IHP Overview
Integrated Human Practices (IHP) refers to engaging with stakeholders, experts, and communities throughout the design process, ensuring that a project is not developed in isolation but rather shaped by real-world needs, ethical considerations, and societal impact. Instead of being an add-on, IHP is woven into every stage of the project. Particularly in today's world of perpetual technological and biological change, IHP should be considered a core part of any research project.
For LiRA, our therapeutic for HBV-induced hepatocellular carcinoma, we built IHP directly into our workflow. We interviewed clinicians, researchers, biotech entrepreneurs, and patient advocates very early on - right from our initial ideation stages, before we began any kind of wet lab or dry lab work. This was key in refining our design priorities; we examined regulatory and IP landscapes to align with translational pathways, and we integrated feedback from stakeholders to guide both our technical choices in terms of our overall output and our outreach strategy. This process helped us transform LiRA from a purely technical concept into a solution grounded in patient needs, clinical workflows, and societal impact.
In this section, we will first provide a roadmap that gives an overview of how the direction of our iGEM project shifted and adapted, before discussing the more concrete survey analysis, interview takeaways, and overall conclusions.
Figure 1: Roadmap of the progress in our project
Click image to enlarge
Below we synthesize the cross-cutting themes, design pivots, and remaining questions that emerged from interviews with clinicians, scientists, NGO leaders, and translational innovators.
What we heard (cross-cutting themes)
- Detection must couple to action. Detecting "possible HCC" without a way to intervene provides limited benefit and may worsen anxiety; a therapeutic angle increases clinical utility and effective action.
- Specificity is paramount, and any liver-wide delivery that kills non-malignant hepatocytes is not suitable for our project's purpose; strong tumor selectivity and liver restriction are non-negotiable.
- Making cancer cells produce long-lived biologics (e.g., antibodies) creates a paradox—success reduces output when it's most needed. Similarly, apoptotic proteins are not a suitable option because they kill all the liver cells. The output protein must be carefully designed and have a specific enough effect, even without an anticipated low transfection rate in human liver cells. An immune-system-inducing protein is necessary.
- Simple, potent outputs beat complex ones. Apoptotic/cytotoxic proteins with well-defined mechanisms are preferred over secreted antibodies or oncolytic viruses for the initial translational step.
- Stigma and underdiagnosis shift value to therapy. In real-world HBV care, low screening rates and stigma mean a diagnostic alone will miss many patients or arrive too late.
We utilized the human practices cycle to inform the outcomes of our interviews, expert consultations, and survey data.
How Expert Feedback Shaped Our Project
Visual representation of how stakeholder input transformed our project direction and design decisions
Qualtrics Survey Findings
We created a Qualtrics survey, with both a "medical professional" and "general public mode." The aim for this was to get a broad understanding of the views surrounding hepatitis B and liver cancer from as many different stakeholder groups and people as possible, and this project was completed near the start of the project, with the responses recorded in early July.
The survey ended up going viral after being posted on the social media platform for colleges, Fizz, where it received the most upvotes that day (1.5K), and was the "top fizzing" post.
In addition, we sent it out to clinicians, Stanford mailing lists and posted it on our iGEM Instagram page to get more reach. Overall, the survey received 350 responses, from Stanford students, faculty and members of the general public.
Survey Questions
For medical professionals, questions included:
- Would you be open to RNA-based therapeutic approaches to treat cancers such as HCC?
- What potential benefits do you see in a programmable RNA therapy system (like LIDAR? RADAR) for HCC?
- What concerns would you have about implementing such a system in clinical practice?
- From your perspective, what are the biggest barriers to translating novel RNA tools into liver cancer detection and treatment?
- How important is equitable access to new therapies in low and middle income countries for you when evaluating emerging biotech?
For non-medical professionals, questions included:
- Have you heard of hepatitis B or liver cancer before?
- What concerns you most about this kind of RNA treatment?
- If this treatment could help save lives but was expensive what do you think should be done?
- What's the best way to help people understand new technologies like this?
Key Findings
Excitement About RNA-Based Methods
When asked "What excites you about using RNA-based methods to fight liver cancer," respondents said:
These thoughts all get at the idea of improved specificity, targeting only cancer cells, which our dual biomarker system intends to further improve and refine.
Awareness of Hepatitis B and Liver Cancer
The responses show that hepatitis B and liver cancer are broadly recognized conditions, but the depth of personal connection remains limited. Most people are aware of these diseases in name, but far fewer have direct experience with them through family or friends (particularly because this survey primarily involved U.S. individuals). This suggests that while advocacy can lean on existing awareness, there is still an opportunity to humanize the issue by foregrounding patient stories and the lived impact of liver cancer. For an emerging therapeutic approach, this level of general recognition creates a baseline of understanding but highlights the need to translate abstract knowledge into a more urgent sense of relevance. As a result, a lot of our outreach and education work involved spreading more awareness about the diseases and their mortality and prevalence, to try to bring more recognition to the issue.
Familiarity with RNA Technologies
When it comes to RNA, familiarity is largely superficial. Many respondents know about RNA technologies in the context of COVID-19 vaccines, but few have a strong grasp of how these platforms can be applied to oncology. This indicates that the public imagination around RNA is already open to scientific innovation, but not yet well-informed about its broader possibilities. The iGEM team's challenge here is to bridge that gap: building on the familiarity of RNA vaccines as an entry point while introducing the novel concept of RNA-based therapeutics for cancer.
Concerns about RNA-based Treatments
The dominant worries voiced were not about whether these treatments could work but about whether they are safe, tested enough, and affordable. This points to a classic trust gap between cutting-edge science and public adoption: though the science may be rigorous and precise, the public want reassurance about side effects, long-term testing, and costs before embracing it. Importantly, privacy and lack of understanding also appeared as concerns, showing that some people are uneasy with the complexity of genetic or molecular therapies. This suggests that public communication should prioritize demystification: making the science feel approachable and transparent.
Communicating New Technologies
Finally, the responses around communication methods highlight a public desire for clarity and credibility. People overwhelmingly preferred videos and animations, reflecting a need for intuitive, visual explanations that can break down complex science without jargon. At the same time, there was strong demand for expert or doctor-led explanations, suggesting that trust is anchored not only in simplicity but also in authority. Social media and school outreach were also valued, but these seem to function more as amplifiers than as primary vehicles of trust. For the iGEM team, this suggests a dual communication strategy: engaging, accessible visuals to broaden reach and authoritative voices to solidify trust. Together, these approaches can ensure that RNA-based cancer treatments are not just seen as novel but as credible.
Expert Interviews (Interviews with Stakeholder Experts and Ways They Informed Our Project Direction)
Our iGEM project has undergone significant changes over the past seven months, as we received expert feedback and iterated on our final product. We started with a vision for a point-of-care diagnostic for the early detection of HBV-induced liver cancer in its very primary stage. We have ended up creating a precision-medicine targeted therapeutic for late-stage HBV-induced liver cancer. The Integrated Human Practices component below documents the rationale for each shift in our goals and scientific discovery over time, culminating in the functional and practical technology that we have developed today. All the while, these interviews were also crucial for gaining valuable clinical perspectives about the needs of patients today, helping us to bridge our science with its clinical application. Our interviews include professors, clinicians, NGO leaders, and patients (in addition to biotech companies and startups that will be further covered in our entrepreneurship section). Through these conversations, we refined our project approach and gained a deeper understanding of the clinical and patient contexts of HBV and HCC.
Below, we summarize the key details from each of these interviews, noting the experts' positive feedback, critical areas for improvement, actionable recommendations, and shifts in our approach going forward. These interviews have all been instrumental in refining our project to be the most effective and fulfill the most significant need area.
Additionally, complete interview transcripts/ recordings are available below for the interviews, which we had permission to record.
Dr. Chari Cohen - President of the Hepatitis B Foundation
Interview Date: July 21, 2025, at 1:00 p.m. PST
Background: Dr. Cohen is the President of the Hepatitis B Foundation, the co-chair of the Hep B United Coalition, co-founder and chair of Hep B United Philadelphia, co-founder and chair of CHIPO: Coalition Against Hepatitis for People of African Origin, and immediate past co-chair of the Hep Free PA Coalition. We were keen to hear her perspective because she is in close contact with many HBV patients.
"The number one concern of patients with chronic hepatitis B is the development of liver cancer and the associated mortality. That is the thing most people think about who have chronic Hep-B, in fact. I think the fear related to liver cancer is underappreciated in the medical community, which is something we aimed to address."
Dr. Cohen validated our need area as something clinically relevant, and currently underresearched in the United States: "Liver cancer has been on the rise in the U.S. for the last 15 years, for both men and women, for both incidence and mortality…We are probably underestimating the amount of liver cancer that Hep-B causes in the U.S. Because Hep-B is stigmatized, providers don't know about it, so they don't test for it. People don't wanna talk about it, so they don't ask to be tested, and so in the U.S., there's about 2.5 million people who have Hep-B, but only about 30% are diagnosed."
Dr. Cohen also critically prompted us to think more about how we can achieve a desired specificity that is needed for our therapeutic to be effective: "The highest level thought leaders think about is, well, when a person has chronic Hep-B infection, what percentage of liver cells are infected and what percentage of cells have integration and how do you think about killing them without killing the liver? That's a very, very fundamentally important question."
Dr. Charles Rice - Nobel Laureate for his work on the Hepatitis C virus
Interview Date: July 23, 2025, at 10:00 a.m. PST
One key topic we discussed with Dr. Rice was the output protein of the system. At the time of the meeting, we were considering using an antibody, with the component two strands produced by each part of the RADAR system. However, Dr. Rice raised some points about the efficacy of cancer cells in making antibodies, which is a very energy-intensive process, that helped us pivot to a cytokine protein instead.
"Why would you want a cancer cell to produce it as opposed to a muscle cell? Suppose the cancer cell is actually producing the antibody, which has an anticancer effect. In that case, it's kind of like you would like a lot of this antibody around until the last cancer cell is gone if you have the cancer cell as your producer cell, as it succeeds. There will be fewer antibodies produced, which could increase the ability of residual cancer cells to persist."
Dr. Rice also helped us to start brainstorming other challenges without a project, such as the method of delivery: "For the RADAR approach, I guess one of the things that may be a bit of a challenge is in an infected individual, how are you going to get this into all of the hepatocytes? Or do you need to?" As a result, we researched and came to the consensus that a lipid nanoparticle would be the best approach, given that most lipids naturally reach the liver, making the delivery aspect slightly easier than if we were targeting a different organ in the body.
Dr. Mindie Nguyen
Interview Date: July 30, 2025
Background: Dr. Nguyen is a Professor of Medicine, a member of the Stanford Cancer Institute, and specializes in the treatment and prevention of primary liver cancer, including hepatocellular carcinoma (HCC).
Our meeting with Dr. Nguyen was very informative and prompted us to pivot our project completely. Dr Nguyen discussed with us how it doesn't really make sense only to treat early cases of liver cancer that also have chronic hepatitis B. She made a good point that technologies already exist to detect HBV very well, and that there is no need to detect HBV-HCC, as they don't differentiate between different HCC causes in treatment.
"The treatment algorithm for HCC is independent of the etiology of HCC. Therapeutics are not commonly developed with respect to a specific etiology."
Dr. Nguyen also talked more about the stigma surrounding HBV, and as a result, the underdiagnosis, because people don't screen or get evaluated. She also mentioned that finances are not an issue in many cases. In many parts of China, for instance, you may be discriminated against and won't get a job, or be denied admission to a particular school due to the diagnosis.
Dr. Jianghong Rao, Professor of Radiology, Stanford University
Interview Date: August 4th, 2025
Background: Dr. Rao is a Professor of Radiology and, by courtesy, of Chemistry at Stanford, and a member of the Stanford Cancer Institute.
In our meeting with Dr Rao, one of the main questions we addressed was the output protein that we should produce as a therapeutic, after our prior conversation with Dr. Rice. At this stage, we began to consider the second part of our AND-gate logic and explored the use of split Granzyme B or alternative split proteins, such as barnase/barnstar.
"If you generate two fragments that come together and then have the active granzyme B, yes, that could be a pretty good target."
He also suggested the idea of increasing local immunity and immune activation: "A strategy to trigger the immune response is a valuable approach; you could put some immune activation factor there to boost the immune response…"
Dr. Jacki Chen - THICA Founder and Chronic Hepatitis B patient
Interview Date: August 1st, 2025
Background: Dr Chen is the founder of the Taiwan Hepatitis Information & Care Association, teaches at New Jersey Medical College, and is also a chronic Hepatitis B patient herself.
Dr Chen mentioned that there are currently many challenges she has faced in reducing stigma, misinformation, and lack of awareness about chronic HBV. Primarily, there is a lot of misinformation surrounding the disease, and anti-vax rhetoric is increasing, especially in Taiwan, with "high-quality content which misleads the public."
"Many people think that no symptoms means no disease. We still don't have a true cure for hepatitis B. Everything we have now is suppressive."
Dr Chen mentioned that liver cancer is the top fear for patients with chronic hepatitis B. She said that flares can be unpredictable and severe, and as a result, monitoring alone is insufficient.
Dr. Josh Makower - Stanford Biodesign
Interview Date: August 5th, 2025
Background: Dr. Josh Makower is The Yock Family Professor of Medicine and of Bioengineering at the Stanford University Schools of Medicine and Engineering and the Director of the Stanford Byers Center for Biodesign.
"This looks really promising as a therapeutic approach."
We asked him about the next steps for our project, and he told us to validate the scientific approach and then move to small animals, as in vivo work will be very important for a better proof of concept.
Professor Ross Venook - Senior Lecturer of Bioengineering, Stanford University
Background: Dr Venook is a Senior Lecturer in the Bioengineering department, and he is the Associate Director for Engineering at the Stanford Byers Center for Biodesign, and leads the laboratory courses at Stanford.
"Current treatments are not targeted at all. There is a big issue with a diagnostic that doesn't have a good therapeutic, there will be the but-then-what question."
Overall, this interview left us feeling more confident in our idea of creating a therapeutic technology over a diagnostic, and also gave us future areas in our expansion of LiRA, as not only a modular system for treatment of specific biomarkers, but working in tandem for the detection of them as well.
Dr. Holden Hsu
Interview Date: August 10th, 2025
Background: Dr Hsu is a distinguished Professor of Medicine at I-Shou University and the Director of the Department of Medical Research at E-Da Hospital. His expertise lies in the field of hepatology, with a particular focus on viral hepatitis, especially chronic hepatitis B.
"If we find the tumor early, when it is only several centimeters in diameter, it is not difficult to resect the tumor via focal ablation, which does not involve cutting liver tissues. The complete response rate is over 90% and the treatment is effective. As a result, the challenge is that when HCC is diagnosed, it is usually at an advanced stage."
This validated our transition from an early-stage therapeutic to a late-stage targeting therapeutic, by showing the greater need for this component in patients.
Dr. Grace Wong
Interview Date: August 14th, 2025
Background: Dr Wong is a Professor in the Department of Medicine & Therapeutics at The Chinese University of Hong Kong and a Consultant Hepatologist at Center for Liver Health, Faculty of Medicine.
Dr Wong said "In Asia, there is a high prevalence of Hepatitis B infection. 1 in 20 people have Hepatitis B, but most are not diagnosed. Viral diagnosis is an issue, even those who know that they are carriers don't regularly get checked because of a lack of such surveillance resources AFP protein is usually used in Hong Kong, as well as ultrasound scans."
Dr. Robert Gish - Hepatitis B Foundation Medical Director
Interview Date: August 26th, 2025
Background: Dr. Gish is the Medical Director at the Hepatitis B Foundation and also an Adjunct Professor of Medicine at the University of Nevada, Las Vegas.
Dr. Gish said, "We have 11 different options… ablation, embolization (TACE/Y90), transplant/surgery… then systemic. First-line systemic therapies… median survival ~24 months in unresectable disease. Checkpoint inhibitors (PD-1/PD-L1) + VEGF combos… and tyrosine kinase inhibitors… toxic and expensive… extend life maybe 12–18 months from baseline."
He advised us that our metric of success does not need to be completely curing cancer, but rather extending life for a longer period of time compared to currently available drugs, and that this would still be very useful and needed.
"Your market size is not the U.S.… China has a million liver cancers diagnosed every year… Southeast Asia, Africa, and Central Asia. I would put China, Asia-Pacific Rim, the U.S., and the EU as where your first level of treatment would go."
Stanford iGEM x THICA Taiwan Workshop - The Future of HBV and HCC Biosensing
On August 2, 2025 (Taiwan time), our team hosted an online livestream in formal collaboration with THICA Taiwan titled "The Future of HBV & Liver Cancer Detection — Stanford iGEM Project Sharing." The event was co-hosted by Professor Jacki Chen, founder of THICA Taiwan, and Rebecca, both long-time advocates for the HBV patient community. The speaker was Liz Tsai, a Taiwanese member of the Stanford iGEM team, who delivered her talk in Mandarin to ensure accessibility for the local HBV community.
THICA Workshop
Collaborative learning session
THICA Workshop Screenshot
Interactive session details
In her presentation, Liz introduced the team's research on developing an RNA biosensor for early detection of hepatocellular carcinoma (HCC) caused by chronic hepatitis B infection. She explained how the system harnesses ADAR-mediated A-to-I RNA editing to sense HBV- and HCC-specific molecular signatures and convert them into a functional protein output. By presenting the science in Mandarin, Liz was able to make complex concepts more accessible to patients, family members, and advocates, thereby bridging the gap between advanced synthetic biology and the lived experiences of Taiwanese HBV communities.
The livestream featured several components: a scientific presentation outlining the biosensor's potential impact, a live Q&A session where participants raised concerns about accessibility, data privacy, and an interview between Liz and Professor Jacki on the importance of integrated human practices. This dialogue emphasized how patient voices, particularly their stories of diagnosis, treatment, and emotional challenges, directly inform technical design choices such as sensitivity requirements, reporting clarity, and user experience.
Bay Area Bioengineering Symposium (BABS)
In collaboration with iGEM Teams, we attended and presented our initial idea to the wider iGEM community in the Bay Area. Our team had no initial expectations of the gathering, but we left with incredibly rewarding friendships, feedback from both students and faculty of the different universities present and inspiration from other team's problem solving approaches. One of our favorite talks was Priyam Baruah's "Identification and characterization novel viral open reading frames"
BABS Poster Presentation
Our team presenting the iGEM project at the Bay Area Bioengineering Symposium
SB. Talk - Meet the iGEM Team
Stanford iGEM has historically been constantly engaged with the wider synthetic biology community. As such, we wanted to continue sharing our yearly project with the community at Stanford. We pitched the proposal to around 20 people from both students and faculty, followed by a Q&A. This was the first time our team presented our idea to a larger public. Having the support of the wider synthetic biology community and receiving their initial feedback was very enlightening.
SB. Talk Event
Community presentation and discussion
SB. Talk Presentation
Team project showcase