By Evangelia Bellas, PhD
As biomedical engineers, we are trained to employ our skill set to work towards solutions to help people. But often, we focus on the details of the problem, on the cells or the tissue, knowing that if we’re successful we could eventually help patients. When we share our research at conferences or through scientific articles, we interact with other researchers, and know their faces and names. But because we are biomedical engineers – and not clinicians – we don’t often meet the patients face-to-face that we are creating solutions for.
In my laboratory, the BellasFATLab, we focus on engineering adipose tissue. Adipose tissue is more commonly known as body fat. When people hear about our work, they usually think of how they would like to get rid of their adipose tissue to lose weight easily and without much effort. Something that many of us would love a magic pill for! But until we get there, BellasFATLab is engineering adipose tissue to develop 3-dimensional tissue models of obesity and metabolic (dys)function. This allows us to study fat cells and their surroundings (microenvironment) to learn how they change when going from a healthy to a diseased state. Then we look to uncover new therapeutic targets to hopefully get closer to that magic pill.
But imagine if the adipose tissue you wanted to get rid of was painful and impossible to reduce, no matter how hard you tried. And doctors insinuated that you were just obese and told to lose weight. But you watch what you eat and work out, and you have various blood tests and it turns out it's not hormonal either. You go through years of unhelpful doctor’s visits, feeling more dejected each time. Finally, you learn about a disease called Lipedema and are relieved that it has a name. Only to find out that a cure does not exist or that not much is known about the disease in general, so you feel dejected all over again.
Learning About Lipedema
I first learned about Lipedema when a trainee asked if I had heard of this disease. I had not. She told me how she and other women in her family have been struggling with Lipedema and how frustrating it is to have doctors wave them off. Her heartbreak was palpable. I listened and then went home to investigate. Lipedema was hard to understand, partly because it is misdiagnosed and partly because we do not know what causes it and why. It haunted me every time I gave a talk because I could not offer a solution.
A colleague, Jennifer Munson of the Fralin Biomedical Research Institute at Virginia Tech-Carilion Medical, told me about a research grant program from the Lipedema Foundation and I was in. We drafted a proposal, acknowledging we do not understand much about Lipedema (as a field, not just as new researchers to the area). We struggled to find literature and studies like we would for other types of diseases. So we went back to the basics – we know it affects adipose tissue (BellasFATLab expertise) and we know there is a buildup of fat, meaning transport in the tissue is affected (Munson Lab expertise). We proposed to collect Lipedema tissue samples and study the transport, then reverse engineer the tissue to better probe the disease mechanisms.
The Lipedema Foundation funded the proposal, and we are excited to build new insight into the disease from our biomedical engineering lens. We will employ clinically relevant methods, including using MRIs, to measure fluid transport and biomarkers in the blood. Initially, we will focus on characterizing the differences in fat cell and tissue microenvironment organization, ensuring we can distinguish them from other diseases like obesity and lymphedema, which may help identify new diagnostic criteria and new biomarkers.
As we learn more about Lipedema, we will increase the tissue complexity to include blood and lymphatic vessels, key regulators in tissue transport and the pathways for drug delivery interventions. Reverse engineering Lipedema tissues, with patient derived cells, will allow us to test and screen potential therapies and interventions on a biologically relevant system with a personalized medicine approach.
Advocating For Women’s Health
When it was announced that the Lipedema Foundation was funding our project, our institutions issued a press release. Usually, our networks see it and congratulate us, and we go on to do the work. However, this time it was markedly different. We had a barrage of emails waiting for us from patients who suffer from Lipedema. They were desperate for solutions and to share their stories and offer us access to their tissue to study. They expressed excitement and gratitude towards the Foundation and us for taking on the research.
Although we usually do not meet patients in person, this project has provided a more tangible goal, patients to serve and a mission. I am grateful for all I have learned from these personal stories.
Something that is not lost on us is how Lipedema nearly only affects women. Women’s health is notoriously understudied and underfunded on many levels of research, education, and healthcare. Women comprise greater than half the population and about half the workforce, so not only is it the ethical thing to study and fund women’s health research, but it would also benefit society as well.
Until that potential is reached, you will catch us using our platforms to advocate for Lipedema research as well as for gender equity in research, education, and healthcare.
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Dr. Bellas is an Assistant Professor at Temple University, College of Engineering, Philadelphia, PA. Learn more about Drs. Bellas’ and Munson’s project for the Lipedema Foundation.