The University of Southampton

Category: Practice blogs

DermaGro: It has to Derma-Go!

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Look younger, look natural, look flawless. In modern society, the pressure to reach an ever-more-unattainable level of youth and beauty as one ages is constant. There is a nonstop barrage of anti-ageing creams and pills advertised on TV and treatments and therapies available by estheticians and plastic surgeons. It all sends a clear message: ageing is offensive and ugly, and something to be prevented by all means possible, not embraced. 

Another treatment joining the legion of other anti-ageing therapies is DermaGro—a ‘miracle’ stem cell technology that has been claimed to treat wounds and burns, relieve eczema, and reverse the visible signs of ageing. Unless you’ve been living under a rock, you’ve likely encountered the buzz around DermaGro. Its aggressive social media marketing and the heated debates about its efficacy and ethics have been hard to miss. Here’s a quick rundown on how DermaGro is purported to work: 

Images from DermaGro’s website.

You sign up for their services online (and pay a hefty fee for the privilege), and soon after go to one of their clinics to have stem cell samples taken for culture. Once these are screened, selected, converted to selectively mutated and cultured, they are sent to you along with your starter kit (for yet another fee), followed by repeating deliveries of stem cells as and when you need them on a subscription basis (which if you haven’t guessed yet, comes with more fees and hidden charges!). You then keep your stem cells in the freezer until you need to apply them, which is done by loading them into the ‘gun’ and applying them to the wound. Easy enough right? They’re your own stem cells in your own home; how can there be any issues?

But there are issues aplenty… even if we ignore the ridiculous fees (you’re coming up to £3000 for just a month of treatment), there are still logistical issues. It is well known throughout stem cell research and bioscience in general that stem cells must be cryogenically preserved at -80 to below -150 degrees Celsius for them to be properly preserved and remain viable. However, DermaGro claims it is perfectly fine to store samples in a regular household freezer which only reaches temperatures of about -18 degrees Celcius, far too high for proper storage of stem cells.

Additionally, DermaGro claims to offer a ‘donor service’ where another person’s allogenic stem cells are used as a replacement for the customer whose stem cells cannot be used. However, no one fully knows where these stem cells come from. Not even DermaGro’s CEO will answer the question when asked (I directly contacted DermaGro, the CEO’s personal email and asked via their Instagram stories to no avail). Although DermaGro implies otherwise, some people have theorised that they are excess cells taken non-consensually from other patient’s samples. This raises massive ethical issues as patients do not consent to their cells being used for other people’s treatments when they sign up, and they receive no compensation for assisting other people’s treatments. Another more theatrical theory is that, much like the Hwang affair, researchers within DermaGro labs and clinicians within their donation centres are being pressured to donate their tissue to increase the supply of allogeneic stem cells, although the proof for this is still yet to come to the surface.

Although rather lengthy, this video and its sequel give a good explanation of the Hwang scandal and, thus, the implications of the DermaGro allegations.

Finally, and most damningly, there have been reports that some early DermaGro trial patients were given a cocktail of drugs to support their treatments, and upon the initial signs of the stem cells being rejected, immunosuppressants were added to the mix. This is absolutely absurd. It displays a deeply horrifying and frightening lack of medical duty and basic ethics by DermaGro. In what world is looking younger or healing a wound faster worth risking cancer? Ultimately, DermaGro is a scam—an expensive, immoral and dangerous scam at that and one which targets the superficial insecurities of ageing women. I certainly won’t let these predatory frauds ‘get under [my] skin’, but I hope this article will get under theirs. We’re now left with only one question: How long until someone dies from DermaGro?

Please note that this blog post is not for marking, and rather is a part of the group project assignment.

Is brain implant possible

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Neuralink

Human testing experiments have been a controversial topic in the science field. A recent news article came across me. Neuralink, a ‘medical research’ company founded by Elon Musk in July 2016, reported that the first chip brain, ‘Telepathy’, was being implanted into the human brain.

https://www.nytimes.com/2024/01/29/business/elon-musk-neuralink.html: Is brain implant possible

‘Telepathy’ was designed for the disabled who have lost the use of their limbs. The human clinical trial was first opened for patients with restricted or zero available use of upper arms caused by cervical spinal cord injury or by amyotrophic lateral sclerosis, a fatal motor neuron disease about degeneration of nerve cells in the spinal cord and brain. By placing a tiny, wireless brain chip on the surface of the brain attached to the cortex, movements could be revived by the intention to move.

Neurological mechanism of neurons

The brain consists of nerve cells called neurons, which transmit signals and messages over the body afferently and efferently.

Afferent neurons refer to receiving stimulations and sending signals from the environment through the spinal cord to the brain. Efferent neurons do the reversing way, sending motor signals from the brain to the peripheral nervous system in order to initiate movements.

The electrodes in the Neuralink chip are responsible for reading these afferent signals, translating them into efferent signals and turning them into motor movements.

Human experimentation

The largest controversy of human experimentation is said to be unethical. Pseudoscientific frameworks like race science are argued to be not ethical. This also raises problems with informed consent, in which research subjects freely volunteer to participate after being made aware of the potential dangers and benefits. However, past incidents where participants were misinformed about the real purpose of the experiment, such as the Tuskegee Syphilis Study in the United States, have brought attention to the significance of informed consent. It also includes torturing people which causes them to be mentally or physically injured. During the experiment, the research subject may be exposed to risks from physical injuries to psychological distress. To balance the benefits of the study and the potential risk to the subjects is the biggest concern a scientist should be aware of.

In May 2023, the US Food and Drug Administration gave the approval for Neuralink’s human clinical trials. However, the specific approach of how Neuralink balances between experimenting and the risk of reseach subjects might face is still unknown.

Conclusion

Similar to other implants in the human body, Neuralink brain implants may result in unfavourable consequences like inflammation and scarring. Additional problems might be bleeding or hardware-related concerns with the implant. Of course, it is still a very new technology and still requires a lot of research and experiment, but it’s a hope for patients with spinal cord injury to move again. Overall, with suitable and appropriate observation under medical and neurological professionals, the brain implant could be a direction for patients to live more conveniently than before.

Bridging Realities: Prosthetics in Fiction, Is Any Of It Real?

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In the realm of fiction, prosthetics often take center stage, portraying characters who transcend physical limitations with cutting-edge technology. From Luke Skywalker’s robotic hand to Iron Man’s sleek armor, prosthetics in popular culture captivate audiences with their seemingly limitless capabilities. But how accurate are these portrayals when compared to the advancements in real-world prosthetics?

While the prosthetics depicted in fiction may appear futuristic and awe-inspiring, the truth is that they often stretch the boundaries of scientific feasibility. However, that’s not to say that there aren’t elements of truth behind these imaginative creations. Many fictional prosthetics are inspired by real-world advancements in prosthetic technology.

One area where fiction tends to diverge from reality is in the speed and ease with which characters adapt to their prosthetics. In many stories, characters seamlessly transition from being disabled to mastering their new limbs or devices in a matter of moments. In reality, the process of adjusting to a prosthetic limb can be long and challenging, requiring extensive physical therapy and training to regain functionality. The Portsmouth Regional Prosthetic Service outline a 5 Stage Rehabilitation Process and they state it usually takes 3-6 months to adjust using the prosthetic limb, such as a leg, through intensive physiotherapy.

Moreover, while fictional prosthetics often boast superhuman abilities, such as enhanced strength or agility, real-world prosthetics are still limited by the constraints of current technology. While significant advancements have been made in creating prosthetic limbs that mimic natural movement, they are still a far cry from the fantastical capabilities seen in movies and television shows.

However, that’s not to say that real-world prosthetics aren’t impressive in their own right. In recent years, advancements in materials science, robotics, and neuroscience have led to significant improvements in prosthetic technology. For example, prosthetic limbs equipped with myoelectric sensors can detect electrical signals from remaining muscles, allowing users to control their prosthetics with astonishing precision. Studies have shown promising clinical outcomes for patients after transhumeral amputation, who received a neuromusculoskeletal prosthesis that allowed intuitive and unsupervised daily use over several years.

Additionally, ongoing research in the field of brain-computer interfaces (BCIs) holds promise for the future of prosthetics. BCIs allow users to control prosthetic limbs directly with their thoughts, bypassing the need for muscle signals altogether. While this technology is still in its infancy, early experiments have shown promising results and could eventually lead to prosthetics that are even more intuitive and responsive.

In conclusion, while the prosthetics depicted in fiction may push the boundaries of scientific reality, they are often inspired by the advancements and possibilities within the field of prosthetic technology. While we may not yet have prosthetics with the capabilities of those seen in movies and TV shows, real-world prosthetics continue to evolve and improve, offering hope and opportunities for individuals with limb differences to lead fulfilling and active lives. As technology continues to advance, the line between fiction and reality may blur even further, bringing us closer to the futuristic visions of prosthetics seen on screen.

Sources:

https://www.porthosp.nhs.uk/departments-and-services/Portsmouth%20Enablement%20Centre/The%20five%20stage%20rehabilitation%20process%20leaflet.PDF

Ortiz-Catalan, M., Mastinu, E., Sassu, P., Aszmann, O., & Brånemark, R. (2020). Self-Contained Neuromusculoskeletal Arm Prostheses. New England Journal of Medicine, 382(18), 1732–1738. https://doi.org/10.1056/NEJMoa1917537

A life for a life

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Over recent years, I have become more aware of the crisis that the NHS has found itself in, regarding organ transplants. The lack of viable donors who agreed prior to death was limited and did not cover anywhere near the number of people waiting for transplants. I know that they tried to get around this by introducing the opt out system for organ donation in 2020 which was a massive step forward, however it still has its limitations. The main thing I think affects organ donations is the disparity of the genetics between the donor and the patient, leading to the need for immunosuppressant drugs to be taken for life.

Organs commonly used in transplants.

One thing that I have seen that could aid this is the use of chimeras with human derived stem cells being used to grow human organs. This would tackle so many of the current problems, as they could be genetically identical to the patient, and not require another person to die at just the right time in a specific way to allow transplant to be safe and effective.

The ethical side of this is a bit less clear cut. Currently, there are thoughts that animal chimeras would be used, for example pigs that grow human hearts or kidneys. These would be genetically engineered to lack certain organs which would be replaced with human grown ones. I can’t help but feel that the use of animals that have higher brain functioning is unethical, as they may experience unknown side-effects and experience pain and suffering that we could not prepare them for. I have always loved animals and the thought that we just decided that we were better than them and they don’t deserve the same rights has always been something that I’ve felt uncomfortable with. They are unable to consent to the research that we would be carrying out on them which makes me thing we are abusing the power we have over them.

This is the same with smaller animals such as rodents, which are deemed ok to test on. I completely understand however that this ethical dilemma is opposed by the number of people that would greatly benefit from the organs that would save their quality and quantity of life. Almost 7000 people in the UK are awaiting transplants, and 439 people died last year whilst waiting. Is it wrong to deny them the chance of life if we could save them?

A comparison of the brain makeup of rat, pig and human brains, showing the similarities between human and pig brains.

When people push for chimeric organs, they often compare it to way we slaughter pigs every day for food, and that there is little difference between this and genetically modifying them. I do not feel this to be accurate, as we are not letting them live their lives as they would do in nature, and we could not be sure that no harmful effects would be experienced by the animals. They would likely have to spend all of their life being monitored and tested to ensure the organs were growing properly, and that they were healthy.

Overall, I think that the use of chimeric animals in organ farming is not clear cut. Laws and ethical regulations would have to be heavily regulated to ensure that the animals were not adversely affected and the organs were of a high enough standard to make the animal lives lost worth it. If implemented, it would likely save countless lives awaiting transplant and reduce the illegal trafficking of organs, leading to better outcomes for all.

Comparing Behind-the-ear and Off-the-ear Cochlear Implants of UK Brands

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Cochlear implants have been an approved method of treatment for the profoundly, and more recently severely, deaf since the late 20th century. Their continued technological improvements since have provided those patients with the ability to hear through a processor (Hainarosie, 2014). The audio is not a perfect replication of natural hearing, but allows for interpretation of speech and sound in a way the brain can understand. Modern technology around cochlear implants provides patients with the option to have the external processor of their implant either behind their ear or off of their ear. Both designs allow for bluetooth connection between phone and processor, and each option has its own positives and negatives for users to consider.

Behind-the-ear (BTE) Cochlear Implants

BTE cochlear implants are the originals – this design for the external processor has been used since implantation in the cochlear began. The processor (containing the microphone) sits on the ear of the user and a short cable connects this to the magnet that transfers the audio information to the electrodes implanted in the cochlear. The location of the microphone on these processors differs between companies. For example, Advanced Bionics’ Naida Cl M sound processor has the microphone dipping down into the outer ear region whereas Cochlear’s Nucleus 8 sound processor has dual microphones. Each company has taken a slightly different approach to the goal of reducing background noise and making the sound as close to natural hearing as possible.

BTE – Naida Cl M sound processor – Advanced Bionics

OTE – Kanso 2 sound processor – Cochlear

Off-the-ear (OTE) Cochlear Implants

OTE cochlear implants are a more recent development in cochlear implant technology with Cochlear’s Kanso 1 sound processor being released in 2016. These processors contain only one piece that sits on the side of the head connecting directly to the magnet inside the head. There is no part that rests on the ear. Because of this, some users find it more comfortable because their ear can have a break from holding the processor. However, it is often found that the magnet needs to be stronger to ensure that the processor does not fall off because it is a less secure connection. This is a problem for some people as they feel more comfortable with a processor on their ear when they are playing sport or in other situations where the processor could get dislodged. The single piece design of the OTE processor means that the microphone is placed on the side of the head. This can have some impact on the audio that the user receives as it is not being collected from the natural location – the outer ear.

Conclusion

Some cochlear implant users opt to obtain both a BTE and OTE sound processor after surgery so that they can use each to their strengths. Throughout reading for this blog I found that my preferred design is the Naida Cl M sound processor by Advanced Bionics because of its microphone location and BTE design. A BTE design allows for better microphone placement and a more secure feeling whilst an OTE design allows for a more discrete processor with fewer pieces attached to the head – perhaps making glasses or hat wearing slightly easier. To improve comfort around OTE sound processors, there are clips and headbands available. I think that it is important for each user to be able to weigh up the pros and cons of each processor type to make an informed decision about which would work best with their lifestyle. Perhaps the difference in age between two patients would be enough to result in different choices. Access to both processor types appears to be a great solution for those who find that OTE and BTE processors are each useful in different parts of their life.

Further reading suggestions:

A Reddit thread discussing personal experiences with OTE and BTE processors:

https://www.reddit.com/r/Cochlearimplants/comments/wtdkvd/ote_kanso_2_vs_traditional_bte_processors/?rdt=42393

A list of current cochlear implant processors available in the UK:

https://www.bcig.org.uk/ci_manufacturers.aspx

Cochlear’s comparison of their current sound processors:

https://www.cochlear.com/us/en/home/products-and-accessories/cochlear-nucleus-system/nucleus-sound-processors/compare-nucleus-sound-processors

References:

Hainarosie, M., Zainea , V. and Hainarosie , R. (2014) ‘The evolution of cochlear implant technology and its clinical relevance’. Journal of Medicine and Life. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391344/ (Accessed: 8 March 2024).

Waiting for a knee replacement

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Photo of Doctor holding a post-op knee

My dad, along with almost 400,000 others, has been waiting for a knee replacement on the NHS for over a year [1]. This wait has caused numerous complications for him, as originally he was only going to need a partial knee replacement. Now a full knee replacement is required, which will drastically increase recovery time, pain levels, complications and the cost of the procedure on the NHS [2].

Partial knee replacements have been shown to improve quality of life and could of saved almost £2000 on the NHS over my dad’s lifetime if they acted sooner [2]. If we were to go private, a full knee replacement would cost around £14,000 [1]. This amount of money is unfeasible for a lot of UK citizens, especially since the cost-of-living crisis. But for those who cant pay up, they have to suffer with degradation of health and lifestyle.

Image showing partial knee (left) and total knee (right) replacement https://www.drsantoshshetty.com/partial-vs-total-knee-replacement/ (accessed 11/03/2024)

Knee replacement surgery is rapidly developing, but is only accessible to those paying privately. By choosing NHS, you will lose access to using CT Scans to create 3D images of the patients knee, having assisting robotics in surgery and less invasive procedures. All of these have the potential to decrease recovery time and increase surgery success [1]. I believe the NHS should offer a partial payment service for those undergoing knee replacement, as some individuals who cannot afford £14,000 for private may still like to pay extra for more modern materials or procedures in order to increase their quality of life. This offers more balanced healthcare across those with different incomes and allows all individuals to have a say on how they want their body to be treated.

Day-to-day life becomes much more difficult; walking is a challenge, so chores around the house become an impossible task. Some individuals may even need to take time off work or find a new job entirely. Exercising can also become difficult, which may lead to weight gain. However increased weight leads to more pressure on the knee, creating higher levels of pain and will make recovery even harder after surgery.

Knee issues can be incredibly isolating and have a massive impact on mental health. It’s important to note how much waiting lists impact mental health. My dad has stated that the stress and pain that he’s gotten from his knee has worsened his heart condition – yet another issue that has arisen from having to wait. He’s also unable to play with his grandsons, as even getting onto the floor is an impossible task.

Treating patients for knee pain also becomes difficult with long waiting lists. Knee pain is excruciating, but there are no pain killers that are designed to be taken for moderate-severe pain daily for over a year.  This limits any help to only walking stick and physio exercises in the hopes of reducing pain.

Current NICE Guidelines state that adults should be allowed a choice between partial and full if both options are suitable [3]. But with increasing waiting lists, the “choice” is made redundant. With no end in sight, my dad’s knee will continue to degrade, leaving him with increasing pain with each passing day.

Recommended watch – Dame Judi Dench’s story on her total knee replacement

References:

1.           Knee Replacement Surgery in 2023: Should you Stick with the NHS or go Private? 2024  11/03/2024]; Available from: https://www.thebestofhealth.co.uk/health-conditions/consultants-specialists/how-much-does-knee-replacement-surgery-cost-in-the-uk/.

2.           Burn, E., et al., Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales. BMJ Open, 2018. 8(4): p. e020977.

3.           Joint replacement (primary): hip, knee and shoulder. 2022, NICE Quality Standard 206.

Stem Cells, Ethical or just Practical?

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I recently reviewed an interesting article highlighting the ethical implications associated with Stem cell research. It highlighted a common pitfall – highlighting the promise of Stem Cells to outweigh the ethical factors associated with them.

Generally when I think about medical advancements and promise, I tend to go straight to stem cells of all natures, ranging from unipotent, mulitipotent and pluripotent stem cells. They all have adept functions and are involved in numerous clinical trials throughout many different cohorts of medical professionals. They are involved in treating a range of disorders ranging from neurodegenerative disease to traumatic injuries which have lead to the deterioration of muscle tissue… Do you see how easy it is for me to talk about the science behind Stem Cells rather than the ethical implications? This is a commonality I have seen throughout my wider research when trying to learn more about Stem Cell ethics.

I know what you’re thinking, excluding the ethicality, this all sounds very promising… and truly it is, however, do you think Stem Cells are being used appropriately? Whatever the answer to that question is, let me lend you some information to reflect on.

The Peer reviewed clinical trials being done on diseases such as Parkinson’s and Alzheimer’s disease are incredibly promising and have shown amazing results… integrated amongst highly scientific jargon. What is not amongst this jargon is what the other uses of Stem Cell include and how much the treatment costs.

Stem Cell research is novel and people suffering from these disorders can undergo clinical trials for the price of normal healthcare, however, this requires a complex selection process so that scientists can pick specific patients in which they believe their treatment might be most effaceable rather than for those who need it most. Additionally, Stem Cell treatment outside of clinical trials is offered to the highest bidder. Personally, I believe Stem Cells are going to be amazing in the future, however, in the current climate, I cannot condone them for a number of reasons! But to name a few:

These treatments require much more testing and evidence to support their beneficial effects as oppose to their negative effects and those who buy into relatively untested Stem Cell treatment programmes might do themselves more harm than good whilst funding the growth of untested treatments. Those who need it most do not have it readily available to them, rather, it goes to the highest bidder. Therefore, a last ditch attempt to save a patients life may be overlooked by scientists wanting more positive outcomes or as they have been shown a bigger pay cheque by a patient and/or their family!

It also supports the genetic editing and creation of babies of a high compatibility to children with a disorder requiring Stem Cell transplants. These are known as saviour siblings who may be born into a life or surgery and hospital treatment. How is that fair? They don’t deserve to be thrown into a life of suffering and torture! This list is endless, however, finally I will touch on the doors that are opened through this Stem Cell research. Genetic engineering is closely linked to Stem Cell research and further advancements in one field will promote advancements in the other. How far out are we from couples with the most money being able to develop the “perfect child”?

Is a medical treatment which goes to the highest bidder and can jeopardise the lives of the youth of tomorrow ethical? Or is it just lucrative?

A regenerative approach to reverse menopause?

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As an aspiring Clinical Embryologist, I was particularly interested in our lecture on tissue engineering and promoting tissue regeneration. In the reproductive system, ovaries are generally the first to suffer decline in function over time. With a growing number of modern women seeking to beat age-related declines in fertility levels, there is much potential in using regenerative medicine strategies to restore ovarian function and overcome infertility. In 2016, success in a new experimental technique to increase fertility potential was published, using platelet-rich plasma (PRP), termed ovarian rejuvenation.

How does ovarian rejuvenation work?

PRP treatment has been used to treat osteoarthritis and joint degeneration. It involves separation of a patient’s blood sample via a centrifugation process to remove red and white blood cells to obtain a concentrated sample of plasma with a 5 to 10 fold higher concentration of platelets. Platelets are well known for their blood clotting abilities; however, they also facilitate tissue regeneration. Platelets contain granules which deliver various growth factors upon activation, including vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF) and fibroblast growth factor (FGF). These promote vessel wall permeability and proliferation of endothelial cells and fibroblasts. Since 2016, interest has grown for applications of PRP in reproductive biology, where direct injection of PRP into the ovary has been reported to induce hormone stabilisation and resumption of menstrual cycles in infertile menopausal women.

Figure 1. Process of ovarian rejuvenation (https://www.ivf-spain.com/en/regenerative-fertility-medicine/)

UK regulations

Whilst ovarian PRP treatment is actively in practice in countries such as Greece, USA and Turkey, it is not currently approved for in the UK by the Human Fertilisation and Embryology Authority (HFEA). Additional therapies and techniques such as ovarian rejuvenation are classified by the HFEA as fertility treatment ‘add-ons’. Although add-ons aim to improve fertility treatment outcomes, the evidence to support their efficacy and outcomes is usually missing, limited or lack reliability. With the UK fertility sector being a competitive market and where 60% of treatments are privately funded by patients, the HFEA is concerned that add-ons are offered for commercial interests rather than as best practice for patients. In December 2023, the Progress Educational Trust held a conference on ‘Updating Fertility, Embryo and Surrogacy Law’ where the HFEA proposed implicating fines as sanctions to fertility clinics for mis-selling of add-ons. Case studies of ovarian rejuvenation appear to present encouraging outcomes, however, there are often limitations in their experimental design such as by absence of sham injection groups or randomisation. The duration of effect after ovarian PRP is unknown, and potential short- and long-term risks are not yet understood. A large-scale, controlled randomised clinical trial is required to confirm efficacy of the therapy before ovarian rejuvenation may be introduced into UK clinics.

Ethical considerations

Ovarian rejuvenation has potential to improve chances of older and menopausal women conceiving their own biological child. However, some debate whether it is ethically acceptable to become a mother at an advanced age, given the likelihood of medical and health-related risks for both the mother and offspring.

I believe that such views are culturally skewed by ageism and ableism, leading to portrayal of older mothers as deliberately risk-taking when infertility and age of motherhood arises from life circumstances outside of a woman’s control. I hope that sufficient research may soon be conducted to prove efficacy of ovarian rejuvenation and its related regenerative therapies in fertility.

References

Pantos K. et al. Ovarian rejuvenation and folliculogenesis reactivation in peri-menopausal women after autologous platelet-rich plasma treatment: https://sa1s3.patientpop.com/assets/docs/111052.pdf

HFEA, The responsible use of treatment add-ons in fertility services: a consensus statement: https://www.hfea.gov.uk/media/kublgcp3/2023-10-19-treatment-add-ons-consensus-statement.pdf

Louisa Gheveart Associates, Fertility Law Reform In The UK: How Much Change Do We Want?: https://louisaghevaertassociates.co.uk/fertility-law-reform-in-the-uk-how-much-change-change-do-we-want/

Ocular Prosthetics – What Can We See In The Future?

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Our eyes are one of the most complex sensory organs in our bodies and are taken advantage of everyday. The geometry and intricacy of our eyes is so specific, sometimes you wonder how biology came up with it! In cases of impairment or complete absence of an eye/eyes, we need to find ways to bring back function effectively as well as making them as realistic as possible, to allow for better quality of life. Prosthetic eyes have been around for millennia, but mainly for the purpose of restoring aesthetics. It’s time to further develop the functional aspect.

Currently…

Traditional ocular prosthetics were typically made of acrylic but now use silicone, or a combination to mimic appearance and natural eye movement. By attaching the prosthetic to residual eye muscles, its allows for limited functionality. Aesthetics have come a lot further in terms of mimicking the natural eye by customising things like colour of the iris, iris patterns and blood vessels. This type of customisation may make patients feel more confident in their prosthetic and further enhance their quality of life. As far making and implanting these prosthetics, the procedure has become easier and more sustainable by using 3D printing and quicker, less invasive surgeries. Research has been conducted to incorporate electronics to give the user rudimentary vision, using things like built-in cameras with sensors, which detect and light and dark. But how can we develop this further?

In The Future…

Loss of vision can come in various forms, e.g it maybe congenital, damage caused by injury or even cancer. Therefore, we must consider the best options which take into account risk of surgery, what patients expect from their implant and if it is the most suitable option. With all these things in mind, advancements in ophthalmology and neural circuits can eventually lead to enhanced functional capabilities of ocular implants. What areas of research does this include?

Curing Blindness using a Bionic Eye, Future Now
  • Neural Interface : Involve incorporating cameras, sensors, and neural interfaces to transmit visual information directly to the visual cortex of the brain, by bypassing components that would otherwise be needed to transmit visual information, for example damage to the optic nerve. This is the type of technology we see in the development of a bionic eye.
  • Biocompatibility: Improvements in materials science could lead to the development of ocular prosthetics that are even more biocompatible and long-lasting, reducing the risk of complications such as infections, tissue rejection and the risk from additional surgery.
  • Regenerative Medicine: Bioengineer artificial fully functioning eyes that are indistinguishable from natural eyes. Using stem cells and other biological materials to create new tissue or make completely artificial eyes, engineered using nanowire to replicate photoreceptors and silicone to replicate the vitreous humor in our eyes. This type of artificial eye has been developed and may surpass the ability of an actual human eye.
  • Artificial Intelligence: Integration of artificial intelligence could enhance the functionality of ocular prosthetics by providing features such as automated image processing, object recognition, and augmented reality overlays, further improving the wearer’s visual experience.

Summary

As scientists, there is much we must take into consideration. Managing patient expectations, improving quality of life but simultaneously making it accessible to everyone. Advancements like these can be heavily capitalized to make a profit, which then creates inequality and reduces accessibility to those who need it most so innovation must come with caution. The future of ocular prosthetics holds promise for significant advancements in both aesthetics and functionality however, it’s important to note that many of these developments are still premature and may take time to implement.

Pre-natal “organoids” – the future of treating congenital disorders?

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Congenital disorders (more commonly known as congenital birth defects) contribute to a large portion of paediatric disabilities, and can persist into adult life, if the patient survives that long. The World Health Organisation (WHO) estimates that 240,000 newborns per year die around the world within 28 days of birth due to congenital birth defects. If the affected child survives beyond this stage, a further 170,000 children aged between 1 month and 5 years will die as a result of congenital abnormalities. So, why are these numbers so high? And what can be done to reduce them?

Video from the Centers for Disease Control and Prevention (CDC) explaining congenital birth defects.

As congenital disorders are usually identified after birth, when the abnormality has truly developed and “set in”, treatment aims to improve quality of life rather than cure the patient. Until now!

A “mini kidney” produced from stem cells in the amniotic fluid. Immunofluorescent staining reveals the presence of kidney-specific markers (e.g. GATA3 (distal tubule marker), LTL (proximal tubule marker) and ECAD (apical cilia marker)).

Scientific researchers from University College London (UCL) and Great Ormond Street Hospital (GOSH) have successfully extracted embryo-derived stem cells that are circulating in the amniotic fluid of late-stage pregnancies (i.e. up to 34 weeks), and developed miniature organs (so-called “organoids”) from these cells. Previously, foetal sampling in the UK has only been permitted up to 22 weeks after conception (which is the legal deadline for termination), hindering the ability to study late-stage foetal development. As the stem cells collected by the researchers are sourced from the amniotic fluid, rather than the foetus itself, it allows a ‘bypass’ of the legislation.

The research paper, published this week (March 4th 2024) in Nature Medicine, explains in detail the process of collecting stem cells from the amniotic fluid non-invasively, and culturing epithelial organoids that exhibit features reflecting their tissue of origin (i.e. small intestine, kidney and lung).

Video by Rajamanickam Antonimuthu explaining the process and potential of stem cell-derived ‘organoids’ in prenatal medicine.

This development is extremely exciting for prenatal medicine! The work provides a new opportunity to study late-stage foetal development (something which has not been possible before now), furthering knowledge and understanding. The organoids can also be used to model congenital disorders, extending knowledge on these, particularly in the later stages of development. Researchers now have the potential to develop new methods of diagnosis, prognosis and personalised therapy for congenital disorders, all because of a tiny little organ!

I find this research inspiring and highly interesting, as well as hugely promising for prenatal medicine. Anything that can help reduce the morbidity and mortality of congenital disorders is a huge step in the right direction. The researchers have since expressed their vision to extend the method into the production of organoids from mesenchymal and haematopoietic tissues, allowing the treatment of a wider variety of diseases. I am excited to see how this develops, and, who knows, maybe these tiny organs will be the key to curing congenital birth defects!