emPOWER: in-body artificial muscles for physical augmentation, function restoration, patient empowerment and future healthcare

Muscles help us move, enable us to interact with objects and the environment, and regulate critical internal functions. Unfortunately, they are susceptible to damage due to disease, ageing and trauma and are a central factor in diverse serious healthcare conditions including sarcopenia (age-related loss of muscle mass and function, where decline in muscle mass between 40 and 80 years ranges from 30% to 50%), stroke, muscular dystrophy, multiple sclerosis, soft-tissue cancers, venous ulceration, diabetes, degenerative myopathy and incontinence (between 3 and 6 million people in the UK, and 24% of older people, suffer from urinary incontinence).

The emPower Transformative Healthcare Technologies 2050 programme will overcome the limitations of current wearable assistive technologies and regenerative medicine by deploying engineered robotic artificial muscular assistance inside the body, exactly where it is needed, to: 1. restore strength and control in mobility and manipulation in older people who have lost muscle strength and precision; and 2. restore controllable muscular capabilities for sufferers of trauma, stroke, incontinence and degenerative diseases. This will have significant knock-on effects on whole-body and mind health through increased confidence, independence and quality of life, massively reducing the healthcare burden and facilitating the return of sufferers to productive and fulfilling lives.

The emPOWER artificial muscles will be engineered to bridge the gap between the nanoscale of fundamental energy transduction phenomena and the centimetre scale of bulk muscle action, and will be implantable using minimally invasive (including robot-assisted) surgery and advanced imaging to replace or supplement ailing muscles, providing short-term rehabilitation, long-term assistance or complete functional restoration as needed.

To achieve our vision, we have brought together leading experts in soft robotics, regenerative medicine, bio-interfacing, smart structures, synthetic biology, polymer chemistry, self-assembly, bio-printing and tissue analysis, and clinical partners in neuro-rehabilitation, cardiovascular disease, head and neck surgery, urology, geriatrics and musculoskeletal medicine. Together, and with key industrial and social care partners, we will deliver the foundational technologies and first-stage proof-of-concept of the emPOWER artificial muscles within the five years of this transformative project, leading to major healthcare, economic and social impact to 2050 and beyond.

emPOWER will generate major impact through the following pathways:

Impact on patients: emPOWER will deliver disruptive healthcare technologies for patients with muscle dysfunction across a range of conditions including sarcopenia, stroke, muscular dystrophy, venous ulceration, diabetes, degenerative myopathy and incontinence. This will result in improved quality of life, restoration of independence and reduced healthcare costs.

Impact through patient involvement: Patient representatives will be a core component of emPOWER and will be recruited to focus groups at project start, and as members of the Independent Advisory Board. We will work closely with Health Integration Teams to engage with patient groups and patient representatives in age-related muscle dysfunction, ENT dysfunction and incontinence.

Impact on Healthcare Professionals and implementation into clinical practice: The project team includes clinical partners in movement disorders, orthopaedic surgery, ENT, vascular, urinary and geriatrics. The embedding of clinical expertise in the emPOWER programme will ensure the project team has a deep understanding of patient and clinical needs and emPOWER technologies are fit for implementation in the clinical environment.

Impact to 2050: emPOWER will develop fundamental healthcare technologies and demonstrate proof-of-concept systems for sarcopenia and urinary incompetence, laying the foundations for a comprehensive programme of translation, spin-out, follow-on funding and regulation. This will place emPOWER technologies in widespread use by 2050. To achieve this, we will leverage applications for funding through multiple routes, including NIHR I4I, MRC DPFS, Wellcome Trust Translation Fund and, with industrial partners, UK and direct commercial funding.

Accelerated translation: In its first 5 years, emPOWER will develop the foundational technologies for bio-mechanical enhancement and restoration and neuro-interfacing. These will generate accelerated impact from the start, including: 1. Wearable artificial muscles for power augmentation, rehabilitation for older people and following stroke; and 2. Bio-interfacing including needle-free glucose sensing for diabetes, infection sensing and smart bandages. We will identify and manage spin-out technologies with core and new project partners.

Industry collaboration and Commercialisation: We will work closely with the University of Bristol's Research Commercialisation Manager to identify, protect and exploit IP. We expect to license emPOWER technologies, including to our project partners, Zimmer Biomet, Olympus Medical, Renishaw, Cellink and Aspect Biosystems.

Impact on people: emPOWER will train a cohort of PDRAs, PhD students and rising star researchers in the field of muscle function restoration, pump-priming the next generation of research leaders that will take emPOWER concepts through to 2050 and beyond. They will be guided in their career development by personal mentors and will be encouraged to develop research independence through the flexible research fund and by leading the emPOWER Workshops and public engagement events.

Impact on the public: Through a programme of patient and public engagement we will ensure that developments are communicated widely, and that public opinion is gathered and considered. This will be aided by our ethics study which will lay the groundwork for emPOWER stakeholder and policymaker engagement. Targeted public engagement events include the Royal Society Summer Exhibition, TEDx, Bluedot and Pint of Science.

Global impact: We have partnered with leading international research groups across metamaterials, soft robotics, biomaterials and tissue implantation in Harvard, Tokyo, Tufts, UC Davis and TU Delft. Through a programme of research visits, exchanges and joint events, including the emPOWER workshops, our partners provide a powerful route to international collaboration, and truly global scientific development.