From 3D-printed Human Hearts to Healthy Pizza: Six Israeli Companies Developing Life-improving Ideas

Energy generated by sea waves, cartilage made of corals, healthful dough, 3D printed organs, a tiny camera that helps blind people see and an ultrasound from the comfort of your living room: A Haaretz project surveys promising Israeli companies

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A 3D heart printed by Matricelf, whose founder, Tal Dvir, says, “I think that within 10 to 15 years, we’ll be able to print for every patient the personalized organ or tissue they need.”
A 3D heart printed by Matricelf, whose founder, Tal Dvir, says, “I think that within 10 to 15 years, we’ll be able to print for every patient the personalized organ or tissue they need.”Credit: Tomer Appelbaum
Meirav Moran
Oded Carmeli
Avi Garfinkel
Meirav Moran
Oded Carmeli
Avi Garfinkel

Printing human hearts

Paralyzed mice were able to walk again, following implantation of an artificial spinal cord. Printing organs for humans may happen sooner than we think

In 2017, a small miracle was achieved at Tel Aviv University: Once-paralyzed mice started to walk after a spinal cord implantation. In the near future humans will be able to experience the same miracle.

“I think that within 10 to 15 years, we will be able to print for every patient the personalized organ or tissue they need,” says Tal Dvir, founder of Matricelf. “There will be no need for organ donations and no fear of implant rejection.”

How does personalized regenerative medicine, as it’s called, work?

“This process is a sophisticated combination of tissue engineering, genetic engineering and use of biomaterials,” Dvir explains. “First we take a biopsy of the patient’s fatty tissue. Each type of tissue in the body consists of cells and extracellular substances, such as collagen and sugars. We separate the cells from this extracellular matrix, reprogram them via genetic engineering to become stem cells [which have the ability to differentiate into a wide variety of cells], and in parallel a personalized gel is created from the extracellular substance, which we use to avoid generating an immune reaction and the implant’s rejection. We introduce the stem cells into the gel and differentiate them until they become a spinal cord implant.” In the case of organs possessing internal architecture, a 1.5-meter-by-one-meter 3D printer prints the cells within the gel, arranging them according to the required spatial alignment.

“Effectively,” Dvir explains, “we are emulating fetal development. Within 30 days, a spinal cord has developed. And finally, it’s a cord that has been ‘cooked up’ in the patient’s own material.”

Matricelf, whose technology has been developed in Prof. Dvir’s lab at Tel Aviv University, thus offers nothing less than a sweeping revolution. Spinal cords are only the first goal, and after the easing of certain regulatory restrictions, the technology could lead to personalized implants of every body organ without fear of rejection, according to Dvir.

Tal Dvir.

“Let’s think about the heart for a moment,” he says. “Today 50 percent of patients who undergo massive heart attacks will die within five years. That’s the situation. The only solution is a transplant, but there aren’t enough donors, and even when a suitable implant is found, the body is liable to reject it. We’ve had excellent results in lab animals in which we implanted hearts engineered by our technology. But it takes a lot of time to get FDA approval to implant heart tissue in humans. Why? Because even if the heart is very sick and working at only 10 percent of its capacity, it can always deteriorate to 5 percent after treatment.

“However,” Dvir continues, “the FDA approves spinal cord treatments faster, because if a person is paralyzed there is no danger of his becoming more paralyzed. The results are also more obvious: Either he moves his foot or he doesn’t. From the regulatory aspect, it’s easier for us to get to [approval for] clinical use with a spinal cord transplant for victims of accidents and injuries. We are currently working with the FDA to get approval for the trial protocol, in the hope that within two years we’ll be ready for human clinical trials. After we have FDA approval – which means the technology is safe – for the spinal cord, we will proceed to the heart, the cornea, the brain, the intestine. There is no organ that can’t be engineered.”

Matricelf was founded only a year and a half ago. It’s a small company, with eight employees, based in Tel Aviv; it will soon be moving to the science park in Nes Tziona, near Rehovot. Another startup in the land of the startups. But it has a number of unprecedented advantages in mustering capital, both human and material: In 2019, Dvir became the first person in the world to 3D print a fully functional human heart. The historic photograph of him holding a small, three-dimensional heart in a plastic box could be seen in newspapers around the world, and in 2020 he signed an agreement with the multinational pharmaceutical company Bayer, which was clearly convinced that the technology he has developed already has very practical applications.

As everyone knows after a year of the coronavirus pandemic, new medications must go through several trial stages before they can be used clinically. In the first phase, the chemical compound in question is tested on human cell cultures in petri dishes. In the second, the medication is administered to lab animals, such as mice. Only in the third stage, and only after it has received all necessary authorizations, does clinical experimentation on humans begin.

As part of the agreement struck with Dvir, Bayer will examine the toxicity and effectiveness of new medications on human heart tissues to be printed in his laboratory at Tel Aviv University. The printed tissues will spare Bayer the first stage of developing substances in petri dishes and will make possible the rapid, inexpensive and safer development of new medications for heart patients.

Dvir: “In a petri dish, the cells are ordered in two dimensions. This is a culture of one type of cell. In contrast, our engineered tissues are 3D printed, and as such, for instance, they more closely resemble cardiac tissues. Our printed tissues include heart muscle tissue, blood vessels and the intercellular matrix that connects the cells biochemically, mechanically and electrically. The transition from petri dishes to printed tissues can significantly streamline the development of medications, because a medication that won’t work on the tissue, or proves to be toxic to it, will simply have its development stopped in the first stage. Our technology will eliminate the need for expensive trials and will save precious time when it comes to developing more effective and safer medications for people.”

The final goal of the initial collaboration with Bayer is to move ahead to preclinical trials on whole printed organs – in other words, to allow the drug company to bypass the stages of trials on both animals and humans.

“The initial agreement between my laboratory and Bayer is a feasibility study ahead of a much larger-scale project,” Dvir relates. “In the end, our goal is to engineer complete human hearts, which will be printed with all the different tissues – the chambers, the blood vessels and so on. The 3D printers will enable us to reconstruct the heart’s complex architecture. Afterward, the effect of the new medications on the engineered heart will be examined.”

Until that happens, Dvir has his fingers crossed as he waits for, literally, the first finger to move – in 2022. “A person who is paralyzed remains paralyzed. There is no treatment today and no horizon for treatment. If we succeed in getting our technology into clinical use and we see people walking, that will be the most thrilling moment a scientist can hope for. Even if someone only succeeds in moving their pinky, it’ll be a ‘wow.’” (Oded Carmeli)

Soy at the Equinom seed-breeding company. The key to simulated milk products that taste like the real deal is the right soybean strain, says CEO Gil Shalev.Credit: Tomer Appelbaum

Pizza without guilt

It’s neither sci-fi nor genetic engineering: At a lab at Kibbutz Givat Brenner, they’re able to control the most complex features of seeds

What the research and development team of Equinom, a seed-breeding company based in Kibbutz Givat Brenner, have come up with evokes the iconic Israeli children’s musical “Bubble Gum Seeds.” Food manufacturers tell the lab staff which aspects of their products they would like to improve, and in response receive soybean, pea or sesame seeds that have been adapted precisely to their needs, in terms of taste, consistency, nutritional content, etc.

For example, vegan hamburgers are still competing for palates accustomed to real meat; plant-based cheese substitutes seem to lack the consistency and taste of the real thing; and simulated milk products used in coffee don’t dissolve well and leave a grainy aftertaste. All of these products, explains Gil Shalev, Equinom’s founder and CEO, are simply made from the wrong types of soybean: If the appropriate strain were used, things would be completely different.

Shalev asks us to imagine a farmer who receives a supply of seeds from a particular manufacturer, knowing that they will produce a soybean that can be easily transformed into a drink with the smooth, foaming traits of milk. From another source, the farmer may get seeds that produce soybeans that are useful in the production of a juicy meat substitute with a protein level closely approximating that of beef patties. Other soybeans will lend themselves, after a special rapid-grinding process that does not necessitate the addition of harmful chemicals, to the production of a powder that can be mixed into a dough that is identical in consistency and taste to its wheat-flour relatives, but contains five times more protein than the flour used in regular pasta and bread. Such powder can also be used in gluten-free foods. It’s important to note that all the soy-based products we consume today, whether milk or cheese or tofu, are made from the same strain of soybean.

The seed bank.

This is not science-fiction, nor does it involve genetic engineering. Equinom’s seeds – whether soybean, pea or sesame – are created by traditional crossbreeding, as has been used for two millennia. However, classic enhancement has been limited to obvious and readily identifiable traits such as size, height, color and the like. Equinom’s innovation lies in encoding the seeds with multiple, complex traits, including some that are not visible in the plants that they yield.

“The ability to identify and encode quantity, type and composition of proteins, starches, sugars and fibers opened a new world of possibilities and traits for food,” says Dr. Sigal Meirovitch, head of product development at Equinom. The magic happens in her realm, where a match is made between characteristics of foods and drinks and production requirements – and the traits of seeds of exotic legumes that have been excluded from the realm of industrialized agriculture. The exotic strains of the different kinds of seeds are crossbred with common strains, imbuing the resulting new variety with the specific qualities sought by the food manufacturers.

Equinom’s seed bank functions like a database: It contains digitized and other data relating to hundreds of types of plant seeds, including the dozens of traits and features characterizing each seed. Together they represent the potential for the development of a new seed type. Once the manufacturer’s requirements are received – in terms of the desired eating experience, nutritional value and the production process involved in turning out a food or beverage – the first step is to consult the databank of seeds. If a variety of soybean or another type of seed exists that possesses all the requisite traits, it will be provided to the food manufacturer, who will in turn supply it to the farmer for cultivation. If it doesn’t exist, a crossbreeding and selection plan is developed that will yield within a relatively short time – usually between four and eight generations, which could take as long as a year or two – a new strain with the desired traits. During this process the staff at Equinom accumulate knowledge useful for producing additional seed types that will suit the needs of other manufacturers. “We are creating the world’s food reserves,” Shalev says.

Bubble gum that grows in a vegetable patch will remain within the realm of a children’s play, but the day is approaching when the pizza slice we buy in the street will be made from different types of peas and soybeans. The hot cheese will be nondairy, juicy and molten but not rubbery, and the dough on which it is melted will be crisp, crackly and soft – precisely to the proper degree. But instead of blaming ourselves for gorging on carbs and fat, we’ll be able to tell ourselves that we’ve eaten healthful food, or at least a decent helping of proteins. (Meirav Moran)

The artificial retina device created by Nano Retina. Born from a doodle scrawled on a napkin. Credit: Hadas Porush

‘Two blind people were able to see’

A tiny camera implanted in the eyes of sightless people will allow them to orient themselves in their milieu

Last March, when Israelis were settling into the first coronavirus lockdown, Peter Stalmans entered the clinic at the University Hospital in Leuven, Belgium. In each hand, he carried a tiny camera, 4x4 millimeters (.15x.15 inches), with the weight of a feather, 42 milligrams (0.0015 ounces).

Each of the two miniature cameras was implanted in one eye of two different sightless people. When the devices were activated, the two blind individuals immediately reported a visual effect. But it was one of the two in particular who made an impression on Prof. Stalmans, who is one of Europe’s leading retina specialists.

“This patient has been completely in the dark for five years now and she immediately reported seeing an image in the center of her visual field when the device was activated, and could show with her hands the size of the image that she saw… I have been working for more than 20 years as an ophthalmologist, but this is the first time I witnessed a completely blind patient being given back a visual perception,” he said, according to a report on the PR Newswire site.

The camera that was implanted in the eye of the Belgian woman was the NR600 – the first artificial retina device created by the Israeli company Nano Retina. But as so often is the case, it was born from a doodle scrawled on a napkin, in this case in a hotel in Dallas, Texas.

“Everyone winds up where he winds up in life,” says Yossi Gross, a co-founder of the company and a serial inventor. “In my case it’s medical equipment. Originally I studied electronics and later aeronautical engineering at the Technion – Israel Institute of Technology in Haifa. Later I worked on the Lavi [fighter jet] project in Israel Military Industries. And for the past 30 years I’ve been in the field of medical equipment. In 2007, together with associates, I established Rainbow Medical. We chose to invest in projects that have huge markets, more than a billion dollars each, and aim to solve concrete health problems: blood pressure, diabetes, Alzheimer’s.”

In 2010, Gross met one of Rainbow Medical’s private investors, James Von Ehr, the founder of Zyvex, a molecular nanotechnology company, in Dallas.

“Von Ehr is one of the best-known physicists in the United States,” Gross explains. “He gave me a tour of Zyvex, which was the first company in the world to succeed in creating three-dimensional structures engineered from individual atoms. I said to him, ‘You know what? Let’s develop an artificial retina.’ Jim said that was science-fiction, but we went back to my hotel and I drew a prototype for him on a napkin. That’s how Nano Retina was born. That’s how it is: If you can’t explain your whole idea on a napkin, the idea isn’t worth anything.”

Here’s how Gross’ idea works. The human eye works like a camera. The cornea concentrates the image into the retina. Nerve cells in the retina transform the optical signal into an electrical one, and those electrical pulses arrive at the brain, where they are converted back into an image. Ninety percent of the blind people in the world lost their sight because of degenerative diseases of the retina that damage the nerve cells and don’t allow the continued conversion of optical signals from the eye into electrical pulses in the brain. The implant developed by Nano Retina essentially skips over the dead cells – and allows the blind to see.

Nano Retina was founded in 2011, a year after the Dallas meeting, as a division of the Rainbow Medical group; today it has 20 employees in its Herzliya-based headquarters. At the beginning of 2020, the technology laid out on Gross’ napkin sketch entered the stage of human clinical trials.

“We received authorization for implantation in people in three countries – Israel, Italy and Belgium. In each country we have two centers that have been mobilized for the trial,” says Yaakov Milstain, the company’s CEO. “The idea is to get European approval, the CE [Conformité Européenne], and afterward also from the FDA. Last March, the first devices were implanted in the eyes of two patients in Belgium. Two completely blind individuals were able to see something. It’s so exciting it gives you the chills.”

Milstain emphasizes that what is experienced is functional – not regular – vision. Normal vision gives us resolution of about 100 million pixels. The quality of the picture in our telephone is 12 million pixels. And Nano Retina-created vision will enable slightly less than 600. Nor is this the only difference in what is perceived.

“We’re talking about a system of 24x24 microelectrodes, which is almost 600 dots,” Milstain says. “The dots appear solely in black and white, the way newspapers used to be printed, without shades of gray. But with enough dots it’s possible to draw a picture. In the blind person’s brain, an image of dots of light is created that provides outlines. If we hold a dish in front of this woman with the implant, for example, she will see a round object. In fact, one of our first trials after the implant involves what’s called ‘follow the line.’ A straight line is marked on the floor leading left or right, and the people with the implants were asked to walk along the line – and succeeded. That’s dramatic. These blind persons can now move about on their own. The period of adjustment was also far shorter than what we had thought. As soon as the electronic implant was activated, they had an immediate feeling that something was there, in front of them.”

To dispel any doubt: Nano Retina’s device is not intended for individuals who are blind from birth. “The development is generating a great deal of hope in patients,” says Yael Hanein, director of the neuro-engineering laboratory at Tel Aviv University’s Center for Nanoscience and Nanotechnology, who is designing the first neural trials for Nano Retina. “But we need to remember that it is intended for patients with retinal degeneration – specifically, of the light sensors or the photoreceptors – that is, cases in which that disease develops on functioning neural layers that are still capable of transmitting information to the brain. The implant bypasses the activity of the light sensors and replaces them with digital sensors. The sensors convert the light into electricity, and a response is generated in the retina – but for that you need a functioning neural layer under the dead layer. Otherwise there is nothing to transmit the information to the brain,” Prof. Hanein says.

A person who’s considered to be an oracle of human-machine interface in Israel, Hanein has a broad historical perspective in this sphere. “We have a technological problem, and there is a knowledge gap, too,” she explains. “The knowledge gap is that we just don’t know about certain things. Everything we know we have learned from animals in the lab – and the animals don’t give us feedback about what they see. That’s why most of our work is based on educated guesses. In addition, even though a great deal of knowledge has accumulated about the retina, in the presence of a degenerative disease, every retina degenerates differently.

As for the technological problem, she continues, “You have to understand that Nano Retina is not the first company in the world to develop a retinal implant. There were a number of companies and quite a few academic initiatives involving implantation of systems of light sensors, but they gave a small return functionally. The cost – when it came to energy [supply], duration and stability – was too high compared to the benefit. In the end, for a product to sell, it needs to show a large enough benefit so that patients and insurance companies will agree to pay the large amounts required. So the game here is not to display technological capability, but to show practical ability.” (Oded Carmeli)

A model of a coral implant, developed by Cartiheal. The bone’s stem cells see such implants as building blocks for generating cartilage.Credit: Tomer Appelbaum

Coral in the bones to stymie pain

Implants developed by a Kfar Sava company will compensate for cartilage loss due to accidents or aging

Like time and youth, when it’s lost, cartilage cannot be restored. Unlike with bone, which knits, or a wound, which heals, the body is unable to restore this rubbery substance, which acts as a lubricant that reduces friction in our joints and allows them to move smoothly. Accordingly, people who have lost cartilage in an accident or due to its deterioration in old age, need to undergo complicated operations to alleviate the pain, usually with only partial and temporary success. Frequently, no totally satisfying medical solution is available and they are compelled to suffer from their pain, to limp or to forgo running, dancing and sports in general.

This tragic situation may soon change, if it’s up to the Kfar Sava-based Cartiheal company. Its means of reversing this seemingly irreversible process involve using an implant whose source lies in corals.

The interior of coral (its inorganic part) is made of calcium and is 99 percent identical to human bone. When coral is implanted in damaged cartilage and bone, the stem cells in the bone marrow do not identify the implant as something foreign or threatening, but see it as a building block for generating cartilage.

Cartiheal’s founder and CEO is Nir Altschuler, 43. To date, it has raised about $100 million from funds like Marus Nacht’s aMoon, and from the pharma and medical-device multinationals Johnson & Johnson and Bioventus, from the Elron holding company and others.

“We do everything ourselves, because our product is unique. It has no parallel anywhere in the world,” Altschuler explains.

Indeed, Cartiheal’s philosophy is that all its activity is in-house: research, development, production (of both the coral implants and the singular surgical instruments used in connection with them), quality control and clinical trials. As a result, in one part of the company’s offices one can see shiny corals in different shapes, sizes and stages of development, and staff members walking about in gowns, with rubber gloves and disposable shoe covers. Before entering a room, hands must be cleaned with sanitizer – a rule that predates the coronavirus crisis.

In the heart of one of the spaces called the “training room,” forceps clasp a pig’s bone dripping with blood. This reporter was compelled to politely but firmly decline the CEO’s offer to practice performing an implant in it, as physicians do before they are able to perform surgery on humans.

The process of growing the coral includes removal of the formerly living organic matter and a singular stage of sanitizing the remaining skeletal tissues, in order to ensure that the body will not develop an immune reaction to the implant. To accomplish this, the coral is placed in a device known as the “dishwasher,” because like that machine it removes such matter and leaves the inorganic matter intact. Thus the implant can be inserted without fear into the body through a channel that is drilled in the bone below the lost cartilage.

The implant can be likened to the material used in a dental filling, except that the implant that serves as a sort of filling is in essence incorporated by the stem cells and generally, within a few months, becomes cartilage resembling the natural tissue – as though the filling in the tooth had converted itself into enamel. Within six months to a year, most patients experience significant pain reduction and can return to full activity.

Cartiheal’s technology is less suited to older patients, because they typically lack sufficient stem cells in their bones. The company thus aspires to restore to active life younger people (ages 30-60) who are not suffering from advanced degeneration of their cartilage, and to postpone or even obviate the need for joint replacements in the future.

Millions of such replacement procedures are performed each year in the United States alone, each costing tens of thousands of dollars. At present, Cartiheal is in the final stages of a large-scale clinical trial, being conducted in dozens of centers and among hundreds of patients worldwide. An external committee that analyzed the interim results of the trial found that the company’s technology has at least a 95 percent chance of success. So certain is Cartiheal that the trial will succeed and that it will be followed by FDA approval that it has already begun to produce tens of thousands of implants, so that they will be available for immediate supply to physicians once the sought-after green light is given.

The economic repercussions of that green light could be enormous, and thus, half a year ago the company signed an option agreement to be sold to the U.S.-based Bioventus company for $360 million to $500 million.

“Our company was founded in 2009,” Altschuler relates. “That year there were about 200 companies in the [Israeli] chief scientist’s technology hothouse, and I estimate that 190 of them have shut down since. That’s the situation in the biotechnology world. In contrast to high-tech, where one can see the return on an investment within three-four years, in the medical field, because of all the regulation and the need for long-term clinical trials, persistence is obligatory. You can’t think about a quick exit, because the process is too far in terms of time and prospects.”

What does it feel like to be so close to the finish line?

Altschuler: “Every day we get phone calls from doctors in Israel and abroad who want to know if we have already received the go-ahead. They are expecting to use our implants to help their patients, who now have no recourse. It’s satisfying to offer such great hope to people in distress.” (Avi Garfinkel)

Inna Braverman, CEO of Eco Wave Power. An entrepreneur asked what her passion was. “Wave energy,” she replied. “Mine, too,” he said – and invested in her idea.Credit: Tomer Appelbaum

Producing electric power from Med Sea waves

She survived the Chernobyl disaster, so what better way to close the circle than for her to produce safe and nonpolluting energy from waves

It makes perfect sense to transform the movement of sea waves into electric power. Unlike the sun that sets and the wind that gusts, waves surge almost all the time and can therefore be a stable and constant source of green energy. Just place floaters (pontoons) in the heart of the sea and convert their rising and falling motion into electric power, and you have solved the problem of world energy, with zero pollution. After all, 60 percent of the world’s greenhouse gas emissions have their source in electrical energy produced from coal, oil or gas.

The problem lies in the words “just” and “heart of the sea.” Many companies have tried. Until not long ago, such ideas were destined to fail, because the expensive and complex equipment involved would be destroyed in storms. The repeated failures meant that banks the refused to provide financing for such projects, insurance companies wouldn’t touch them, and the promising idea sank to the depths.

Solving the problem required a series of impossible events, beginning with the most disastrous attempt to produce alternative energy in history: the explosion of the Chernobyl nuclear reactor. Inna Braverman was a two-week-old infant in Ukraine on that day in April 1986. The day after the explosion, and in the wake of the environmental catastrophe that ensued, she suffered heart failure and, she was later told, suffered clinical death. (Many children who went outside and let the rain run on their tongues died.)

Braverman recovered, thanks to resucitation given her by her nurse mother, but the dire economic situation in the Soviet Union and the antisemitism she and her family endured led them to immigrate to Israel four years later. They settled in the north, in Acre, a seaside city that at the time, she recalls, had no shopping center or movie theater, “or anything else to do.” That’s why she spent “all my leisure time by the sea and fell in love with it,” she says today, from her chair as the CEO of Eco Wave Power, aka EWP.

Braverman studied political science and English literature at the University of Haifa, and after graduating found herself translating technical texts for an energy company. At the age of 24, after familiarizing herself with the subject, she decided to investigate independently the reason for the failure of efforts to produce energy from sea waves. All the companies involved, she discovered, were foiled by the same problem. If so, she asked herself, why not install all the equipment onshore, with only the floaters, attached to breakwaters, extending into the water? That would be a lot less expensive and a lot safer, would not affect the habitat of the fish in the ocean depths, would not require expensive and complicated transport of the energy via underwater cables. In the very rare cases of storms threatening the shore it would be possible to remove the floaters quickly from the water by means of an automated system.

All that was needed at that stage was for Braverman to attend a social event and to meet – by chance, of course – a businessman who would ask her, “What’s your passion?” “Wave energy,” she would reply. “Mine, too,” he would say, and would decide to invest money in her idea.

No Hollywood studio would accept such an implausible scenario. But reality, we know, is more tolerant, and that is exactly what happened. Braverman and the Jewish-Canadian entrepreneur David Leb declared a competition among 300 engineers in Ukraine to find a way to implement their basic technological concept.

Five years later, in 2016, EWP had set up and was operating a station on the coast of Gibraltar that supplied, and is still supplying, electric power to up to 100 households (depending on the size of the waves) at a construction cost of $1.2 million per megawatt, comparable to the cost of producing energy from wind. The lifespan of each such station: 25 years.

A similar station is currently being built in Israel, in Jaffa’s harbor, and aims to be operating by 2022, supplying electricity to up to 100 households at a cost of about 2 million shekels (currently $622,000), and thus to integrate into the Tel Aviv-Jaffa Municipality’s vision of green energy. Discussions are now underway between the sides on extending the pilot to additional breakwaters on the city’s shoreline. About a year ago, EWP raised $13 million at Nasdaq Stockholm, thus becoming the first Israeli company traded on that stock exchange. The company has only 20 employees, as it is responsible only for planning and designing the stations, collaborating with Siemens, which does the construction work.

“My dream,” Braverman says in her office in Tel Aviv, which of course has a sea view, “is for EWP to become a company on the scale of the Israeli geothermal-energy company Ormat [market value: about 15 billion shekels]. I’m certain we have the potential to get there. There are 800 million people in the world who don’t have regular access to electric power, mainly in Africa. Many of them live close to the sea, and our solution could help them.”

Indeed, Braverman was awarded the United Nations’ Global Climate Action prize for green energy and innovativeness.

The company recently signed a contract to supply electricity to 20,000 households in Porto, Portugal, via a plant that is expected to be operational around 2024. “The technology is so innovative that most countries don’t yet have appropriate legislation and regulation to supervise it, and that is the main source of delay,” Braverman says.

The infant who just barely managed to survive the Chernobyl disaster and went on to study literature is thus poised today to make a significant contribution toward solving the global energy problem. (Avi Garfinkel)

A technician examining a PulseNmore ultra-sound device. The scan images appear on a patient’s phone in real time, and are sent directly the physician.Credit: Eliyahu Hershkovitz

Ultrasound scans in your living room

Devices are being designed in Be’er Sheva’s industrial zone that allow monitoring of internal organs without leaving home

Baring one’s chest is not usually part of a business tour, but Elazar Sonnenschein sometimes resorts to that stunt for visitors to the small plant of PulseNmore, the medical-technology he founded and runs, in the industrial zone adjacent to Be’er Sheva. Amid the electronics laboratories and the workshops for assembling at-home ultrasound devices, Dr. Sonnenschein will loosen his tie, undo the buttons on his shirt and attach a prototype of one of the various devices his company makes to his chest. When he places his phone on the device, a black-and-white ultrasound clip appears on the screen, showing his beating heart, and thus expressing his vision: home scanning of internal organs for remote review by medical professionals. The goal is to reduce the cost of services while improving the monitoring of patients in various medical fields, to cut down on visits to hospitals and clinics, and to enable symptoms to be treated before they become acute.

The body of this domestic ultrasound device is made of plastic and is slightly larger than the palm of the hand. Within it is a transducer that broadcasts and receives back the sound waves sent to the organ being scanned, and processes the data into electronic signals. Most of the device is a cradle for a mobile phone, which is integral to the system. The device uses an application that provides the user with information even in the course of the scan. It issues a stop alert if the device is being moved too quickly or is not being moved in straight lines, signals if insufficient gel has been applied, instructs the user to press more strongly or less strongly, and filters out images of low quality or poor resolution. The images appears on the phone’s screen during the scan in real time, and the user forwards them to the physician the way you send a regular clip.

PulseNmore is developing models for diverse medical uses: to measure prostrate size, a procedure now done in hospitals; or to detect ovarian follicles in in vitro fertilization, something that currently requires a visit to a gynecologist. Another device is planned that will measure fluid retention in the lungs in dialysis and cardiac patients. At present their condition can only be assessed remotely on the basis of an increase or decrease in body weight. Scanning the lungs by ultrasound and forwarding the results to one’s physician – by oneself, without the need for a technician – will enable an accurate diagnosis for preemptive medication when an aggravation of the condition looms, before there is a need to hospitalize.

Another sophisticated ultrasound model developed by the company will enable a three-dimensional heart scan. A patient who has undergone cardiac catheterization or aortic valve replacement, for example, will be discharged to his home with the device. In the event of a change in the way the patient feels, the ultrasound images will allow the physician to decide whether the patient’s report reflects normal post-surgical discomfort or whether another problem exists that requires his return to the hospital.

The first PulseNmore model due to come on the market in Israel in the next year or so for commercial use is the at-home ultrasound device for pregnant women. At this stage, it is not intended to take the place of such routine checks as organ scans, which are done by a gynecologist, but to be a first measure, as an immediate response if the mother-to-be senses no fetal movement and is apprehensive. Instead of going to the ER, she will scan her own abdomen and send the clip of the uterus for analysis by a gynecologist at a medical center. Only if a problem appears will she be referred to the hospital for further tests.

A pregnant woman in Israel pays an average of three visits to the ER per pregnancy. According to Sonnenschein, in 75 percent of the cases, the tests show that everything is normal, and the woman is sent home. An at-home ultrasound device could thus obviate unnecessary visits to the hospital. This does, however, raise another issue. Gynecologists warn that particularly anxious women are liable to use the device more frequently than is called for medically, thus overloading medical staffs. To prevent a flood of cases, the health maintenance organizations can be expected to set a quota of tests for each person and will be able to charge a fee for each test exceeding that number. As such, ultrasound scans will become a source of income for the HMOs, in contrast to the situation today, when the HMOs reimburse the hospital every time a pregnant woman visits the ER.

This year a practical pilot of the at-home ultrasound will be launched in Israel, in collaboration with the Clalit HMO. Sonnenschein believes that conducting as many tests and treatments as possible in the home will improve the health system, by obviating the need for physicians to intervene in each case and exploiting technology that’s activated in an automatic way. It’s both more convenient and more economical: less clinic area, fewer technicians needed. He’s eagerly awaiting the development of artificial intelligence software that will receive data from at-home devices, analyze it and send the patient instructions for what action to take and also forward prescriptions for medications – without the intervention of a physician.

“Patients will thus receive treatment with maximum efficiency,” he says, “and the health system will divert resources to other in-demand services.”

It sounds effective, but it also keeps the patient from seeing their doctor.

Sonnenschein: “There is no substitute for a face-to-face meeting, but there are meetings that are necessary and others that are not. In this instance the doctor is less involved in dealing with a patient’s emotional state, and observes the disease objectively, in a physical way, and can pay 100 percent attention to the treatment.”

Sometimes a person just needs to speak with someone who will put a hand on his shoulder and reassure him.

“A hand on the shoulder is not medicine, it’s psychology. Maybe a new function should be devised for the ER: a person who reassures and addresses anxieties. There’s innovation and progress in that regard, too: psychotherapeutic bots. What’s certain is that reassuring the patient is not part of the doctor’s job.” (Meirav Moran)

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