Let there be light!

Madison company OnLume is on the cutting edge of technology aimed at improving surgical outcomes.

Dimming or turning out the lights seems like a good idea for a magic trick or scary story, not surgery.

However, performing surgery in the dark is actually what surgeons are forced to do for some procedures, where darkened operating environments are optimal for utilizing fluorescent compounds that highlight specific tissues — think cancer — in patients’ bodies.

OnLume, a Madison company founded in 2015, is aiming to change that with technology designed to shed new light on complicated surgical procedures.

According to Adam Uselmann, co-founder and CEO of OnLume, the company was founded with the goal of increasing adoption of fluorescence image-guided surgery (FIGS) through developing devices that overcome many of the current barriers and difficulties with the technique — the most pressing of which was the need to turn off the lights in the operating room.

“The idea originally came from the experience of co-founder Andreas Velten,” Uselmann explains, “who spent hours in a dark room as an imaging researcher performing microscopy. This problem turned into a solution through technology developed by several of the co-founders while they were colleagues at the Morgridge Institute for Research.”

OnLume’s technology allows for intraoperative imaging fluorescence at high sensitivities with fluorophores of any color without needing to operate in a dark room, Uselmann states. “Not requiring the surgeon to become dark- and light-adapted as you switch the lights on and off, and allowing the other doctors and nurses to continue working in a well-lit room while the surgery is performed, ultimately will lead to safer, shorter surgeries and reduced health care costs across the board.”

These screen captures from a TED Talk by Dr. Quyen Nguyen on the topic of fluorescence image-guided surgery show a procedure to remove cancer containing metastatic lymph nodes. In this composite image, the left image is the white light image (what the surgeon traditionally sees). The center image is the fluorescence, with the metastatic lymph nodes illuminated. The right image is the superimposed white light and fluorescence image that may be used by the surgeon to guide the procedure.

Other people involved in OnLume include Rock Mackie, a serial entrepreneur and medical device commercialization expert well known for his business success with Tomotherapy, among other companies; Ben Titz, a molecular imaging expert with a strong background on the pharma side of the coin; Kevin Eliceiri, a microscopy expert and prolific collaborator with solid ties to researchers across the country; and Daniel Seemuth, a talented electrical engineer with broad expertise in hardware and software development, notes Uselmann.

OnLume has been funded so far by an initial investment by founders, a Phase I SBIR grant from the National Cancer Institute (NCI) at the National Institutes for Health (NIH), and the UW–Extension SBIR Advance Matching Grant Fund through its partnership with the Wisconsin Economic Development Corp. and the University of Wisconsin System.

Luminous applications

Cancer surgery is one of the most exciting applications of FIGS technology, Uselmann says.

“A number of cancer-targeting fluorophores are currently in development by pharmaceutical companies and at various stages of clinical trials. When imaged under the right illumination and with the right hardware, residual cancer cells at the edge of a surgical field ‘light up,’ and can be displayed to the surgeon in real time to guide their removal of additional tissue,” notes Uselmann. “To illustrate the scale of this problem, 25% or more of breast cancer lumpectomies require a secondary surgery or complete mastectomy. By increasing the odds that the surgeon removes all the cancer, you reduce the chance of the patient needing an additional surgery and of the cancer spreading.”

Another application of fluorescence guidance is using a dye called Indocyanine green to perform imaging of angiography and blood supply (perfusion). Techniques using this dye are already FDA approved and are seeing growing use, according to Uselmann.

“An example of this application is in the case of breast reconstruction surgery, where you can image a piece of tissue that has been operated on and ensure that tissue is receiving adequate blood supply before it would otherwise be apparent,” Uselmann explains. “This allows the surgeon to fix these issues before the tissue dies, which can cause serious complications to the patient.”

FIGS also has many applications in the veterinary space, according to Uselmann, and veterinary surgeons OnLume has spoken to have been excited about the possibilities of using FIGS to improve surgical outcomes in pets.

“There is an unmet need here, and the veterinary market will provide us with revenue and valuable user feedback as we pursue FDA clearance of our first clinical device moving forward,” says Uselmann.

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Madison made

Uselmann says Madison has been an ideal city to develop and grow OnLume for a number of reasons.

“The university is a hotbed of research and talent, especially in the medical realm,” explains Uselmann. “This has allowed us to collaborate with a number of top-tier surgeons and researchers and better understand the real problems and needs of the field.

“The UW Business School also does a great job of fostering a culture of entrepreneurship within the university, through programs like the Wisconsin Entrepreneurial Bootcamp (WEB),” continues Uselmann.

Local and statewide organizations including the Center for Technology Commercialization (CTC), Wisconsin Technology Council (WTC), Wisconsin Alumni Research Foundation (WARF), and Advocacy Consortium for Entrepreneurs (ACE) are great resources for early-stage companies in terms of education, events, networking, and several other forms of support, notes Uselmann.

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