By Jill Kato, UC Irvine Beall Applied Innovation

Tom Milner, former UC Irvine professor of surgery and biomedical engineering, makes revolutionizing laser medicine sound easy.

“It was a pretty smooth path. The first time we tried it, we thought, ‘Hey, this looks like it’s going to work,’” he says about his work on lasers thirty years ago.

Milner, who recently served as the director of the Beckman Laser Institute, was a vital part of the team that invented the Dynamical Cooling Device (DCD), a medical device that sprays a cooling agent onto the skin before a laser pulse to enhance effectiveness and lessen pain.

The DCD developed from an epiphany, Milner’s colleague, distinguished professor of surgery and biomedical engineering J. Stuart Nelson, had while watching a player get hit by a “stinger” during a baseball game. He noticed how after the hit, a trainer would spray a cooling agent on the player’s injury to numb the pain.

Milner’s research team was in the midst of applying for grants from the National Institutes of Health (NIH) when Nelson wondered whether a cooling agent could be used in combination with lasers to cool and numb the skin. Over dinner, Nelson discussed his idea with Milner and visiting engineer Lars Svaasand, and the three agreed the idea had legs.

After spit-balling their ideas over the weekend, Milner went out to buy a valve while Svaasand and a student went down to the local Pep Boys to purchase R-134a, a refrigerant commonly used in automotive air conditioning systems. In the lab, they connected the refrigerant to the valve and controlled the valve with a delay generator that created a pulse to trigger the spray. In a short amount of time, their first prototype was built. The result: a breakthrough device that has since treated millions of patients and shaped the future of laser medicine.

Cold Comfort

Before the invention of epidermal cooling, the effectiveness of laser treatment was limited by the laser’s intensity. The heat caused patients pain, possible scarring, and pigmentation changes in the skin. Plus, the treatment wasn’t effective on patients with darker skin tones, since melanin in the epidermis, or top layer of skin, limited the amount of light that could reach the blood vessels that physicians were trying to treat.

When Milner first arrived at UCI in 1992, he was a research fellow joining Nelson’s team. Nelson, who is also the current medical director at the Beckman Laser Institute, was trying to come up with a more effective way to treat port-wine stains, hemangiomas, and other vascular malformations.

“We understood from the physics point of view that it was a question of how to make the skin really cold in a short amount of time,” Milner says.

The team’s challenge was to find a way to protect the outer skin while allowing the laser to penetrate deeper to the blood vessels that created these vascular abnormalities. They knew they needed to cool the skin; it was just a matter of how.

Before coming up with the cooling spray idea, the team’s original plan was to bring a cooled window onto the skin before quickly removing it.

“To me, this seemed a lot harder to build than spraying a liquid on the skin with a valve. Since I was the person who had to execute the solution, I preferred the new idea,” Milner says.

A Big Step Forward

The DCD works by delivering a quick burst of a cryogen or cooling agent, onto the skin immediately before, and often after, a laser pulse. The cryogen evaporates and the laser is triggered to target blood vessels in the dermis (the thick part of the skin under the epidermis). The technology is then incorporated into a handheld laser device that is used by a physician.

Once cooling was implemented to protect the skin’s surface, higher energy levels could be used to produce greater effectiveness. The technology also expanded treatment to patients of all skin types by mitigating the blocking effects of melanin. It also reduced patient discomfort by minimizing injury to the skin.

Dermatology chair Kristen Kelly was a research fellow at the time and worked with Nelson on studies investigating the DCD’s early uses.

“The DCD greatly advanced laser skin surgery. We’re able to provide treatment to a wider range of patients. It made the treatments less uncomfortable, and it helped to increase our efficacy. It really was a big step forward,” she says.

Cool Collaborators

Creating the device turned out to be the easy part. While the physical construction of the DCD presented minimal challenges, its complexity lay in comprehending its interaction with human skin. This is where Milner and his colleagues spent most of their time. They needed to measure the temperature of the skin as it cooled and the temperature of the skin when the laser was fired. They had to ensure their measurements were mathematically predictable and confirm their theoretical understanding of its behavior.

Click here to read full article on the UC Irvine Beall Applied Innovation website.

By Gabrielle M. Grasso | Helio.com
Fact checked by Kristen Dowd

Key takeaways:

• After being named a “big nine” food allergen, sesame was found to be associated with alopecia areata in children.
• Chemical sunscreens applies near the hairline were also linked to frontal fibrosing alopecia.

MIAMI BEACH, Fla. — Atopy from food allergies to environmental factors can increase hair loss prevalence among children and adults, according to a presentation at South Beach Symposium.

“The thing that I want you to take home today is the role of allergies in immune conditions,” Natasha A. Mesinkovska, MD, PhD, vice chair of clinical research in the department of dermatology at the University of California, Irvine, said during her presentation. “What we really should be doing for both adults and kids is asking them what they are allergic to, because if you treat the allergy, you can actually prevent people’s hair from falling out.”

According to a study conducted by Sorrell and colleagues, atopy, including food allergies, is the No. 1 comorbidity in alopecia areata among adults and children. In fact, food allergies are on the rise in the U.S., with 2% to 3% of adults and 8% of children reporting a food allergy, according to a 2023 study from Bright and colleagues. While milk, fish and peanuts may be the most common food allergies, another inflammatory ingredient has been traced to hair loss — sesame.

“I had a lot of alopecia areata kids complaining of belly aches, so I ran food panels on them and 9 out of 10 tested positive for a sesame allergy,” Mesinkovska said. “I thought to myself, how did this happen and why are all these kids testing positive?”

As Healio previously reported, sesame became a major food allergen in the U.S. on Jan. 1, 2023, after former president Biden signed into law the Food Allergy Safety, Treatment, Education and Research Act in April 2021.

The law requires food manufacturers and companies handling food to avoid sesame cross contamination and provide labels on foods that did contain the allergen. However, as Healio previously reported,this law has unintended consequences.

Companies considered the new sesame cross-contamination laws “too stringent” and instead decided it would be easier to sprinkle a little bit of sesame flour into every food item and provide a label indicating the addition of sesame to bypass the cross-contamination regulations.

As a result, patients with a sesame allergy were experiencing reactions to previously safe foods, causing a surge in comorbidity prevalences like hair loss.

“I will tell you that I have had two kids that were unable to go on [Janus kinase (JAK)] inhibitors, so we had them stop eating sesame and we stopped their alopecia areata,” Mesinkovska said. “You could say, well that’s only two for two, but for them, it was life changing.”

In another case presented by Mesinkovska, a patient with alopecia areata on JAK inhibitors who was previously doing well suddenly experienced an acute flare of facial dermatitis and increased hair loss. When Mesinkovska asked what the patient thought may be causing this flare, the patient stated they were cutting olive trees in her neighborhood, and she believes she may be allergic to the olive trees.

“When she told me that I just thought, ‘yeah, yeah sure,’” Mesinkovska said sarcastically. “So, I ran an allergy panel and guess what comes up as very, very positive? Olive trees.”

According to her presentation, food allergies are not the only factors that may cause hair loss.

Frontal fibrosing alopecia, a type of hair loss that involves many signs and symptoms outside of hair loss such as hyperpigmentation, facial papules and even forehead wrinkles, can be aggravated by chemical sunscreen.

“A study in the U.K. found that people that have this condition actually tended to use year-round sunscreens,” Mesinkovska said. “Dr. Sinclair’s group in Australia also showed a patient who stopped using sunscreen and her hair came back.”

Sinclair Dermatology now advises patients with FFA to avoid applying sunscreen products to the hairline and instead wear a wide-brimmed hat or simply avoid the sun.

“I definitely stay away from chemical sunscreens and just don’t let my patients apply it, definitely not on that area,” Mesinkovska said.

The connection between allergies, inflammation and hair loss may be complicated, but Mesinkovska recommends that it should be considered when treating patients. Running serum IgE testing on patients with alopecia areata may elucidate the root cause of symptoms as it provides high specificity and a good positive predictive value.

While dermatologists are the foremost experts on skin, hair and nails, patients themselves may offer insight into what exactly is occurring in their bodies. Mesinkovska encourages dermatologists to listen to their patients’ concerns and ideas about their disease, recalling her encounter with her patient that had the olive tree allergy along with hair loss.

“Guess who was right? She was,” Mesinkovska said. “So maybe we should listen.”

References:

• Adoori N, et al. Br J Dermatol. 2016; doi: 10.1111/bjd.14535.
• Bright DM, et al. Am Fam Physician. 2023;108(2):159-165.
• Frontal Fibrosing Alopecia (FFA). https://www.sinclairdermatology.com.au/wp-content/uploads/2019/05/Brochure-Frontal-Fibrosing-Alopecia.pdf. Accessed Feb. 10, 2025.
• Sorrell J, et al. Pediatr Dermatol. 2017;doi:10.1111/pde.13238.

Sources/Disclosures

Source: Mesinkovska NA, et al. Alopecia and comorbidities 360 view. Presented at: South Beach Symposium; Feb. 6-8, 2025; Miami Beach, Florida.
Disclosures: Mesinkovska reports having financial relationships with Abbvie, Arcutis, Arena, BMS, Concert, Galderma, Kadmon, Lilly, Merz, National Alopecia Areata Foundation, Novartis, Nutrafol, Pfizer and Sun Pharma.

Click here to read full article on Healio.com.

UC Irvine’s Beckman Laser Institute & Medical Clinic researchers, led by Dr. Chris Barty, Distinguished Professor of Physics and Astronomy, have developed an innovative method for capturing x-ray images. This new technique aids doctors in detecting breast cancer earlier and more safely, addressing a critical need as traditional mammograms often miss tumors in women with dense breast tissue.

The method, called Scanning K-edge Subtraction (SKES) imaging, utilizes a specialized x-ray beam that produces much clearer images while using only 3 percent of the radiation used in standard tests. This significant reduction in radiation exposure enhances patient safety.

Dr. Barty’s team included five graduate students: three Physics P.D students (Christine Nguyen, Eric Nelson, and Kyle Chesnut) and two M.D-Ph.D. students (Trevor Reutershan and Haitham Effarah). These students were recipients of UC Irvine’s National Institutes of Health (NIH)-funded Medical Scientist Training Program (MSTP), which trains students as both scientists and clinicians to accelerate the translation of laboratory discoveries to patient care.

The team’s findings demonstrate that SKES imaging has the potential to locate tumors often missed by current imaging technologies while exposing patients to less radiation. This breakthrough not only promises to enhance patient care and improve outcomes but also has the potential to prevent many patients from developing cancer-related illnesses in the first place.

Click here to read full article published in Medical Physics.

Student researchers Nanour Arakelian and Mary Javaherian were awarded UC Irvine Undergraduate Research Opportunities Program (UROP) Travel and Research Experience Fellowship Awards for dental research conducted in the laboratory of Dr. Petra Wilder-Smith at UC Irvine Beckman Laser Institute & Medical Clinic.

The UROP Research Experience Fellowship Award provides recognition and funding to UC Irvine undergraduate students from various disciplines in support of research or creative activities under the guidance of UC Irvine faculty members.  Arakelian and Javaherian will present their research projects at the annual UC Irvine Undergraduate Research Symposium in May 2025.

The UROP Travel Award provides recognition and funding for awardees’ research-related travel or publication expenses.  The award will support Arakelian and Javaherian’s presentation at the 54^th Annual Meeting and Exhibition of the American Association for Dental, Oral, and Craniofacial Research (AADOCR) and the 49^th Annual Meeting of the Canadian Association for Dental Research (CADR) on March 12-15, 2025, in New York City, New York.

The AADOCR is the leading professional community for multidisciplinary scientists who advance dental, oral and craniofacial research.  Arakelian and Javaherian look forward to attending the annual meeting, which will feature oral and poster presentations, hands-on workshops, lunch and learn sessions, keynote addresses and symposia presented by experts from around the world.

Click here to learn more about the Dr. Petra Wilder-Smith Laboratory at UC Irvine Beckman Laser Institute & Medical Clinic.

Click here to learn more about the UC Irvine UROP.

Click here to learn more about the AADOCR and CADR.

Using light projections to see beneath the skin, Modulim’s device detects subtle changes in a diabetic patient’s microvascular circulation.

By Jill Kato, UC Irvine Beall Applied Innovation, December 17, 2024

By reducing the need for diabetes-related amputations, Modulim is poised to achieve the biotech trifecta: improve patient outcomes, deliver cost-savings to insurance companies, and streamline physicians’ workload.

David Cuccia will never forget sitting in Professor Bruce Tromberg‘s office with a group of faculty when the conversation shifted to the future of their research. A company had recently approached UC Irvine to license their technology and Cuccia, then a graduate student, turned to the faculty to ask what they planned to do about the offer.

“David, we’re faculty,” they said. “The question is, what are you going to do about it?’”

Cuccia realized he wasn’t interested in licensing the technology to someone else. Instead, he logged on to Legal Zoom to set up his own company for $250 that night.

That company was Modulated Imaging Inc., now known as Modulim, a medical device startup focused on preserving human limbs with medical imaging technology. With Cuccia as chief technology officer, Modulim is set to bring transformative changes to the field of diabetes care.

Curiosity Meets Innovation

Cuccia first arrived at UC Irvine as a freshman and lived at The Shire in the Middle Earth dorms. Initially, he saw himself becoming a doctor. Since he liked science and helping people, he assumed this would be his path. But after witnessing his first surgery, Cuccia knew medicine wasn’t for him. He switched to physics and joined Tromberg’s lab. The undergraduate research he conducted there eventually grew into Modulim, a venture that would come to define his career.

As Cuccia began planning for life after graduation, Professor Anthony Durkin suggested that writing a few more papers could allow him to quickly earn a Ph.D. Taking this advice, Cuccia decided to stay on and pursue his doctorate. Durkin was right about the timeframe. The average time to complete a Ph.D. in biomedical engineering is five to six years. Cuccia earned his in three and a half.

At the time, researchers at the Beckman Laser Institute had spotted a fascinating new trend. Combining near-infrared light and digital projectors, the researchers were able to capture extensive information about tissue in a novel manner. Cuccia and his colleagues invented Spatial Frequency Domain Imaging (SFDI), a non-invasive light-based imaging technique that can capture data on oxygen levels and hemoglobin concentrations in the skin. Instead of a single data point, SFDI captures whole images and examines tissue up to five millimeters deep. Moreover, it’s much quicker than other assessment methods, delivering widefield results in seconds without exposing patients to harmful radiation.

While a graduate student, Cuccia successfully applied for Small Business Innovative Research (SBIR) grants. By the time he graduated, he was able to transition from a Ph.D. student to a principal investigator with his own company. He also discovered that other researchers wanted to buy devices like the one he had built in the lab.

As Cuccia transitioned from graduate student to founder of a startup, Amaan Mazhar arrived at UC Irvine to start his Ph.D. in biomedical engineering. This turned out to be serendipitous. Not only was Mazhar interested in Cuccia’s work, but he was passionate about solving real-world problems.

“The growth of knowledge and technology development was fueled by Amaan. He was director of research, building the devices, and in charge of clinical collaborations. He’s been my partner in crime from the beginning,” says Cuccia. Mazhar now serves as Modulim’s CEO.

In his pitch to the first round of investors, Cuccia introduced a versatile platform with a diverse range of potential applications. Because the technology provided a lens into the properties of tissue and materials, potential applications included improving outcomes of surgical procedures, advancing wound care, and even streamlining fruit inspection. Out of the gate, Cuccia and Mazhar wanted to make sure they helped the most people and made the biggest impact. Their challenge lay in figuring out where to focus their attention first.

Revolutionizing Diabetic Foot Care

Through their clinical collaborations, Cuccia and Mazhar learned more about the scale of the amputation epidemic. Every 20 seconds a person with diabetes undergoes a lower-limb amputation. Poor circulation in diabetes patients starves tissue of nutrients and leads to a breakdown of the skin, which results in chronic ulcers. Nerve damage, a common complication of diabetes, often masks the symptoms of these ulcers. As a result, patients may not even know they have an issue until a chronic ulcer has formed, leading to infection, gangrene, and hospitalizations. In severe cases, this can lead to the need for amputation.

In addition to the personal trauma of losing part of a lower limb, amputations come with significant financial costs. In total, the treatment of diabetic limb-related complications costs about $17 billion in the United States, which is more than the top five most costly cancers.

In a healthcare system that prioritizes treating acute conditions over preventative care, busy physicians often lack the resources to perform foot assessments on all diabetes patients. While it’s possible to train other healthcare personnel to conduct these exams, the current approach still isn’t ideal, since it is highly subjective and dependent on level of skill and interpretation. To effectively address this healthcare gap, Modulim plans to take the subjectivity and guesswork out of diabetic foot exams and make them widely available.

While light is ubiquitous in wearable devices like Fitbits and Apple watches, Modulim’s device uses light projections to see beneath the skin, detecting subtle changes in a patient’s microvascular circulation. Cuccia’s team is developing a handheld version of the technology that is about the size and shape of a smartphone, where a technician with minimal training could operate it in community settings. The device would be compact enough for healthcare personnel to carry in their bags, allowing them to bring it on home visits or to nursing homes.

Integrating a Multidisciplinary Problem

Besides subjectivity, accessibility, and cost, Modulim’s technology tackles another critical aspect of the amputation crisis. Diabetic foot care is a complex, multidisciplinary problem involving physicians from various specialties. A patient with diabetes could potentially see a primary care physician, an endocrinologist, a nephrologist, a vascular medicine specialist, and a podiatrist. Their provision of care often remains fragmented, with no single discipline taking lead.

“We can bridge these specialties by introducing an objective and quantifiable assessment that everyone can use,” says Mazhar.

To complement the device, Modulim has developed cloud-based software to help clinicians in care-management, to help track patients, monitor their microvascular changes, and to share insights within an organization. The device, combined with the algorithm and cloud-based software, has the potential to greatly enhance front-line diabetic care.

Collaborative Roots

The first office space Modulim used was, in fact, a converted printer closet. To help get the startup off the ground, UC Irvine faculty rearranged their postdocs so Cuccia and Mazhar could have a small space. Humble as it was, they were grateful for the “office,” especially since it was in UC Irvine’s Beckman Laser Institute, where groundbreaking work like theirs was taking place.

“Maybe they helped with the space out of pity, but I’m thankful for it,” says Cuccia. “I felt like we had a hundred percent support from everyone all of the time. They wanted to make this happen for us.”

In moving the invention from a university research discovery into a product in the private sector, Cuccia appreciates the freedom and fairness of the deals he’s made with UC Irvine through UCI Beall Applied Innovation.

“They gave us a long leash in terms of the initial fund repayment timeline. They understood that our need for cash was critical. This gave us a solid foundation to find the right fit,” he says.

As a licensing officer for UCI Beall Applied Innovation, Alvin Viray ensured that Cuccia had the support and resources he needed to protect and commercialize his Ph.D. research.

“It has been incredibly rewarding to see his ideas grow into a venture that has real potential to impact the health industry and patients,” Viray says.

These resources and support have generated a lot of loyalty from Cuccia and Mazhar. Even for a UC Irvine-born and incubated startup, their connection and loyalty to the university is deep. They take part in round tables and advisory boards. Their workforce includes a significant number of UC Irvine alumni. They work closely with UC Irvine Beall Applied Innovation by mentoring other startups and by speaking at events. Cuccia serves on the Campuswide Honors Collegium advisory board and Mazhar reviews Proof of Product (PoP) grants in his spare time. Both Mazhar and Cuccia even met their spouses while students at UC Irvine.

“UCI remains supportive of us, and we do our best to contribute in return,” Cuccia says.

A Bold Vision for Healthcare and Beyond

Modulim has attracted over ten million dollars in grants and private investment. Their solution has been rolled out with multiple partners, including Fresenius dialysis clinics, University of Arizona, University of Southern California, and Kaiser Permanente, to study patient populations with a heightened risk of amputation.

And diabetic foot care is only the beginning. With a $2.5 million dollar contract from the Department of Defense, Modulim has partnered with Anthony Durkin in UCI’s biomedical engineering department to build a tool for digital assessment of burns using their technology. Durkin’s lab has already demonstrated the ability of machine learning to map the area and severity of burns using Modulim’s proprietary outputs.

Moreover, the startup can tackle much more than just healthcare. Its technology has been used by research collaborators to understand skincare products, characterize produce quality, and visualize inks in tattoos and old manuscripts. The technology can also be applied in augmented reality by rendering a person’s appearance under different lighting conditions, utilizing a deeper understanding of how light interacts with skin.

But these projects are awhile away. Cuccia jokes that maybe when he’s retired, he’ll be able to work on these broader applications. For now, Modulim is focused on bringing their newest handheld version of their system to market. Understanding that collaborating with major payers and providers is crucial for commercial success, Modulim’s strategy aligns with the healthcare shift toward value-based care models, which focus on reducing costs and improving patient outcomes.

“If there’s a way that technology can help even the playing field and get patients earlier and better access to care,” says Mazhar, “it’s an opportunity for us to contribute to improving our health system.”

Learn more at: https://modulim.com/.

Click here to read the full article on the UC Irvine Beall Applied Innovation website.