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

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

Culturally appropriate screening and diagnosis of cervical cancer in East Africa

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

Towards a viable solution for a see and treat paradigm for cervical pre-cancer in East Africa

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

Publications:

Feasibility and Outcome of Training Field Workers to Use the Transvaginal Colposcope for Point of Care Diagnosis and Management of Precancerous Cervical Lesions

Background: Screening programs in low-middle-income countries have high attrition rates during referral and treatment. Portable colposcopes can decrease costs, reduce referral rates and improve compliance with treatment especially if performed at primary care facilities. The objective of the present study was to assess the ability of field workers (FW) to perform colposcopy. Methods: The study was conducted in two phases: In phase-1, women aged 21–65 years referred for colposcopy for an abnormal screening report or cervical symptoms were enrolled, underwent visual inspection with acetic acid (VIA) and colposcopy. The performance of FW in capturing colposcopic images using a transvaginal colposcope (TVC) was analysed and compared with those captured by a physician using TVC and digital video colposcope. In phase-2, an experienced FW and a new FW captured images of the cervix from 100 women with TVC, and the images were assessed by colposcopist. Findings: Among 125 subjects enrolled, 96 (76.8%) were VIA positive and 12 (9.6%) had CIN2+ lesions. Of the images captured by FW, 122 (97.6%) were adequate for interpretation. Swede score calculated from the images captured by FW and the physician showed high level of agreement (K = 1.0). On image review, FW and colposcopist recommended referral in 98 (78.4%) and 34 (27.2%) subjects, respectively. The images captured by both FW were reassessed and the Swede scores were same in 87% women with weighted k-value of 0.945 on histopathology correlation. Interpretation: TVC can be used by FW to capture cervical images which can be reviewed by colposcopist to reduce referral rates.
Authors
Natarajan, J; Krieger, M; Ramanujam, N; Vashist, S; Bhatla, N
MLA Citation
Natarajan, J., et al. “Feasibility and Outcome of Training Field Workers to Use the Transvaginal Colposcope for Point of Care Diagnosis and Management of Precancerous Cervical Lesions (Accepted).” Indian Journal of Gynecologic Oncology, vol. 21, no. 1, Mar. 2023. Scopus, doi:10.1007/s40944-022-00681-6.
URI
https://scholars.duke.edu/individual/pub1560236
Source
scopus
Published In
Indian Journal of Gynecologic Oncology
Volume
21
Published Date
DOI
10.1007/s40944-022-00681-6

Physiologic, Metabolic, and Structural Alterations in Breast Cancer: Assessment via Optical Technologies

Optical spectroscopy was used to assess structural and functional changes which occur in breast tissue for the optical diagnosis of cancer in humans in vivo, and characterization of mammary tumor biology in animal models.
Authors
Ramanujam, N; Brown, JQ
MLA Citation
Ramanujam, N., and J. Q. Brown. “Physiologic, Metabolic, and Structural Alterations in Breast Cancer: Assessment via Optical Technologies.” Optics Infobase Conference Papers, 2006.
URI
https://scholars.duke.edu/individual/pub1535510
Source
scopus
Published In
Optics Infobase Conference Papers
Published Date

Development of a multimodal mobile colposcope for real-time cervical cancer detection.

Cervical cancer remains a leading cause of cancer death among women in low-and middle-income countries. Globally, cervical cancer prevention programs are hampered by a lack of resources, infrastructure, and personnel. We describe a multimodal mobile colposcope (MMC) designed to diagnose precancerous cervical lesions at the point-of-care without the need for biopsy. The MMC integrates two complementary imaging systems: 1) a commercially available colposcope and 2) a high speed, high-resolution, fiber-optic microendoscope (HRME). Combining these two image modalities allows, for the first time, the ability to locate suspicious cervical lesions using widefield imaging and then to obtain co-registered high-resolution images across an entire lesion. The MMC overcomes limitations of high-resolution imaging alone; widefield imaging can be used to guide the placement of the high-resolution imaging probe at clinically suspicious regions and co-registered, mosaicked high-resolution images effectively increase the field of view of high-resolution imaging. Representative data collected from patients referred for colposcopy at Barretos Cancer Hospital in Brazil, including 22,800 high resolution images and 9,900 colposcope images, illustrate the ability of the MMC to identify abnormal cervical regions, image suspicious areas with subcellular resolution, and distinguish between high-grade and low-grade dysplasia.
Authors
Coole, JB; Brenes, D; Possati-Resende, JC; Antoniazzi, M; Fonseca, BDO; Maker, Y; Kortum, A; Vohra, IS; Schwarz, RA; Carns, J; Borba Souza, KC; Vidigal Santana, IV; Kreitchmann, R; Salcedo, MP; Ramanujam, N; Schmeler, KM; Richards-Kortum, R
MLA Citation
Coole, Jackson B., et al. “Development of a multimodal mobile colposcope for real-time cervical cancer detection.Biomedical Optics Express, vol. 13, no. 10, Oct. 2022, pp. 5116–30. Epmc, doi:10.1364/boe.463253.
URI
https://scholars.duke.edu/individual/pub1553620
PMID
36425643
Source
epmc
Published In
Biomedical Optics Express
Volume
13
Published Date
Start Page
5116
End Page
5130
DOI
10.1364/boe.463253

One-Photon Autofluorescence Microscopy

Autofluorescence from cells has been detected and utilized by scientists for well over 100 years for a variety of applications. The need for fluorescence as a noninvasive tool for cell studies was spurred by advances in optical microscopy, fueling the need for better contrasting agents to image samples. Initially, fluorescent dyes such as fluorescein, acridine orange, and neutral red provided a very high level of contrast due to their specificity in attaching to specific proteins in plant and animal cells. Cell and tissue autofluorescence was simply observed as a biological phenomenon that tended to interfere with the signal and reduce image contrast. It was not until the landmark studies of Britton Chance (Chance and Williams 1955a, b, c; Chance et al. 1962) that autofluorescence from cells was attributed to specific coenzymes, such as pyridine nucleotides, or flavoproteins in mitochondria. Further, it was argued that because the oxidized pyridine nucleotides (NAD+) and the reduced form of flavins (FADH2) were not fluorescent, it was possible to ascertain the reduction-oxidation (redox) state of cells. Since then, autofluorescence from cells in the form of NADH and FAD fluorescence has been used in many studies to investigate the metabolic activities of various organs. Specifically, some of the very first in vivo studies for examining intracellular redox states were performed using single-photon fluorescence microscopes (Chance et al. 1962). In this chapter, we discuss the important components that are essential in the design of fluorescence microscopy, calibration techniques, and image processing methods.
Authors
Rajaram, N; Ramanujam, N
MLA Citation
Rajaram, N., and N. Ramanujam. “One-Photon Autofluorescence Microscopy.” Natural Biomarkers for Cellular Metabolism: Biology, Techniques, and Applications, 2014, pp. 67–76. Scopus, doi:10.1201/b17427-10.
URI
https://scholars.duke.edu/individual/pub1553621
Source
scopus
Published Date
Start Page
67
End Page
76
DOI
10.1201/b17427-10

Cervical Cancer-Related Knowledge, Attitudes, Practices and Self-Screening Acceptance Among Patients, Employees, and Social Media Followers of Major Brazilian Hospital.

<h4>Background</h4>Brazil has a high burden of cervical cancer, even though it is preventable, traceable and treatable. Hence, this study evaluated levels of knowledge, attitudes and practices (KAP) related to cervical cancer screening and diagnosis and acceptance of self-screening techniques among women aged 24 and greater.<h4>Methods</h4>A cross-sectional KAP survey was administered to n = 4206 women and spanned questions relating to cervical cancer, HPV, speculum, Pap test and colposcopy. Questionnaire was disseminated through a major hospital's social media platforms, intranet and gynecologic-oncology clinics. Logistic regressions evaluated associations between sociodemographic characteristics and knowledge, attitudes, and preventative behaviors against cervical cancer. Participants indicated willingness to try DNA-HPV self-sampling and cervix self-visualization (self-colposcopy).<h4>Findings</h4>Participants were mostly white individuals (70.5%) with higher education and from social classes A and B. They demonstrated superior levels of KAP than described in the literature, with over 57.8% having answered 80+% of questions correctly. KAP scores were predicted by social class, educational attainment, race, history of premalignant cervical lesions and geographic location. About 80% and 63% would be willing to try DNA-HPV self-sampling and cervix self-visualization, respectively. Interest in self-screening was associated with adequate attitude (OR = 1.85) and inadequate practice (OR = .83).<h4>Interpretation</h4>Adequate KAP are fundamental for the successful implementation of a self-screening program. Participants were interested in methods that provide them with greater autonomy, control and practicality. Self-screening could address barriers for under-screened women such as shame, discomfort, distance from clinics and competing commitments, enabling Brazil to reach the WHO's cervical cancer elimination goals. It could also decrease excess medical intervention in over-screened populations by promoting shared decision-making.
Authors
Perez, L; Tran, K; Alvarenga-Bezerra, V; Chadha, D; Dotson, L; Assir, F; Cordioli, E; Tamura Vieira Gomes, M; Podgaec, S; Lopes da Silva-Filho, A; Ramanujam, N; Moretti-Marques, R
MLA Citation
Perez, Luiza, et al. “Cervical Cancer-Related Knowledge, Attitudes, Practices and Self-Screening Acceptance Among Patients, Employees, and Social Media Followers of Major Brazilian Hospital.Cancer Control : Journal of the Moffitt Cancer Center, vol. 29, Jan. 2022, p. 10732748221135440. Epmc, doi:10.1177/10732748221135441.
URI
https://scholars.duke.edu/individual/pub1557546
PMID
36433760
Source
epmc
Published In
Cancer Control : Journal of the Moffitt Cancer Center
Volume
29
Published Date
Start Page
10732748221135441
DOI
10.1177/10732748221135441