SINGAPORE – Madam Chia Lu Ting, 71, was wheelchair-bound after being badly injured in a fall in July. But her weekly use of the Bixeps machine at the Care Corner Senior Care Centre in Toa Payoh East had her back on her feet within three months.

All she had to do was to put one leg into the machine for 10 minutes on a weekly basis.

“I’m very happy. I now have no problems with the 15- to 20-minute walk home from the centre,” said Madam Chia, who suffered severe bruising but no fractures from the fall.

She is one of the many seniors going to about 30 care centres here who have access to the Bixeps machine, which has been shown to improve muscle mass in older people who are too weak or frail to do vigorous exercise. Most of these centres do not charge clients for the use of the machine, which forms part of their caregiving.

The machine, which was developed in Singapore, uses low-energy magnetic fields to stimulate cells in the muscles, strengthening them.

Although only the leg is inserted into the machine, the benefit extends throughout the body, said Associate Professor Alfredo Franco-Obregon of the National University of Singapore (NUS), the primary researcher behind the machine.

He started work on the machine at ETH Zurich, a Swiss university, and finished it at NUS. He and cardiac surgeon C.N. Lee – the man who got him to join NUS – are two of the owners of QuantumTx, the company hived off to commercialise the Bixeps machine. The patent belongs to the university.

Ms Mary Wee, who heads the centre that Madam Chia goes to, said most of the seniors at the centre are aged 75 to 95.

“I noticed their walking patterns were unsteady, and they were at high risk of falls. I wanted to do something to help them.”

She had heard of community studies of the machine and was impressed with the reported results – better mobility and balance, and less pain after 10 weeks. There have been several such studies, starting with 90 seniors in 2019.

So, Ms Wee wrote a paper to the Community Silver Trust and received its dollar-for-dollar donation matching grant from the Government to buy a Bixeps machine, which costs more than $42,000.

The trust, which comes under the Agency for Integrated Care, has sponsored such machines for care centres run by three organisations.

Besides Care Corner Singapore, the other two are St Andrew’s Mission Hospital and AWWA.

Bixeps simulates the effects of exercise by activating and stimulating mitochondria – the energy-making part of cells in the body – with the use of magnetic pulses.

The stimulated mitochondria produce energy that triggers a metabolic response in the cells, causing factors called myokines to be released into the bloodstream and carried throughout the body. Myokines aid the regeneration of muscles, as well as regulate the body’s organs.

There have been more than half a dozen community studies showing the benefits of the machine.

Prof Franco-Obregon said more than four in five people showed significant improvement after a couple of months, but a small number did not seem to benefit.

The latest verification of Bixeps’ claims came from a clinical trial by the Chinese University of Hong Kong and the Prince of Wales Hospital in Hong Kong. The results of the study were published in the Frontiers in Medicine journal in October.

The double-blind eight-week clinical trial involved 60 patients suffering from end-stage knee osteoarthritis. All did a series of exercises and spent two 10-minute sessions on the machine.

For the control group of 30 participants, the machine did not emit any electromagnetic waves.

Both groups showed improvement after eight weeks, but the improvement in knee muscle strength and reduction of pain in the 30 who were treated with the Bixeps machine were significantly superior to the control group.

Their ability to function and the reduction in pain was 20 per cent to 30 per cent more than in the control group.

The researchers said Bixeps offers a new way to replicate some of the metabolic effects on the body that usually happen during endurance exercise.

They concluded: “Early improvements in strength and function can set the stage for better long-term outcomes, potentially delaying the need for surgical interventions, such as total knee replacement.”

For the past two years, Singapore General Hospital (SGH) orthopaedic surgeon Tay Boon Keng has been putting his patients who have osteoarthritis and sarcopaenia, which is age-related loss of muscle mass and strength, on the machine, which was offered by QuantumTX for trial.

With this non-invasive treatment, his patients appear to benefit with stronger muscles, as seen in the grip-strength test, he said.

“After surgery, if their muscles are weak, they might fall again, so it’s important to strengthen their muscles.”

He said more than 100 of his patients have used the machine and quite a few swear by it. At SGH, their treatment is only for four weeks. Those who want to continue need to pay for it at QuantumTX in Tiong Bahru, which charges $50 for a 10-minute session.

Earlier studies showed that the ideal treatment is 10 minutes, up to a maximum of three times a week. When done more frequently, the stimulation of the mitochondria weakens.

One of Professor Tay’s patients, Mrs Louisa Chen, 82, used to struggle to stand up. After trying out the machine at SGH two years ago, she continued her rehabilitation at AWWA, which also has the machine. Now, she has no difficulty getting up.

QuantumTX has applied to both the Health Sciences Authority (HSA) and the US Food and Drug Administration for approval for its next-generation machine, which allows for adjustment of signal strength so healthcare professionals can adjust it to suit the frailty of patients.

The current machine is sold as a wellness machine and does not require approval from health regulatory bodies.

Prof Tay said, once approved by the HSA, he would urge the hospital to acquire several Bixeps machines so patients undergoing physiotherapy can benefit from it.

However, the researchers are now finding that the benefits of using the machine extend beyond just increasing muscle strength.

Prof Tay said that aside from strengthening of muscle, his patients have also shown higher bone density, since the myokines generated by the mitochondria are spread throughout the body.

Prof Franco-Obregon said NUS has also initiated two clinical trials of Bixeps for patients suffering from breast cancer and leukaemia, to see if it can reduce the inflammation that exacerbates these diseases. They also hope it can slow the cancer progression. He said the preliminary results are promising.

資料參考：Clinical study in HK confirms Singapore’s Bixeps machine improves muscle strength

原文連結： https://bit.ly/4ilARMz

SINGAPORE – A Singapore-developed device to strengthen muscles and reduce pain has gained approval from health regulators in Singapore and the US – allowing it to be sold as a medical device in both countries.

Called Quantum Mitohormesis (QMT), the device uses magnetic pulses to stimulate and regenerate muscle cells, a process similar to what happens during exercise.

It is the next-generation version of the Bixeps device, which has been available here for some years as a fitness device. Unlike Bixeps, QMT is portable and can be used by bed-bound patients. It also has two levels of intensity to cater to the different needs of patients.

Singapore’s Health Sciences Authority (HSA) has approved the use of QMT for rehabilitation of patients to improve muscle strength, reduce pain, improve muscle energetics post-injury or surgery, and to increase mobility.

However, the approval is only for the lower intensity level, which is similar to that of the Bixeps device.

The US Food and Drug Administration has approved both intensity levels for prescription use to stimulate healthy limb muscles to improve performance, and to prevent retardation and atrophy of muscles.

As a medical device, QMT has to be operated by a healthcare professional such as a doctor, nurse or physiotherapist.

In Singapore, Kwong Wai Shiu Hospital will be among the first to get the device for its patients, likely in about four months’ time when the first batch of 30 machines are produced.

The hospital’s chief executive officer, Dr Mok Ying Jang, said about 900 of its 1,100 inpatients receive some form of rehabilitation. He hopes the QMT will help to slow down sarcopenia, a condition that occurs when older adults lose muscle mass, strength and function.

A clinical trial of Bixeps conducted by the Chinese University of Hong Kong and the Prince of Wales Hospital in Hong Kong found that, after two 10-minute sessions per week for eight weeks, patients’ ability to function improved by 20 per cent and their pain was reduced by 30 per cent.

Currently, about 30 senior centres in Singapore use Bixeps to help seniors regain or maintain their muscle strength.

Mr Ivan Goh, chief executive of QuantumTX, which owns the devices, said some users, especially those who are frail, gain about 250g to 500g of muscle mass after eight weeks of use.

The device has also been used at the Singapore General Hospital (SGH) for the past two years to help patients who have sarcopenia and osteoarthritis, a degenerative joint disease.

Orthopaedic surgeon Tay Boon Keng, who introduced the device to SGH, said his patients appear to benefit from stronger muscles, as seen in the grip-strength test. He also likes that the treatment is non-invasive.

Professor Tay said it is crucial to strengthen the muscles of patients after surgery to reduce the risk of them falling again.

Now that the QMT device has HSA certification, he said: “We look forward to using this more widely in the hospital for patients with sarcopenia. In addition, with the more portable design, we intend to use this for post-operative elderly patients, who would benefit from a quicker and more sustained recovery.”

Dr Mok said QMT is better suited than Bixeps for his patients as it can be lifted onto the bed for use by bed-bound patients.

One such patient who will benefit is Mr Michael Mahendran, 81, a retired school teacher who suffered a stroke seven years ago that left him unable to walk.

Mr Mahendran remains mentally alert and spends most of his days watching news programmes on a tablet provided to each patient for entertainment.

Dr Mok hopes the QMT can give Mr Mahendran more strength in his arms so that he can pull himself up.

With one machine, about 160 patients can each have a 10-minute session a week for 12 weeks. Another batch of 160 patients would then have their turn.

Dr Mok plans to start with those who are still mobile so that they can continue doing activities to keep themselves physically fit.

If the device proves useful to his patients, Dr Mok said the hospital will want to acquire more if it can get funding for them.

The primary developer of Bixeps is Associate Professor Alfredo Franco-Obregon, who brought the semi-developed device from ETH Zurich, a Swiss university, when he joined NUS more than a decade ago.

The development of the machine was completed here.

The device produces magnetic pulses that activate the energy-producing mitochondria in muscle cells.

This then triggers a metabolic response in the cells and releases myokines, which aid the regeneration of muscles. The same response occurs during exercise.

Prof Franco-Obregon said that while the magnetic pulses target the limbs, the therapy improves the metabolism of the entire body since the myokines are released into the bloodstream.

資料參考：
Singapore machine to strengthen muscles approved for clinical use locally and in the US
https://news.nus.edu.sg/boosting-chemotherapy-uptake-in-breast-cancer-treatment/

A recent study explained the mechanisms by which pulsed electromagnetic field therapy enhances doxorubicin uptake, paving the way for precision-driven cancer therapies with fewer side effects

Researchers at the National University of Singapore (NUS) have developed a non-invasive method to improve the effectiveness of chemotherapy while reducing its harmful side effects.

By applying brief, localised pulses of magnetic fields, the team demonstrated a significant increase in the uptake of doxorubicin (DOX), a widely used chemotherapy drug, into breast cancer cells, with minimal impact on healthy tissues. This selective uptake enables more precise targeting of cancer cells, potentially improving treatment outcomes and reducing the adverse effects often associated with chemotherapy.

The study, led by Associate Professor Alfredo Franco-Obregón, Principal Investigator at the Institute for Health Innovation & Technology (iHealthtech) at NUS and faculty member of the Department of Surgery at NUS Yong Loo Lin School of Medicine (NUS Medicine), is the first to systematically show how pulsed magnetic fields enhance DOX uptake in cancer cells. The team also showed that this approach could suppress tumours at lower drug doses.

The team’s research was published in the journal Cancers on 18 November 2024. It builds on earlier work from 2022, which first revealed that certain cancer cells are more vulnerable to magnetic field therapy.

Targeted therapy for better chemotherapy outcomes and fewer side effects

DOX is a commonly used chemotherapy drug for breast cancer. It works by binding to DNA components and disrupting cell replication and respiration, which then kills off cancer cells. Despite its efficacy, it is a non-selective drug, which means it can also damage healthy tissues, leading to side effects ranging from mild to severe, including cardiomyopathy and muscle atrophy.

To address these challenges, the NUS researchers developed a novel approach that uses brief pulses of magnetic fields to selectively increase DOX uptake into breast cancer cells. Their study revealed the role of a calcium ion channel known as TRPC1, which is often found in aggressive cancers, including breast cancer. Magnetic field exposure activates TRPC1, enhancing its ability to facilitate the entry of DOX into cancer cells.

The researchers conducted experiments comparing the effects of the magnetic field therapy on human breast cancer cells and healthy muscle cells. They found that breast cancer cells took in significantly more DOX when exposed to magnetic pulses, while normal tissues were not targeted as much. A 10-minute magnetic field exposure reduced the drug concentration needed for similar amount of cancer killing by half, particularly at low doses of the drug.

In contrast, healthy muscle cells did not show an increase in cell death in response to the combination of DOX and magnetic pulses indicating greater protection for non-cancerous tissues.

The team also demonstrated that reducing TRPC1 expression or blocking its activity eliminated this effect, which confirms the crucial role of TRPC1 channels in the process. “Importantly, when we increased the amount of TRPC1, we observed an increase in DOX uptake — this means that TRPC1 can be used as a viable therapeutic target for aggressive cancers,” said Mr Viresh Krishnan Sukumar, the paper’s first author and a PhD candidate at NUS Centre for Cancer Research (N2CR) under NUS Yong Loo Lin School of Medicine.

“What’s promising is that this mechanism works strongest at low drug concentrations, enabling us to target cancer cells more effectively while reducing the burden of chemotherapy on healthy tissues,” Assoc Prof Franco-Obregón added.

With breast cancer remaining the leading cause of cancer-related deaths among women worldwide, the need for novel treatment strategies is urgent. “The majority of women who undergo chemotherapy experience side effects from treatment, and in some cases, doses of chemotherapy need to be reduced, or in severe cases, stopped prematurely,” said research team member Assistant Professor Joline Lim, Principal Investigator at N2CR and Senior Consultant, Department of Haematology-Oncology, National University Cancer Institute, Singapore. “Moreover, prolonged exposure to high-dose chemotherapy can also lead to drug resistance. This targeted approach represents an excellent opportunity to potentially improve treatment outcomes while preserving patients’ quality of life.”

Advancing the frontier of precision oncology

The team’s magnetic-assisted approach addresses one of the biggest challenges of chemotherapy, namely its toxic effects on healthy tissues. By selectively enhancing drug uptake into cancer cells, this method has the potential to drastically reduce the systemic side effects often experienced by breast cancer patients. This not only improves treatment outcomes and quality of life, but also encourages earlier treatment for those hesitant about treatment side effects. The study also underscores the role of biomarkers, such as elevated TRPC1 expression, in transforming cancer care by enabling precision-driven treatment options.

Future work will focus on translating these findings into clinical practice by localising magnetic field exposure specifically to tumours in patients. This would further validate the potential to reduce systemic DOX doses while maximising localised drug delivery in cancer cells.

“Our approach will be patented and form the foundation for a startup specialising in breast cancer treatment. We are currently in discussions with potential investors in Southeast Asia and the United States to translate this technology from bench to bedside,” shared Assoc Prof Franco-Obregón.

資料參考：
NUS researchers boost chemotherapy uptake in breast cancer treatment with localised magnetic fields
https://news.nus.edu.sg/boosting-chemotherapy-uptake-in-breast-cancer-treatment/