Engineering and medicine to address health challenges

In an editorial entitled The Future of Medicine published in January 2025 in Nature Medicine to celebrate the magazine's 30th anniversary, attention is drawn to the challenges facing medicine over the next 30 years.

What will medicine be like in 2055? A model of medicine that is “the same for everyone” could soon become obsolete. We are moving towards increasingly personalized therapies based on each person's genetic profile, microbiome, and health data collected in real time.

Which tools will be used to achieve this? Nature Medicine mentions the continuous monitoring of biomarkers through wearable and implantable biosensors, enabling early intervention long before signs and symptoms appear. It also mentions “digital twins,” virtual simulations of a person's physiology, to allow medical staff to test interventions virtually before applying them in practice. Furthermore, the editorial predicts that understanding how multiple related conditions affect a person's health will lead to more interdisciplinary and comprehensive care.

Continuous, multimodal monitoring of physiological functions, wearable biosensors, biological and digital twins, a multifactorial and multidisciplinary approach: health research at Politecnico di Torino is pushing the boundaries in this cutting-edge field, while remaining focused on the practical problems faced by doctors and patients.

Let's consider one of the most talked-about issues in Italy today: the aging population. One of the areas of health research at Politecnico aims to develop wearable microdevices that detect movement and, among other objectives, assess the risk of falls in the elderly population, identifying the categories most at risk who need preventive treatment.

Wearable devices have a variety of applications beyond fitness tracking. Some have been developed to monitor walking, which can provide valuable information for rehabilitation protocols. Additionally, there are even bracelets designed to detect when the wearer is stressed or at risk of falling asleep while driving. At Politecnico, researchers are studying advanced materials for the development of biological twins to enable personalized drug testing. They are also exploring the use of specialized "patches" for the heart to help remodel tissue after a heart attack. Additionally, digital twins are being created to evaluate the reliability of prosthetic devices and to customize them for individual patients before implantation.
Who can forget the ventilator helmets that became sadly familiar during the COVID pandemic? Politecnico led studies to evaluate the distribution of carbon dioxide produced by patients' breathing inside them, to make them safer.

What do such seemingly different projects in the field of health have in common? Innovation and the need for an interdisciplinary approach, which are cultivated at Politecnico through its interdepartmental centres. We discussed this with Andrea Cereatti, bioengineer and professor of Telerehabilitation and Telemonitoring, who has extensive experience in developing methods and technologies for studying and monitoring human movement (biomechanics, gait analysis, wearable sensors, rehabilitation).

Prof. Cereatti coordinates the Polito^BIOMed Lab, where Politecnico's health research comes together: an interdepartmental center (involving seven different departments) designed to systematically organize the university's expertise and resources in engineering and biomedical sciences, also offering them as a resource to the local area, thanks to collaborations with other universities, hospitals, and companies.

The goal: to study and design solutions at the interface between the biological world and artificial systems, from the nanoscale to the macroscale, leading to technologies that can be applied at the patient's bedside and in their daily life.

The interdepartmental core of the center is more than just an organizational detail. Cereatti explains: “Integrating the expertise of different departments is a prerequisite for addressing real health issues—diagnosis, monitoring, therapy, and rehabilitation. This approach combines materials, devices, models, algorithms, and sensors to achieve experimental and clinical validation.”

The PolitoBIOMed Lab Center has access to infrastructure that supports experimental research and technology transfer, including the PAsTIS (Park of Innovative Technologies for Health) infrastructure, which is shared with the University of Turin and coordinated by Professor Alberto Audenino.

Mara Terzini, professor of Biomedical Engineering at DIMEAS Department and affiliated with Polito^BIOMed Lab, adds: “We can say that PasTISs is the most industrial aspect of the Center, the one most closely linked to technology transfer, where we cooperate with three departments of the University of Turin that deal with clinical practice: to develop technologies for health, it is essential to work closely with the end user, clinician, and patient.”

Multidisciplinarity is crucial: “Biomedical engineering was born as an intrinsically interdisciplinary discipline,” emphasizes Cereatti. "Whatever we develop as engineers will not work if it is not designed from the outset in collaboration with clinicians: they may be experts in neurology, orthopedics, physiatry, geriatrics, or even physical therapy... they are the ones who know what patients need. The cultural challenge is to move, when needed, from interdisciplinarity to transdisciplinarity: that is, to think in terms of many disciplines that not only collaborate but merge to form a single one. Historically, this is exactly what happened in Italy with the creation of the biomedical engineering degree: a new degree program that from the outset recognized the need to include medical knowledge alongside engineering skills."

Politecnico's health-related activities mainly focus on three areas: information and communication technologies (ICT), new materials and nanotechnologies, and integrative biomechanics, i.e., the application of biomechanical knowledge and methods to address clinical problems. As Cereatti notes: "These three pillars cover the entire path ‘from discovery to technology’: with a multi-scale and multi-factor approach, starting from the study of nanomaterials and individual cells to arrive at the person and the tools they use in everyday life, becoming smaller—a concrete example is the increasingly smaller and wearable motion sensors—to study the larger picture, i.e., not only the person, but also the environment in which they move."

Studying the interface between living systems and technology is one of the crucial areas of health research today, made famous by the media hype surrounding the wireless brain microchips implanted by Elon Musk's Neurolink. This research could lead to important results for patients, for example in the field of disabilities.

This area of research encompasses a wide range of work, from micro and nano-systems designed for studying cell cultures to solutions and protocols aimed at patient rehabilitation and monitoring. It falls under the pillar dedicated to ICT (Information and Communication Technology) for health, which includes the development of devices, instruments, algorithms, models, and strategies for studying physiological systems and pathological conditions. Here follows a list of fields of research:

• Digital monitoring projects based on wearable sensors and smartphones: a case in point is the “electronic diary” for Parkinson's disease, which aims to assess the patient's motor status even at home, using artificial intelligence algorithms to estimate clinically relevant parameters such as walking, transitions from one posture to another (e.g., from sitting to standing), and stability. This allows for more precise calibration of drug therapy;
• Human-machine interfaces and non-invasive control of assistive and rehabilitative devices, for use in orthotics, prosthetics, and rehabilitative robotics.
• Ultrasound cardiovascular imaging: automated measurement of artery thickness, non-invasive characterization of atherosclerotic plaque, and measurement of arterial wall aging and deformation.
• Oncological imaging: quantification of the vascular pattern of tumor lesions, automated segmentation and classification of suspicious lesions (thyroid and ovary), and automated processing of histological and fluorescence images.

Andrea Cereatti emphasizes the importance of developing systems that can collect information from individuals in their environments: "We need to shift the focus of medicine from an episodic model—where only a few data points are collected at separate moments—to a continuous model that gathers many data points over an extended period of time. To achieve this, technology must become smaller. Thanks to recent advancements, we can now create wearable sensors that are compact enough to monitor a person's data over long periods. My scientific dream is to detect specific multi-signal patterns that can indicate the onset of a disease while it is still asymptomatic. For instance, this could help predict the risk of falls in the elderly population. By combining data from bioimaging, biological biomarkers, and mobility markers recorded using sensors, we are investigating the possibility to identify groups of people who are at particular risk. This would allow us to provide them with targeted interventions, whether they be pharmacological treatments, training, or other therapies. While a device that can signal a fall and raise an alarm is certainly valuable, the real challenge lies in developing a device that can predict falls before they occur."

Politecnico recently launched a number of wearable devices at the SaluTO event, in collaboration with the University of Turin's School of Medicine.
One is a bracelet that can analyze various parameters to determine if the wearer is stressed, anxious, or excessively relaxed, such as when driving. Based on the detected state, the bracelet provides targeted sensory feedback. For instance, if it senses a drop in attention while the user is driving, it sends a stimulus to alert the patient.

Two technologies have also been proposed that analyze movement and promote correct posture: one works playfully, creating a sort of avatar on a screen that users can interact with to modify their posture. The other uses sensors inserted into shoe insoles to monitor walking and collect useful information, such as for rehabilitation protocols.

In addition, those who wished to do so were able to wear a portable exoskeleton for the arms to reduce the effort required to move heavy loads.

As Filippo Molinari, bioengineer and Vice-Rector for Politecnico’s Strategic Plan, commented: “We are at a crucial moment for technologies applied to the health sector. It is essential that users are properly informed about the use of these technologies, which is why we decided to bring them to the public.”

Another major field is bioimaging, which involves developing biomedical imaging methods for analyzing biological tissues by combining engineering, math, and ICT skills. The goal is to turn complex images and signals into reliable, interpretable info to support biomedical research and develop advanced healthcare solutions.

One of the most innovative methods is photoacoustic imaging, which exploits the ability of certain molecules to emit ultrasound when excited by light, for the in vivo analysis of body tissues: harmless to the patient, it allows optical and acoustic information to be combined, offering a non-invasive view of the properties of biological tissues.

It sounds like science fiction: creating a biological twin of a sick person to test treatments before applying them to the real patient. In reality, it is one of the most advanced areas of biomedical research today. Please note: this does not involve creating human clones, so we should not think of dystopias such as those imagined by Nobel Prize winner Kazuo Ishiguro in Never Let Me Go.

As Francesca Frascella, professor of Physics and Advanced Technology at Politecnico's Department of Applied Science and Technology and expert in materials and nanotechnology, explains: “This research is at the forefront of science and presents several challenges, particularly when working with cells. For instance, it requires the use of large equipment operating in sterile environments. Additionally, we often utilize the latest instruments, sometimes being the first to experiment with them.”

The creation of “biological twins” is the goal of one of the major projects in which Politecnico is involved in the field of health: D34Health (Digital Driven Diagnostics, prognostics, and therapeutics for sustainable Healthcare), funded by MUR with funds from the National Plan for Investments complementary to the PNRR. As part of this project, Politecnico is leading Spoke4, dedicated to the development of biological twins to study and treat tumours, degenerative diseases – such as multiple sclerosis – and metabolic disorders – such as diabetes. By implementing both biological and digital twins, the aim is to develop innovative therapies, creating a technological platform that can lead to real innovation in the healthcare system.

Integrative biomechanics addresses fundamental clinical problems at both the tissue and organ levels using knowledge and methods in the field of biomechanics on a multi-scale basis.

Terzini explains: “In our field of study, we use mechanical engineering methods in biology and biomedicine, examining multiple scales. We can investigate cells or tissues, develop specialized bioreactors, and focus on specific systems like the cardiovascular or respiratory systems. Our research also encompasses the entire organism, where we study human movement mechanics and how the body interacts with medical devices, such as implanted prostheses or heart valves. Some concrete examples: when we talk about living tissues, we evaluate the mechanical characteristics of the dermis intended for implants in cases of severe burns, to understand how it will behave after implantation. On the device front, we study what happens during the interaction between the device and the human body. One example is ventilatory therapy helmets. Lung ventilation helmets, which have become familiar during Covid, are polymer devices that provide respiratory support to patients with severe difficulties, often avoiding intubation. However, they have a critical issue: exhaled carbon dioxide can accumulate inside the helmet and, if not properly removed, pose a risk to the patient. At Politecnico, to analyse the distribution of carbon dioxide inside the helmets, we initially used a simulator capable of emitting carbon dioxide, measuring with dedicated sensors how much was re-inhaled. Starting from these experimental data, collected locally, we then developed fluid dynamic models of helmets with different inlet and outlet configurations, so as to extend the analysis to the entire volume of the device and identify the safest solution for the patient. This shows how integrating experimental data and numerical methodologies lets us not only evaluate existing devices, but also design new ones.”

Terzini continues: “Another field of application concerns joint prostheses. When a prosthesis is implanted, the main challenge is not only to restore movement immediately, but also to ensure its reliability over time.”

At Politecnico, thanks to multiscale digital models that integrate different sources of information, it is possible to estimate the mechanical behaviour of implants . The motion analysis laboratory collects data on how patients move, providing input for their musculoskeletal model, a “digital twin” that replicates movement and provides biomechanical information such as the pressures affecting the joint, which would otherwise only be measurable using invasive procedures.

At the same time, diagnostic images such as CT scans or X-rays allow the 3D geometry of the bone to be reconstructed and the prosthesis to be positioned virtually both in pre-operative planning and in post-operative checks.

Terzini concludes: "The calculated loads are transferred to high-resolution biomechanical models that analyse stresses and deformations at the bone-prosthesis interface. The integration of these models, from movement to tissue scaling, links patient behaviour to local stresses on bone and implant. This provides support for surgical planning and evaluation, and for research, it offers an environment for analysing complex biomechanical interactions. The common goal is to transform data into more informed decisions, increasing the safety, reliability and durability of prostheses for the benefit of the patient."

These methodologies also find applications in the field of cardiovascular engineering, led by Professor Umberto Morbiducci, where medical imaging and modelling, both computational and experimental, are integrated to improve diagnosis and treatment, right through to the design and optimisation of devices and procedures. Here, computational biofluid dynamics simulations help study blood flow and support predictive and personalised medicine. They help us understand disease mechanisms by providing biomarkers that can't be obtained by other methods. They also help with virtual assessment of post-operative scenarios for personalised surgical planning and designing safer and more effective cardiovascular devices.