Nimmi Ramanujam

Overview:

Dr. Ramanujam is the Robert W. Carr Professor of Engineering and Professor of Cancer Pharmacology and Global Health at Duke University and co-program leader of the Radiation Oncology and Imaging Program (ROIP) at the Duke Cancer Institute. She founded the Center for Global Women’s Health Technologies (GWHT) in 2013 where she empowers trainees to create impactful solutions to improve the lives of women and girls globally. This center, since inception, has catalyzed new research activities and the development and commercialization of several technologies that advance prevention and treatment of cervical and breast cancer. 

Dr. Ramanujam’s work has led to low-cost and efficient health care and home-based technology innovations that provide surveillance of cancer and its recurrence. To complement her translational efforts, Dr. Ramanujam’s work exploits the dynamic changes in tumor metabolism that allow cancers to go under the radar and recur in a stealth mode when conditions are favorable. She is also creating a liquid-based ablative therapy with dual roles - (1) to address the pressing issue of cancer control in environments where access to surgery is scarce, and (2) enhance tumor kill through a combination of necrosis and T cell infiltration occurring as a result of tumor antigen presentation following ablation.

Dr. Ramanujam has built several global initiatives. The most notable is a consortium to impact cervical cancer prevention in low resource settings. Her MacArthur Foundation 100&Change proposal, Women-Inspired Strategies for Health:  A Revolution against Cervical Cancer (WISH) was recognized as one of the Top 100 of the 755 proposals submitted to this $100M grant competition (Macarthur 100&Change). In addition to her cervical cancer prevention initiative, she has also created a global women’s education program that intersects design-thinking, STEM concepts, and the U.N. Sustainable Development Goals to promote social justice awareness (IGNITE). She has launched an arts and storytelling initiative to raise awareness of sexual and reproductive health inequities (The (In) Visible Organ).

She has created two companies Zenalux and Calla Health to commercialize her technologies.

 

Calla Health, a GWHT venture, is centered on sustainably improving women's access to cancer prevention and creating innovations that increase wide scale surveillance of cervical pre-cancers and cancers. Zenalux Biomedical, in collaboration with Duke University, is developing a suite of optical microscopy and spectroscopy tools for preclinical and clinical applications in cancer research. Zenalux’ newest product offering is the Zenascope™ ZF1, a combined portable platform for optical imaging and spectroscopy to characterize the major axes of metabolism along with key vascular features.

Dr. Ramanujam has more than 20 patents to-date and more than 150 publications for screening, diagnostic, and surgical applications. She has received funding from a agencies including NIH R01s and R21s, NIH Bioengineering Partnerships, NCI Academic Industry Partnerships, NIH Small Business grants, DOD, Burroughs Wellcome Fund, DIHI: Innovation Jam, Prevent Cancer and USAID funding. As the director of the Center for Global Women’s Health Technologies, she has developed a network of 50+ partners including international academic institutions and hospitals, non-governmental organizations, ministries of health, and commercial partners; this consortium works to ensure the technologies developed at the center are adopted by cancer control programs in geographically and economically diverse healthcare settings. 

Dr. Ramanujam has received a number of awards including the MIT TR100 Young Innovator award (MIT), the Global Indus Technovator award (MIT), the Stansell Family award (Duke), multiple Era of Hope Scholar awards (DoD), the Emerging Leader in Global Health Award (CUGH), the Social Impact Abie Award (AnitaB.org), the Biophotonics Technology Innovator Award (SPIE), the Women in Molecular Imaging Leadership Award (WMIC), the Michael S. Feld Biophotonics Award (OSA) and the Wom C Global Impact Award (Duke). She is a fellow of several optical and biomedical engineering societies including OSA, SPIE, and AIMBE. She is a Fulbright scholar and the 2020 IEEE Distinguished Lecturer. She is an elected member of the National Academy of Inventors. She has demonstrated her work’s global impact through presentations at the United Nations and TEDx events, and a number of national and international plenary talks. Her work has been featured in a number of venues including Medical Daily, Wired Magazine, NPR and several podcasts.

Positions:

Robert W. Carr, Jr., Distinguished Professor of Biomedical Engineering

Biomedical Engineering
Pratt School of Engineering

Professor of Biomedical Engineering

Biomedical Engineering
Pratt School of Engineering

Research Professor of Global Health

Duke Global Health Institute
Institutes and Provost's Academic Units

Professor of Pharmacology and Cancer Biology

Pharmacology & Cancer Biology
School of Medicine

Affiliate of the Duke Initiative for Science & Society

Duke Science & Society
Institutes and Provost's Academic Units

Core Faculty Member, Duke-Margolis Center for Health Policy

Duke - Margolis Center For Health Policy
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.S. 1989

University of Texas, Austin

M.S. 1992

University of Texas, Austin

Ph.D. 1995

University of Texas, Austin

Grants:

A Portable low-cost, Point of Investigation CapCell Scope to Image and Quantify the Major Axes of Metabolism and the Associated Vasculature in In vitro and In vivo Biological Models

Administered By
Biomedical Engineering
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

A Novel Optical Spectral Imaging System for Rapid Imaging of Breast Tumor Margins

Administered By
Biomedical Engineering
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Novel see and treat strategies for cervical cancer prevention in low-resource settings

Administered By
Biomedical Engineering
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Closing the gap between identification and treatment of cervical abnormalities in Lima, Peru through integration of pocket colposcopy, telemedicine and visual counseling

Administered By
Biomedical Engineering
Awarded By
US Agency for International Development
Role
Principal Investigator
Start Date
End Date

Harnessing the power of light to see and treat breast cancer

Administered By
Biomedical Engineering
Awarded By
United States Army Medical Research and Materiel Command
Role
Principal Investigator
Start Date
End Date

Publications:

KeyLoop: Mechanical Retraction of the Abdominal Wall for Gasless Laparoscopy.

<i>Background.</i> Despite favorable outcomes of laparoscopic surgery in high-income countries, its implementation in low- and middle-income countries (LMICs) is challenging given a shortage of consumable supplies, high cost, and risk of power outages. To overcome these barriers, we designed a mechanical retractor that provides vertical tension on the anterior abdominal wall. <i>Methods.</i> The retractor design is anatomically and mathematically optimized to provide exposure similar to traditional gas-based insufflation methods. Anatomical data from computed tomography scans were used to define retractor size. The retractor is constructed of biocompatible stainless steel rods and paired with a table-mounted lifting system to provide 5 degrees of freedom. Structural integrity was assessed through finite element analysis (FEA) and load testing. Functional testing was performed in a laparotomy model. <i>Results.</i> A user guide based on patient height and weight was created to customize retractor size, and 4 retractor sizes were constructed. FEA data using a 13.6 kg mass (15 mm Hg pneumoperitoneum) show a maximum of 30 mm displacement with no permanent deformation. Physical load testing with applied weight from 0 to 13.6 kg shows a maximum of 60 mm displacement, again without permanent deformation. Retraction achieved a 57% larger field of view compared to an unretracted state in a laparotomy model. <i>Conclusions.</i> The KeyLoop retractor maintains structural integrity, is easily sterilized, and can be readily manufactured, making it a viable alternative to traditional insufflation methods. For surgeons and patients in LMICs, the KeyLoop provides a means to increase access to laparoscopic surgery.
Authors
Gupta, A; Brown, E; Davis, JT; Sekabira, J; Ramanujam, N; Mueller, J; Fitzgerald, TN
MLA Citation
Gupta, Aryaman, et al. “KeyLoop: Mechanical Retraction of the Abdominal Wall for Gasless Laparoscopy.Surgical Innovation, July 2021, p. 15533506211031084. Epmc, doi:10.1177/15533506211031084.
URI
https://scholars.duke.edu/individual/pub1487937
PMID
34242531
Source
epmc
Published In
Surgical Innovation
Published Date
Start Page
15533506211031084
DOI
10.1177/15533506211031084

Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research.

<h4>Background</h4>Nearly 90% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system-level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs.<h4>Objective</h4>We aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation.<h4>Methods</h4>A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research.<h4>Results</h4>In the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions.<h4>Conclusions</h4>Current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies.
Authors
Rossman, AH; Reid, HW; Pieters, MM; Mizelle, C; von Isenburg, M; Ramanujam, N; Huchko, MJ; Vasudevan, L
MLA Citation
Rossman, Andrea H., et al. “Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research.Journal of Medical Internet Research, vol. 23, no. 5, May 2021, p. e23350. Epmc, doi:10.2196/23350.
URI
https://scholars.duke.edu/individual/pub1473151
PMID
34042592
Source
epmc
Published In
Journal of Medical Internet Research
Volume
23
Published Date
Start Page
e23350
DOI
10.2196/23350

Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research (Preprint)

<sec> <title>BACKGROUND</title> <p>Nearly 90% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system–level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs.</p> </sec> <sec> <title>OBJECTIVE</title> <p>We aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation.</p> </sec> <sec> <title>METHODS</title> <p>A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research.</p> </sec> <sec> <title>RESULTS</title> <p>In the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions.</p> </sec> <sec> <title>CONCLUSIONS</title> <p>Current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies.</p> </sec>
Authors
Rossman, AH; Reid, HW; Pieters, MM; Mizelle, C; von Isenburg, M; Ramanujam, N; Huchko, MJ; Vasudevan, L
URI
https://scholars.duke.edu/individual/pub1457090
Source
crossref
DOI
10.2196/preprints.23350

Optimizing ethyl cellulose-ethanol delivery towards enabling ablation of cervical dysplasia.

In low-income countries, up to 80% of women diagnosed with cervical dysplasia do not return for follow-up care, primarily due to treatment being inaccessible. Here, we describe development of a low-cost, portable treatment suitable for such settings. It is based on injection of ethyl cellulose (EC)-ethanol to ablate the transformation zone around the os, the site most impacted by dysplasia. EC is a polymer that sequesters the ethanol within a prescribed volume when injected into tissue, and this is modulated by the injected volume and delivery parameters (needle gauge, bevel orientation, insertion rate, depth, and infusion rate). Salient injection-based delivery parameters were varied in excised swine cervices. The resulting injection distribution volume was imaged with a wide-field fluorescence imaging device or computed tomography. A 27G needle and insertion rate of 10 mm/s achieved the desired insertion depth in tissue. Orienting the needle bevel towards the outer edge of the cervix and keeping infusion volumes ≤ 500 µL minimized leakage into off-target tissue. These results guided development of a custom hand-held injector, which was used to locate and ablate the upper quadrant of a swine cervix in vivo with no adverse events or changes in host temperature or heart rate. After 24 h, a distinct region of necrosis was detected that covered a majority (> 75%) of the upper quadrant of the cervix, indicating four injections could effectively cover the full cervix. The work here informs follow up large animal in vivo studies, e.g. in swine, to further assess safety and efficacy of EC-ethanol ablation in the cervix.
Authors
Mueller, JL; Morhard, R; DeSoto, M; Chelales, E; Yang, J; Nief, C; Crouch, B; Everitt, J; Previs, R; Katz, D; Ramanujam, N
MLA Citation
Mueller, Jenna L., et al. “Optimizing ethyl cellulose-ethanol delivery towards enabling ablation of cervical dysplasia.Sci Rep, vol. 11, no. 1, Aug. 2021, p. 16869. Pubmed, doi:10.1038/s41598-021-96223-9.
URI
https://scholars.duke.edu/individual/pub1494616
PMID
34413378
Source
pubmed
Published In
Scientific Reports
Volume
11
Published Date
Start Page
16869
DOI
10.1038/s41598-021-96223-9

An Accessible Laparoscope for Surgery in Low- and Middle- Income Countries.

Laparoscopic surgery is the standard of care in high-income countries for many procedures in the chest and abdomen. It avoids large incisions by using a tiny camera and fine instruments manipulated through keyhole incisions, but it is generally unavailable in low- and middle-income countries (LMICs) due to the high cost of installment, lack of qualified maintenance personnel, unreliable electricity, and shortage of consumable items. Patients in LMICs would benefit from laparoscopic surgery, as advantages include decreased pain, improved recovery time, fewer wound infections, and shorter hospital stays. To address this need, we developed an accessible laparoscopic system, called the ReadyView laparoscope for use in LMICs. The device includes an integrated camera and LED light source that can be displayed on any monitor. The ReadyView laparoscope was evaluated with standard optical imaging targets to determine its performance against a state-of-the-art commercial laparoscope. The ReadyView laparoscope has a comparable resolving power, lens distortion, field of view, depth of field, and color reproduction accuracy to a commercially available endoscope, particularly at shorter, commonly-used working distances (3-5 cm). Additionally, the ReadyView has a cooler temperature profile, decreasing the risk for tissue injury and operating room fires. The ReadyView features a waterproof design, enabling sterilization by submersion, as commonly performed in LMICs. A custom desktop software was developed to view the video on a laptop computer with a frame rate greater than 30 frames per second and to white balance the image, which is critical for clinical use. The ReadyView laparoscope is capable of providing the image quality and overall performance needed for laparoscopic surgery. This portable low-cost system is well suited to increase access to laparoscopic surgery in LMICs.
Authors
Mueller, JL; Rozman, N; Sunassee, ED; Gupta, A; Schuval, C; Biswas, A; Knight, B; Kulkarni, S; Brown, M; Ramanujam, N; Fitzgerald, TN
MLA Citation
Mueller, Jenna L., et al. “An Accessible Laparoscope for Surgery in Low- and Middle- Income Countries.Ann Biomed Eng, vol. 49, no. 7, July 2021, pp. 1657–69. Pubmed, doi:10.1007/s10439-020-02707-6.
URI
https://scholars.duke.edu/individual/pub1475475
PMID
33686617
Source
pubmed
Published In
Ann Biomed Eng
Volume
49
Published Date
Start Page
1657
End Page
1669
DOI
10.1007/s10439-020-02707-6