A device developed by a Virginia Tech engineer and tested by a Virginia Tech Carilion School of Medicine student may show promise in monitoring blood flow of patients with sickle cell disease.

Sickle cell disease occurs because of a genetic mutation that leads to “sickling” of red blood cells, which can cause them to block blood vessels. This prevents blood flow and can cause pain and damage of tissues leading to long term health complications for the patient.

A few years ago when Ali Roghani was still a doctoral engineering student at Virginia Tech, he  developed a noninvasive sensor that could measure blood perfusion, or how well blood is flowing through blood vessels. “The device used to take 15 to 20 minutes to take a single measurement, but I got it down to one second during my master’s degree work,” Roghani said. “At that time, my advisor said it was time to look for clinical applications.”

Roghani and his advisor, Tom Diller, professor of mechanical engineering, demonstrated the sensor to Jennifer Vaughn, previously an oncologist/hematologist at Blue Ridge Cancer Care and faculty member at VTCSOM, now at The Ohio State University.

Vaughn was a research mentor for Anna Shvygina, a fourth-year student at the Virginia Tech Carilion School of Medicine. Prior to medical school, Shvygina worked at the National Institutes of Health in a lab focused on sickle cell disease. She wanted to continue working with that patient population for her comprehensive research project, a requirement for all students at VTCSOM.

“When Anna mentioned sickle cell disease as her interest area, an idea came to mind. We know that sickle cell disease patients have decreased perfusion in their capillary beds, which is one of the reasons they develop the symptoms that they do,” Vaughn said. “I thought, I wonder if this device would actually be able to detect those differences.”

Shvygina and Roghani partnered to see if his device could be beneficial for sickle cell patients. “We were trying to see if we could use this sensor to detect differences in blood flow when it comes to healthy patients and then patients with sickle cell disease,” Shvygina said. “The hope in the future is to be able to use this sensor to help patients with sickle cell disease predict when they are going to have pain because they're not having normal blood flow. We hope that this will give these patients more agency when it comes to managing their disease.”

Since the device had never been used in humans before, Shvygina’s project first focused on making sure the device was safe and could accurately measure blood flow in humans. “As engineers, we tend to look at a project very analytically,” Roghani said. “Anna came into the project looking at it from the patient’s perspective.” She recruited healthy volunteers and was able to show the device was safe and effective.

Next, she wanted to discover if the device would detect differences between healthy pediatric patients and sickle cell pediatric patients. They chose to focus on pediatric patients because they are less likely to have other comorbidities that could impact the study results. Shvygina worked with Violet Borowicz, a pediatric hematologist and oncologist with Carilion Clinic and assistant professor of pediatrics at VTCSOM, to recruit local patients. “Anna is the exact type of person you want on your team. She is committed to medicine in every aspect. Anna cares deeply for the patients she cares for, and she has a strong interest in continuing to move medicine forward with her passion and interest in research,” Borowicz said.

Shvygina also made connections at the University of Virginia School Medicine’s Division of Pediatric Oncology and Hematology because of their robust sickle cell disease program to have access to a bigger population of sickle cell patients.

“We still have eight sickle cell patients left to recruit. Even though we are looking at preliminary data and can’t draw definitive conclusions, we can already tell there is a difference between healthy patients and patients with sickle cell disease when it comes to how well their blood flows,” Shvygina said. “That’s exciting, and a first-year medical student will now pick up the project where I’m leaving it to keep it going.”

Even while preparing to transition the research to a new student, Borowicz said Shvygina has continued to focus on the project. “Anna truly desires to improve health care in the underserved through both clinical and research aspects,” Borowicz said. “She also thinks outside the box and has found ways to help continue to enroll her last few remaining patients onto her study.”

Vaughn said Shvygina was the perfect student to get this project off the ground. “Because of Anna's time in the NIH laboratory conducting sickle cell disease research, she was uniquely equipped to do this project. She came to VTCSOM with an extensive knowledge of complicated sickle cell physiology, and she was able to combine that knowledge along with that that she gained in the clinic to develop this translational study,” Vaughn said.

“What I took away from those three years at NIH was how complex the social situation of sickle cell patients is. A lot of patients in the U.S. who have sickle cell disease are African American and already face a lot of challenges to getting adequate health care,” Shvygina added. “In addition, the main symptom of their disease is chronic pain, and with the opioid epidemic and implicit biases that exist in medicine, it's hard for these patients to find physicians who understand what they’re going through. I saw that as an area of improvement in medicine and wanted to continue working with these patients.”

The patient connection is what led Shvygina to leave research and pursue medical school. “I didn't want to just meet the patients and never see them again,” Shvygina said. “I wanted to keep coming back, hear their stories, connect with them, and advocate for them. I thought that as a physician I would have a better platform to do that.”

Shvygina graduates from VTCSOM in May and is pursuing residency in obstetrics and gynecology. She hopes to continue being involved in research during and after residency. Her NIH background and now a robust research project in medical school has prepared her well.

“I have an appreciation for all the things that go into medical research and a lot of different things that make sure that we're doing this safely,” Shvygina said. “After all the work, patients benefit from this research.”

“Anna is the kind of person who not only says she has a passion for helping underserved populations, but she's demonstrating that through her actions, both in terms of her research and her passion for providing excellent clinical care,” Vaughn said. “She's just a fantastic clinician and will continue making an impact, working with women and underserved populations in her future OB-GYN career.”

Shvygina will give a presentation on her project at the VTCSOM’s annual Medical Student Research Symposium on Friday, March 26, from noon to 6 p.m. The eight students in the class who are selected to receive letters of distinction for their project, including Shvygina, will give oral presentations. The rest of the class of 2021 will give poster presentations on their projects.

Guests are encouraged to attend the symposium, which will be shared virtually this year. Participants are asked to register to receive the Zoom information to attend.

Roghani finished his doctorate degree in May of 2020. “I really appreciated that my mentor, Dr. Diller, allowed me to go venture out and find these kinds of relationships and build upon them,” Roghani said. He hopes to continue working with Shvygina on future clinical applications for the device.