Breakthrough or Hype: The future of engineering transplant organs

http://www.mystatesman.com/news/news/local/the-future-of-engineering-transplant-organs-has-al/nnc4C/
The future of engineering transplant organs has (almost) arrived

By Mary Ann Roser - American-Statesman Staff
Posted: 2:27 p.m. Friday, Sept. 11, 2015

As 22 Americans die each day waiting for a transplant, researchers are trying to regrow or build new organs to remedy scarce organ donations.

An Austin-based nonprofit, Solving Organ Shortage — or SOS — is holding a symposium in Austin on Monday and Tuesday so that researchers, doctors and others can brainstorm in the same room and set goals for advancing research to regenerate organs and engineer new ones in the lab.

“Our job is to take those goals — each organ has its own set of goals — and go out and try to raise the funds for that research,” said Catarina Wylie, executive director of Solving Organ Shortage, founded last year by former neurosurgeon Ronald Landes of Georgetown.

With a new University of Texas medical school opening in a year, Solving Organ Shortage said it’s important to bring in the field’s best minds to set priorities so Austin can be part of one of the fastest growing areas of medical research. Solving Organ Shortage is raising money for grants.

It has held seminars on liver and lung transplants in other cities and is now focusing on kidneys, the organ sought by 83 percent of Americans on waiting lists. A scientific coordinator for the kidney group, Tom Carroll, associate professor of internal medicine and molecular biology at UT Southwestern Medical Center in Dallas, discussed organ regeneration and engineering with the American-Statesman.

Here’s an edited version of the conversation:

Aside from the world’s first transplant of a synthetic windpipe in 2011, have any other organs been engineered that work permanently?

I don’t know of any.

So, what is the status of organ regeneration and engineering?

Nobody right now is able to engineer an organ that can completely replace the function of an organ in the body. But a convergence of technologies has made what may have seemed impossible 10 years ago not only possible but probable.

What technologies?

One of the most significant discoveries is we can now make adult stem cells that act like embryonic stem cells (which can be made into many different cell types). There’s also a new technique for genome editing. This technology allows us to turn genes off and on and enables us to create stem cells and regulate what they do.

The third technology is bioengineering, which allows stem cell biologists and engineers to collaborate on 3-D printing and other strategies to engineer replacement organs.

When you take these three technologies and combine them, you’ve created the perfect storm, enabling advances that just 10 years ago people said were impossible. Every major medical center is starting a center for regenerative science, including UT Southwestern. People are starting to recognize the lack of organs for transplantation is a huge, huge problem.

Are these technologies used now?

They are being used in human cells and animal models. I hope we will be able to transfer these findings over to the clinic (soon).

When will engineered organs be available to us?

I don’t know, but I would be disappointed if 10 years from now we don’t have at least one organ we’re able to regenerate or engineer. The technology has been way behind the ideas people have had.

What’s the difference between regenerating an organ and engineering one?

Certain organs in the body are able to regenerate themselves, like your liver. But there are now techniques and technologies that provide growth factors that give a boost to the natural regenerative processes. We can provide these growth factors after an injury and trick the organs into regenerating.

The second option is to introduce stem cells into the organ. If they get into the proper niche, the niche signals where to re-form the organ. A third possibility, which will be covered at our conference, is directly introducing genes into cells within an injured organ and reprogramming those cells back to the stem cell state so they can initiate the developmental process and re-form an organ.

Engineering is starting from scratch in the laboratory.

What’s the status of using 3-D printing to create an organ?

You could take the different cells and use an engineering technique and print out an organ. In some cases, we have all the cell types, and we are ready to go. But 3-D printing doesn’t have the resolution yet needed for small vessels and capillaries. The technique is improving daily. It could be years — if not months — before we can begin using 3-D printing for organs.

What are the biggest challenges you all face?

Two major obstacles are funding and getting researchers with very disparate backgrounds working together. There’s really not a system in place to encourage this.

Is there still interest in using animal organs in humans?

There certainly is, but the biggest problem with transplanting a pig kidney into a human is rejecting the organ. It wasn’t possible to make a nonimmunogenic pig kidney, but with these new technologies, that is something that is actively going on right now.

Wouldn’t a heart be easier to engineer than a kidney?

I certainly think so. The heart is basically just a pump, and I think the heart is going to be one of the first organs to be grown artificially. The liver also will be one of the first.

But we need to start engineering ways to replace a kidney. Kidney disease is an epidemic throughout the world. The two big causes are diabetes and high blood pressure, and I think individual taxpayers are going to have to get involved. This is really a health care nightmare in the United States, and we’re going to have to address it.

Solving Organ Shortage
http://www.solvingorganshortage.org