Imagine a tiny balloon in your stomach that expands to help you feel full. Or a capsule you swallow that vibrates to tell your brain when it’s time to stop eating. MIT is breaking new ground in the field of weight loss by developing approaches that don’t involve pharmaceuticals or surgery.
Dr. Giovanni Traverso — gastroenterologist, professor of mechanical engineering at MIT and senior author of these studies — joined GBH’s All Things Considered host Arun Rath to share more about how these approaches stack up against other more traditional methods.
Arun Rath: I mentioned these two methods very briefly, so could you start us off by giving us a deeper explanation first? Let’s start off by talking about the inflatable gastric balloon.
Giovanni Traverso: Absolutely. So, where we started was really by thinking about the fundamentals. By that, I mean when you eat ... what is it that is happening in the stomach, in the gastric environment? And really, it’s that process that informs the two approaches.
When we ingest food, what happens is that the material lands in the stomach and extends or expands the stomach, and essentially gives us that sense of fullness. That’s something that several companies and investigators around the world have really looked at for several years in the form of balloons. They are really trying to use balloons to provide that sense of fullness, that sense of satiety. That’s really the challenge we first focused on here with this device.
Rath: Tell us how this differs from the gastric balloons that are already in use.
Traverso: Absolutely. One of the things that we recognize with the balloons that are out there — there are a couple of studies showing this — is that, essentially, the subject gets used to having that balloon. By that, I mean that their weight loss essentially stops, so they start gaining weight again, just at a different level.
That process is referred to as “accommodation.” The stomach, and essentially the sensory aspects of the stomach, that are sensing that sense of fullness are settling out. That ballon is no longer providing the level of, or signaling of, fullness.
What we reasoned was that, potentially, we could have a system that is dynamic. By that, I mean [the balloon] changes in its volume to try and mimic the process of, let’s say, three standard meals a day.
Rath: Interesting. That way, your stomach doesn’t get used to it, for lack of a better term.
Traverso: Exactly. What we showed was that, indeed, we could develop a balloon system that we could then trigger to inflate at the time of the meal to provide that feeling of fullness at that time, but then decrease so that we could have the potential to mitigate the onset of that feeling of fullness and not really allow for that accommodation.
In this initial proof of concept study, we developed the initial device that can do this — it can inflate three times a day and then deflate — and we showed in initial pig experiments that, indeed, these systems could still provide that sense of fullness that minimizes the amount of food, at least in pigs, that would support lower amounts of food being consumed during their meal times.
Rath: For the balloon, what’s the process like from here? How far is it to get from here to human trials?
Traverso: Great question. Right now, we’re really looking for collaborators and partners to help continue this work. We have this early proof of concept work in pigs, so the next stages are really around manufacturing and further de-risking the system from material science.
I mean, certainly, we’ve done quite a bit of that in the lab, but we now would like to really focus on the manufacturing aspects that really enable the placement of these systems in people, but then also to engage with regulatory experts to help us engage with the FDA to test these systems in humans in some early clinical trials.
Rath: Let’s talk about the vibrating capsule. What does this ingestible capsule do, and how does it work?
Traverso: Absolutely. So there, again, we really aimed to tackle that same sense of fullness. What Dr. Shriya Srinivasan, the lead author of that study, showed was that we could enhance or transiently stimulate the stomach to provide that sense of fullness by vibration.
When we provided a vibration on the inside of the stomach, there was signaling that was occurring that was similar to the signaling that is provided when you inflate a balloon, but now with a vibratory stimulation event.
Using that system, we showed in pigs that we could also reduce the amount of food. In this case, we were able to also, in these early experiments, show that we could monitor the behavior of pigs — this is using computer vision — and show that they would eat less when the pill was on. We were able to compare pills that were vibrating versus pills that weren’t, and showed that when the pill was vibrating, indeed, the pigs did eat less.
But again, both technologies really aim to provide a sense of fullness to help minimize the hunger or drive for eating that a large mammal has.
Rath: This is fascinating, especially [because of] how we’re used to thinking about medical interventions for weight loss involving pharmaceuticals or, in some cases, surgery. What were the thinking processes with you and your team that led you to these new approaches?
Traverso: Absolutely. Our team does a lot of work on ingestible systems, ingestible capsules that can do many things, from delivering drugs for many days or many weeks. We’ve demonstrated, even in humans, capsules that can deliver drugs like insulin or molecules like Humira and several others using these systems, including mRNA. Here, what we reasoned was that we potentially had a way of providing, or really inducing, that sense of fullness using medical devices.
You know, we recognize that we live now in a world where we have really incredible therapies that are very effective for the treatment of diabetes and obesity. But we also recognize that they’re not for everybody. There are people who have side effects, people who can’t take them, so these are certainly alternatives, or potentially synergistic interventions, that could work together either with those drugs or, as I was mentioning, for folks that have side effects from the drugs.
