Science on the verge of art

Artists will best tell about the latest achievements of scientists
Ella Bikmurzina, Telegraph "Around the World"

Two young people stand for a few minutes in disbelief at the photo. The picture shows a man with a real ear sticking out of the forearm of his left hand. The explanatory caption under the photo says that this is the third ear of the Australian artist Stelarc (Stelios Arcadiou), which was grown artificially from his own cells. However, this ear implanted in the arm is useless in a practical sense – it does not hear. Why does Stelark need it? "Probably, this is how he wants to show others what progress has come to," one of the young people thinks out loud.

Australian artist Stelark claims that he decided on the Extra Ear project out of love for art.
He believes that the human body is obsolete, and therefore it should be modified.
It is worth paying tribute to Stelark – his performances are very spectacular.
For example, in 1973, he sewed up his eyes and mouth,
he spent a week in the gallery in a "sealed state",
listening to the rhythms of your body.
Photo Creative Commons license, Nina Sellars/Ars Electronica

To an unprepared audience, all this seems almost fantastic, but the purpose of the exhibition is "Life. The Version of Science", which is currently taking place in Moscow as part of the science festival of the same name, organized by the Dynasty Foundation for Non–profit programs, and consists in giving the layman an idea of what scientific progress has come to, what modern scientists know about life, what "miracles" they can do and, most importantly, - what practical benefits can be derived from all these incredible achievements. One of the most interesting topics raised by the organizers was regenerative medicine, in particular autotransplantation – the transplantation of organs grown using the patient's own cells. The guests of the festival replenished their piggy bank of knowledge on this issue by exploring the exhibits and listening to lectures by the stars of world science – to whom, by the way, anyone could ask a question.

Regenerative medicine has been practiced since the 1930s. Then the researchers faced three main problems that needed to be solved in order for autotransplantation to become a reality. First, it turned out that human cells outside the body grow quite differently from inside. Secondly, for the cultivation of artificial organs, biocompatible materials were needed that the patient's body would not reject. And third, the biggest problem is the integration of an artificial organ into the system. Will it be able to vascularize and innervate, that is, become covered with a network of blood vessels and nerves? If not, the transplanted organ will simply not work.

Surgery to implant the third ear of the Stelark.
The artist had to make a lot of effort,
to find doctors who would agree to implant an extra ear in him –
there were no medical indications for that.
Photo Creative Commons license, Nina Sellars/Ars Electronica

How successfully scientists manage to solve these problems can be seen by walking from the third ear of the Stelark to the neighboring exhibit – monitor, which shows a film about a unique technique developed by the head of the Department of thoracic surgery of the University Clinic of Barcelona (Hospital Clinic de Barcelona), professor of the Medical School of Hanover (Hannover Medical School) Paolo Macchiarini. In 2008, an article about this technique was published in the authoritative medical journal Lancet. Macchiarini, who led an international group of scientists, performed a tracheal transplant operation on a patient Claudia Castillo, who was diagnosed with stenosis of the main left bronchus.

The transplant was grown on a donor frame using the patient's own cells – derived from cells of the inner layer of the trachea and bone marrow. As a frame, doctors used a 7 cm long tracheal segment taken from a corpse. The trachea was separated from the connective tissue and 25 cycles of devitalization were performed – purification from donor cells and histocompatibility antigens, the main culprits for the development of rejection reactions during organ transplantation from donor to recipient. This procedure took six weeks. "The particular difficulty here was not to damage the integrity of the structure of the collagen framework during prolonged chemical treatment," Professor Macchiarini shared with reporters after the operation.

After that, the doctors applied a suspension of the patient's cells to the inner and outer surface of the frame and placed it in a specially designed bioreactor, where it constantly rotated for 96 hours, in contact with the culture medium and air. After that, the finished transplant was used to replace Claudia's bronchus. She completely removed the main left bronchus and the trachea section to which it adjoined. All stages of this unique operation are filmed, and every visitor of the exhibition can see how this procedure takes place. The transplant was successful, Claudia has fully recovered.

However, Paolo Macchiarini did not stop at this achievement: for his next patient, he simplified the technique by eliminating the cultivation stage. Already in 2009, it was possible to grow a section of the trachea not in a bioreactor, but in the human body, using – as in the first operation – a segment of the trachea borrowed from a corpse, mesenchymal stem cells obtained from the bone marrow of the patient herself, and substances that stimulate the reproduction and differentiation of stem cells. The operation took an hour and a half. Two months later, a full-fledged tracheal segment was formed on the transplanted frame. Macchiarini claims that the operation can be repeated in almost any surgical clinic. What is especially encouraging is that the new technology is much simpler and cheaper than the one used in the case of Claudia, which means it will help solve the problem on a socially significant scale.

In this image of Claudia Castillo's lungs, you can see the stenosis of the left bronchus.
Total bronchotomy, which was offered to the patient by doctors, was associated with a high risk of death.
Therefore, the Macchiarini group decided to replace part of the trachea with an artificial transplant.
Photo: University of Bristol

By the end of 2010, eight similar transplants were performed, one of which took place in Russia – it was done to a 26-year-old student from Kazakhstan who was injured in an accident in 2006. Nine months of coma on an artificial respiration machine led to serious degradation of the trachea. Specialists of the Russian Scientific Center of Surgery named after Academician B. V. Petrovsky, where the girl got, decided to carry out transplantation using the Macchiarini method. The professor himself brought the processed frame to Russia. Before the operation, 320 milliliters of specially selected mononuclear cells of the patient's bone marrow and fragments of the mucous membrane were injected into the frame, around which their own mucosa should then form.

To make this operation possible, Macchiarini came to our country more than once, where he told Russian transplantologists about his technique. Some of them had internships with him last year. The professor spends a lot of time working with colleagues: "If you want to prove that your method is effective, you have to work wherever it is implemented, show with your own hands how it is done." Macchiarini is sure that this approach is necessary for the further development of medicine, the only way to avoid situations when a doctor has no idea about the latest achievements of fundamental science or believes that their implementation will happen sometime in "another life".

The topic of regenerative medicine was supported at the festival by Anthony Atala, a practicing surgeon and researcher, director of the Wake Forest University Institute of Regenerative Medicine, who delivered a lecture "Regenerative Medicine: New approaches to treatment". Scientific American magazine named him "Medical Treatments Leader of the Year" for achievements in the field of cell, tissue and organ regeneration. In 2008, Esquire included Atala in the list of the 75 most influential people of the century.

Anthony Atala spoke about the latest achievements in this field in an accessible form for a wide audience. About 20 years ago, his team started with the simplest – growing flat tissues consisting of the same type of cells, for example, cartilage and skin. The first cartilage transplant operation was performed 16 years ago. Later, more complex tubular organs, such as blood vessels, began to succeed. They consist of two types of cells, one of which lines the inner surface, and the other the outer; therefore, it is more difficult to grow tubular organs than flat tissues. The next stage of the work was the creation of artificial hollow organs – we started with the bladder. Such organs are in constant contact with the brain and must be integrated into a common system, so it is especially difficult to create them. If you do not go into medical details, it happens like this: doctors take fragments of the patient's tissues, multiply them outside the body and transfer the resulting cells to a frame of biocompatible material. One type of cells covers the frame from the outside, the other – its inner side. 6-8 weeks in the bioreactor, and the new organ is ready for transplantation. Now the professor's team grows and transplants the bladder as successfully as vessels and cartilage. The first such operation was performed 12 years ago, at the moment the technique is undergoing clinical trials in the USA.

 
With the help of artificially grown organs and tissues, it is possible not only to save people's lives,
but also to study how various viruses and bacteria affect these tissues.
So, a group of researchers from the Stevens Institute of Technology (Stevens Institute of Technology)
I studied how epidermal staphylococcus affects osteoblast
(Staphylococcus epidermis), the culprit of bone inflammation.
Photo: Stevens Institute of Technology

Anthony Atala said that it is most difficult to work with solid organs like the heart or kidneys. There are several times more cells per unit of their volume than in hollow, tubular or flat organs. According to the professor, it is now possible to grow these organs only on the basis of donor organs obtained as a result of human death. All cells are "washed out" of such an organ, only the "skeleton" remains, on which the artificially grown cells of the patient are built up.

One of the latest developments of the professor's team is printing technology, something like 3D printing of solid organs. The organ is created using a device similar to an inkjet printer. Instead of ink, human cells of different types are used. These cells are in a special gel that protects them from damage. "Print" an organ on a "printer"? It seems almost a fiction, a bold fantasy, but Atala hopes to achieve success in this area in a few years. "Well, what a primitive!" – we are now talking about the "iron lungs" that were used 60-70 years ago for artificial ventilation of these organs. Perhaps our descendants will say the same about the developments that we are currently conducting and consider promising, Atala jokes.

There are high hopes for autotransplantation. There are several reasons for this, the main one being the catastrophic shortage of donor organs. This was stated, for example, by the largest French specialist in the field of medical ethics, honorary professor of the Descartes University of Paris (L'Université Paris Descartes) Didier Sicard, who gave a lecture in Moscow in February this year. Anthony Atala also began his lecture with this: "Every 30 seconds, a person dies in the world whose life would be saved by an organ transplant." But there are not enough donor organs for everyone. The second reason is no less significant: since the organs are grown with the help of the patient's cells, it is possible to avoid the risk of rejection and the need to take immunity-suppressing medications for life, as happens when a donor organ is transplanted.

At the exhibition "Life. Science version" science art,
in which art and the latest scientific developments are woven together,
it has proved to be a very effective way to popularize science.
Photo: Dynasty Foundation

Regenerative medicine is just one problem that was raised by the organizers of the festival. An inquisitive and inquisitive visitor got an excellent opportunity in an exciting way – by coming into contact with art objects, participating in real scientific experiments, feeling, listening and peering – to significantly replenish their knowledge.

Portal "Eternal youth" http://vechnayamolodost.ru13.04.2011