sciences, chose their graduation project two years ago, they had no idea they would embark on an extraordinary journey to potentially bring a new medical machine to the thousands of people affected by cutaneous leishmaniasis – a neglected parasitic disease that causes disfiguring skin lesions.
And they never knew that ‘simple’ heat could provide a cure for a disease which is currently mainly treated by toxic and often ineffective drugs.
‘I had never heard of this disease before we started our research,’ recalls Davide Paparo. ‘But once we began talking with doctors and experts in Peru and Guatemala, where the disease is endemic, we realized how big the problem is – and that we had the potential to help.’
Cutaneous leishmaniasis is a parasitic disease transmitted by the bite of a sandfly. Up to one million people are infected every year. This ‘flesh eating parasite’ causes skin lesions, which look like open wounds, on the face or other exposed areas, and leaves permanent, disfiguring scars. Affected people, especially women and children, are often ostracized and stigmatized within their community. The disease is endemic in 89 countries, including in Latin American countries such as Brazil, Colombia, and Peru.
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‘Cutaneous leishmaniasis is neglected by traditional pharmaceutical research. Existing drug treatments are outdated, toxic medicines that were developed more than 60 years ago,’ explains Dr Byron Arana, Head of Cutaneous Leishmaniasis at DNDi.
‘Antimonial treatments, for example, involve painful injections given in hospital for 21 days. These forms of treatment are long and toxic, and their effectiveness can be low. Fortunately, for uncomplicated cases of cutaneous leishmaniasis, thermotherapy is a good option. This is how we brought the idea of building a new thermotherapy machine to the Zurich University of Applied sciences.’
In theory, thermotherapy for cutaneous leishmaniasis is simple: you apply the right level of heat to the lesion to kill the parasite and cure the patient.
In practice, it is much more complex – and this is where Paparo and Häusler put their skills to good use.
‘You need to apply heat at a very precise depth, 2 to 5 mm under the skin, for 30 seconds. If you exceed that temperature, it may cause second degree burns,’ explains Paparo.
‘You also need to make the device portable and robust enough to be used in all types of environments, not only at the hospital. And of course, the most important is to make the machine affordable, so it can reach as many patients as possible.’Davide Paparo
After speaking with doctors in endemic countries and DNDi researchers to learn as much as possible about the disease and the type of device practitioners need, the two students set to work. They found an innovative way to measure skin temperature using an infrared sensor. They wanted to make thermotherapy a whole lot safer and were also able to reduce the manufacturing costs significantly.
To reach the deeper layers of the skin, the machine uses radio frequency: two electrodes applied to the lesion generate an electromagnetic field that results in heat. ‘It is actually very hot, that is why it is critical not to exceed the target temperature,’ says Paparo. In the initial development phase, the two students tried the electrodes… on themselves. David Paparo still has a small burn mark on his forearm from this trial-and-error process. ‘Our machine is now very safe,’ he smiles.
Many people with cutaneous leishmaniasis live in rural areas and must travel long distances to go to hospital and get treatment, so Paparo and Häusler wanted their device to be portable and suited to use in rough conditions, and to have a long battery life. ‘We designed the housing to withstand humidity, light rain, and also shocks.’
‘At the end of our bachelor studies, we had this great product in our hands, and it showed a lot of potential in terms of treatments. It became pretty clear to us that we should pursue this. Our goal is now to bring as many devices as possible to patients and make thermotherapy accessible to everyone who needs it.’Davide Paparo
Setting their sights on achieving this, Davide Paparo and Ian Häusler decided to create their own startup, DermatoTherma, to bring their device to market.
They know they still have a long way ahead of them. Clinical studies need to be conducted to demonstrate the safety and efficacy of the device in comparison to the existing device, which has been designed in the 80s, and to register it with the relevant regulatory authorities. But they have good reasons for optimism: their startup already received two grants from foundations in Switzerland to support its development.
‘Now we need to find investors who are not only interested in revenue but also in social impact,’ says Paparo.
‘We need people who see the need for this machine and believe in the startup to build a sustainable revenue stream, not people who want to make as much money as possible in the shortest possible time.’Davide Paparo
Now with their bachelor’s degree in hand, the two engineers are brimming with new ideas to continue improving their machine. ‘We are developing a smart system that will allow the device to automatically detect the part of the body the electrodes are applied to. If you treat the arm, or the face, you will have different skin characteristics – and different electrical properties. Being able to detect those would help control the output more precisely and improve the device’s safety,’ says Paparo.
During development, they faced a gap in data that is all too familiar to researchers of neglected diseases: ‘We realized that most of the existing human skin data we needed is from white males, but there is little data on women, Latinxs, etc. We want to contribute to building a more diverse database that can be used by medical scientists to support further research in this field,’ says Davide Paparo. ‘A more representative database could really boost future discoveries.’
Photo credit: ©BOOSTR; Sydelle Willow Smith-DNDi