Parts Is Parts

Parts Is Parts

   You've heard the saying, often in a humorous form, but still, I couldn't help but think of those words when my two other root canals (side by side so done at the same time) were being filled with files and measuring tools as shown in the photo.  And that saying came up again when several of us went hiking the next day and the discussion came up about our aching knees, hips and whatever other joints we had banged and abused on the way up to the lakes.  Almost all of us either knew or had heard about someone with new knees or a hip replacement, or a stent or a pin in the shoulder.  Before long, we thought, there'd be parts on demand...medically.

   Our discussion began because of a recent article in Smithsonian by Matthew Shaer on lab-created body parts and the industry growing around it. “Think about it like the Dell model,” said Anthony Atala, a pediatric urologist and the institute’s director, referring to the computer company’s famous “direct” relationship model between consumer and manufacturer.  We were sitting in Atala’s office on the fourth floor of the research center.  “You’d have companies that exist to process cells, create constructs, tissue.  Your surgeon might take a CT scan and a tissue sample and ship it to that company,” he said.  A week or so later, an organ would arrive in a sterile container via FedEx, ready for implantation.  Presto, change-o: A new piece of me—of you—made to order...“What’s interesting is that there are no real surgical challenges,” Atala said.  “There are only the technological hurdles that you’ve got to overcome to make sure the engineered tissue functions correctly in the first place.”  We’re getting close, with “simple” organs like skin, the external ear, the tube-like trachea.  At the same time, Atala can’t help but look to what might come next.  At his most sanguine, he likes to envision a vast bioprinting industry capable of cranking out big and complex organs without which the body would fail, like the liver or the kidney.  An industry that could make traditional transplants --with their long, often fatal wait times and the ever-present risk of organ rejection-- completely obsolete.

   Although the article mentions that the first successful organ transplant didn't happen until 1954, one need only consider the changes that have occurred in a little over half a century.  About six years ago, when my mother had a piece of her retina starting to detach, I took her into the eye surgery center and expected to basically finish a book while I waited; after all, this was her eye and something way in the back of her eye.  Things could go wrong with such a intricate and difficult procedure (or so the complicated scenario played out in my mind).  But 30 minutes later, the nurse said that my mother was recovering nicely and could be on her way in another half hour (and those 30 minutes included the wheeling into surgery, the surgery itself, and the wheeling out into the recovery room).  Much was the same when my wife had her cataract surgery...eyes open, lens dissolved and vacuumed out, new plastic lens popped in via a tiny slit (the new lens is folded like a tortilla and "pops" open once inserted into the newly created space), suture and out into recovery (her surgery was even quicker, about 12 minutes).  

   I've said it before, I have zero medical background or practice, but I do know that even trying to imagine repairing the tendon on a chicken leg quarter is near impossible.  Try it at home the next time you are preparing chicken chasseur or something similar that uses that portion of the chicken, only realize that you've got tons of room and can manipulate that leg quarter to your liking...careful to avoid the main blood vessels, and be sure to avoid accidentally cutting any of the nerves lest you leave the poor creature's limb paralyzed.  I make light of the subject, of course, but it gives one an idea of just how far the replacement and repair of our body parts has become, that we can accept such a complicated procedure ("going in for a new hip replacement") so nonchalantly.  We watch them go in, and usually within a few hours, watch them come out.  

   A few years ago, bio-researcher, Geraldine Hamilton, posted a TED talk on recreating cellular body functions on a chip, everything from lungs to our stomachs: Our bodies are dynamic environments.  We're in constant motion.  Our cells experience that.  They're in dynamic environments in our body.  They're under constant mechanical forces.  So if we want to make cells happy outside our bodies, we need to become cell architects.  We need to design, build and engineer a home away from home for the cells...And at the Wyss Institute, we've done just that.  We call it an organ-on-a-chip.. Right here in my hand is a breathing, living human lung on a chip...the true power of this technology, however, really comes from the fact that we can fluidically link them.  There's fluid flowing across these cells, so we can begin to interconnect multiple different chips together to form what we call a virtual human on a chip.  Now we're really getting excited.  We're not going to ever recreate a whole human in these chips, but what our goal is is to be able to recreate sufficient functionality so that we can make better predictions of what's going to happen in humans.  For example, now we can begin to explore what happens when we put a drug like an aerosol drug.  Those of you like me who have asthma, when you take your inhaler, we can explore how that drug comes into your lungs, how it enters the body, how it might affect, say, your heart.  Does it change the beating of your heart?  Does it have a toxicity?  Does it get cleared by the liver?  Is it metabolized in the liver?  Is it excreted in your kidneys?  We can begin to study the dynamic response of the body to a drug.

 

   Ages ago, an episode of The Twilight Zone showed a time in the future when (if you had enough money), you could walk in an have your entire inner body, brain and all, removed and re-inserted into a new younger body.  The scene shows an elderly couple walking in, the man emerging some time later, lively and jumping with youthful vigor (they could only afford to have one of their bodies done so that was the moral dilemma).  But imagine a time not so far away when heavy smokers could have lungs replaced, or cancer patients could have new vascular systems created.  Such ideas, even hearts and kidneys, are being worked on in research labs across the world.  And if it all sounds a bit too preposterous, think back to the first knee replacement, a joint that takes pounding and requires an extensive range of motion...such a procedure would have seemed quirky at best, and likely not something that would become commonplace or accomplished in an hour.

 

   Still, I couldn't help but pant and almost revel in my exhaustion at completing the hike.  We were all tired, and sore, and ready for a helicopter ride down (ha!, like that was going to happen).  But we had made it, and look at the stunning views, even spotting two moose way in the back (you'll have to look closely), each resting comfortably on their own wobbly knees...as were we.  After all, we thought, some things just can't be replaced, even with the right parts.