The University of Southampton

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Stem cells: Hope for spinal chord injuries?

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Spinal chord injuries (SCIs) due to trauma or disease can have a profound impact on a persons life. Damage to the delicate nerves within the spinal chord can disrupt signals from the brain to the muscles which can result in loss of sensation or paralysis. As an avid rock climber, injuries such as SCIs can be a devastating reality. My bodies ability to function is integral to the sport I love. I don’t know what I would do without it.

Treatment options for SCIS are often limited and uncertain. Many have to come to terms with their injury and learn to adapt to it. But what if they didn’t have to? Stem cells have the remarkable ability to turn into any type of cell, including nerve cells! The idea is simple – why don’t we use artificially grown nerve cells to replace damaged cells?

Early studies have show that stem cells can promote nerve regeneration and restore limited function in SCIs. Watch this video to hear Chris’s story!

How can stem cells be used?

Diagram of a nerve cell with stem cells added with labels highlighting their abilities.

Abilities to repair damaged nerves with stem cells is currently limited but promising! The nervous system especially after trauma, is complex and unfortunately struggles to heal itself.

Here’s what stem cells can help with:

  • Regenerate new nerve cells
  • Release growth factors and proteins to protect damaged nerves.
  • Promote mature stem cells to grow and reconnect.
  • Break down scars at the site of damage enhancing growth.

This video explains it in more detail!

Stem cells can help promote nerve growth and repair, to reconnect the pathways and restore movement. This is slowly redefining what we think irreparable damage is.

Challenges that remain

Research is slow due to a high level of regulation around the gathering of embryonic stem cells. This undoubtedly hinders research that could have profound changes on someone’s life. Initially I saw these restrictions as an annoyance to scientific advancements, however discussions highlighted concerns of exploitation, destruction of potential life and wider public perception and trust. These views left me conflicted. Imagine if it was your ability to walk that hung on the line?

There are also concerns over whether the risk of stem cells out-way potential rewards which raises certain moral/ ethical questions.

Risk Moral/ethical dilemma
The extent of meaningful functional recovery is currently limited and uncertain. Is it worth going through an operation to potentially only regain slight tingling?
Stem cells have a high likelihood of forming tumour cells.Would you want to risk cancer?
Immune system might reject and attack the new stem cells.Surely attempting something that might be beneficial is better than not doing anything?

This entire time I’ve been assuming that people want to repair nerve damage. There has been pushback in the deaf community surrounding the use of cochlear implants as some believe there’s no need to ‘fix’ those hard of hearing. Its possible that people with SCIs, especially those born with the condition might not even want ‘normal’ function. Would you want to change yourself again/ for the first time after already becoming comfortable and able in your body? I’m not so sure that I would.

Nerve damage repair with stem cells holds promise but there sadly there are no proven treatments that exist yet. I cant wait to see the progress and advancements that become availible over the next few decades. Do you think SCI repair will be possible someday? I hope so.


Answers to your questions about stem cell research (no date) Mayo Clinic. Available at: https://www.mayoclinic.org/tests-procedures/bone-marrow-transplant/in-depth/stem-cells/art-20048117 (Accessed: 28 March 2025).

Assen, L.S. et al. (2021) ‘Recognizing the ethical implications of stem cell research: A call for broadening the scope’, Stem Cell Reports, 16(7), pp. 1656–1661. Available at: https://doi.org/10.1016/j.stemcr.2021.05.021.

Figure 2. Schematic representation of the repair of peripheral nerve… (no date) ResearchGate. Available at: https://www.researchgate.net/figure/Schematic-representation-of-the-repair-of-peripheral-nerve-damage-with-a-stem-cell-based_fig1_341051575 (Accessed: 25 March 2025).

Lavender, F. (2021) ‘The stigma around cochlear implants – Deaf Action’, 30 September. Available at: https://deafaction.org/ceo-blog/the-stigma-around-cochlear-implants/ (Accessed: 28 March 2025).

New hope for spinal cord injuries (2024). Available at: https://www.youtube.com/watch?v=D_GuSZT_6eI (Accessed: 28 March 2025).

Progress and Promise of Stem Cell Research: Fixing nerve damage in spinal cord injury (2017). Available at: https://www.youtube.com/watch?v=QdBW4ntaimc (Accessed: 28 March 2025).

Stem Cell Research Controversy: A Deep Dive (2024) (no date). Available at: https://www.dvcstem.com/post/stem-cell-research-controversy (Accessed: 28 March 2025).

Sullivan, R. et al. (2016) ‘Peripheral Nerve Injury: Stem Cell Therapy and Peripheral Nerve Transfer’, International Journal of Molecular Sciences, 17(12), p. 2101. Available at: https://doi.org/10.3390/ijms17122101.

Just Out of Reach: Restoring Sensation with Prosthetic Technology

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In the sensing and sensors lecture, we were shown an example of a prosthetic limb in 2021 with haptics responsive enough that a blindfolded 85-year-old could pick up a hollow eggshell without damaging it1.

This really made me think about the functions you’d need to replicate in a prosthetic arm beyond it being just an appendage for it to fulfill all the roles of the lost limb. I’d only come across haptics being used to extend a user’s ‘self’ in videogame hardware, but with some reflection and research (including on WW2 planes using haptics to forewarn pilots of stalls2) it made sense that the device increasingly becomes an extension of the user with improvements to effective information flow.

So what other sensations are there to improve this link? What other advancements have there been? The sense that immediately comes to mind is temperature, but following that, pain. Pain and discomfort naturally protect us from harm, driving you to avoid potential injury.

In 2018, researchers at Johns Hopkins’ University displayed an electronic synthetic skin called “e-dermis”. A structure of rubber and fabric with sensor “nerve endings” could interact with peripheral nerves of amputees, feeding back curvature and sharpness as “touch” and “pain” respectively. The e-dermis can be implemented on existing prosthetics, enabling users to tell whether they were holding a sharp or smooth object3.

Later in 2020, RMIT University (Royal Melbourne Institute of Technology) developed another electronic synthetic silicone skin. Vanadium oxide’s electronic behaviour changes in response to temperatures above 65˚C, creating a temperature trigger when integrated into the “skin” for pain decision making. Researchers suggested potential applications in non-invasive skin-grafts upon further development, with the “brain-mimicking circuit” having adjustable thresholds to modify sensitivity4.

The temperature sensitive synthetic skin from RMIT

For anyone reading on these advancements there’s a point that probably stands out though. Do the advantages of simulated pain outweigh the discomfort a prosthetic could inflict on the user when the sensor is on a repairable part?

“After many years, I felt my hand, as if a hollow shell got filled with life again,”-Anonymous principal volunteer tester3.

When implementing the “e-dermis”, stimuli produced by the synthetic skin matched sensations in users’ phantom limbs. Additionally, interaction with peripheral nerves is increasingly well documented to reduce phantom limb pain5,6,7. If reactive pain and sensory feedback can reduce persistent phantom limb pain in amputees, improving brain body mapping for prostheses, the very pain and discomfort we want to avoid could act to unify prosthetic and person.

I was also curious what advancements in sensory prosthetics could do for those paralysed by extension. A 2025 study by researchers at the University of Chicago8 worked with individuals with spinal cord injuries. Electrodes were implanted into the sensory and motor regions of the brain, allowing not only control of a robotic arm and hand, but sensation through it. Subjects could feel edges, shapes and movement through their connection to the robotic arm.

Amazingly, subjects had such good control of the limb they could even drive cars (in simulation).

Pictured use of the robotic hand, taken from the University of Chicago Medicine site.

The development of sensation in prosthetics is so much further than I realised, where else could these technologies go? Where else might they end up?  If pain, touch, and temperature feedback can be integrated into artificial limbs, could future developments allow individuals to experience a completely artificial yet fully sensory body?

References

Human-Animal Hybrid Brains: A Dr. Frankenstein Dilemma

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Introduction:

While studying for a debate regarding the use of embryonic stem cells (ESCs) in research, I stumbled across articles about organoids. I remembered them being mentioned in one of our earlier lectures, therefore these articles peaked my interest. So I dug deeper. What interested me was the slightly morbid idea of growing a human brain and what that means. This digging led to another branch of this scientific, dystopian tree: brain chimeras. In this blog, I will be discussing why brain organoids and chimeras are made, what they are used for and what ethical issues rise.

Are we as scientists, justifying the use of these chimeras the same way Dr. Frankenstein justified the creation of his monster, selfishly in pursuit of greater knowledge despite the pain and suffering this may create?

What are they and how are they made?

Organoids are 3D, self-organised tissue cultures made from stem cells. They are made by using iPSCs (induced pluripotent stem cells) which are made from adult somatic cells. This is done by reprogramming these somatic cells using transcription factors to make the cell pluripotent similar to ESCs.

To grow these organoids the iPSCs are cultured to form an embryoid body (EB) which mimics the features of an early stage embryo. This is exposed to different mediums to encourage differentiation into brain cells then grown in a growth medium.

Organoids can be made with human stem cells and animal stem cells. This results in brain Chimeras which are made by engrafting human foetal tissue/iPSCs into a neonatal animal (e.g. mouse) brain.

Why are they important?

We all know someone who is battling with a neurological condition. Many of these conditions are debilitating, ruin lives and have high mortality rates. This highlights the significance of this research.

One in two of us will suffer with dementia in our lifetime. Therefore, research into neurodegenerative disease is more important than ever before.

Although these organoids and human-animal brain chimeras are relatively new there has been a tremendous volume of studies which use this technology. They can offer important insight into the progression of neurodegenerative disease leading to new treatments. However, one could argue that these ‘brains’ are still fundamentally different and less complex than a real human brain as most animals are biologically very different and display different symptoms of neurological problems.

The issue

The main debate lies with the idea that human brain organoids or human-animal brain chimeras could be capable of intelligent thought. This raises many concerns as currently organoids hold no legal or moral rights within science. Are these chimeras thinking the same as a human may think? Are they self aware? More complex than say an ordinary mouse? And why should this matter?

There are significant regulations when using hESCs for research, such as the 14 day rule, however, organoids and human-animal chimeras are not regulated the same way, it does not even require a license as long as it does not use hESCs. Why is this?

These brain organoids and chimeras have the same moral status as many animals that are used in research. Should this be the case?

There is no right answer here as you cannot possibly know what a chimera or brain organoid could be thinking.

Conclusions and Reflections

Prior to researching this topic I did not appreciate the complexity and possible future of these models, I had a similar initial reaction to using any animal model; that it is a cruel and disturbing idea. However, animal models and hESCs have contributed greatly to the world of science, without them many treatments (HIV medication, cancer medications, vaccines) would not have been developed. This shows how important in vivo research is and these organoid/chimeric models may just add to the possibilities.

Contrary to this, I was surprised to find that making an organoid does not require any sort of formal license. I believe organoids should be treated with the same moral significance as hESCs as there is a grey area regarding their consciousness.

In conclusion, organoids and chimeric models raise many ethical and thought provoking questions, however, they offer invaluable research opportunities which could help many people, although they should be treated with more moral significance similar to that of hESCs.

References:

CAPPS B. Do Chimeras Have Minds?: The Ethics of Clinical Research on a Human–Animal Brain Model. Cambridge Quarterly of Healthcare Ethics. 2017;26(4):577-591. doi:10.1017/S0963180117000093

Grenier, K., Kao, J. & Diamandis, P. Three-dimensional modeling of human neurodegeneration: brain organoids coming of age. Mol Psychiatry 25, 254–274 (2020). https://doi.org/10.1038/s41380-019-0500-7

Kwisda, K., White, L. & Hßbner, D. Ethical arguments concerning human-animal chimera research: a systematic review. BMC Med Ethics 21, 24 (2020). https://doi.org/10.1186/s12910-020-00465-7

Eigenhuis KN, Somsen HB, van der Kroeg M, Smeenk H, Korporaal AL, Kushner SA, de Vrij FMS, van den Berg DLC. A simplified protocol for the generation of cortical brain organoids. Front Cell Neurosci. 2023 Apr 4;17:1114420. doi: 10.3389/fncel.2023.1114420. PMID: 37082206; PMCID: PMC10110973.

Can Humans Grow Limbs? The Genetic Science of Regeneration and the Search for Limb Regrowth

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Would it even be natural for a human to regrow a limb?

When we think of animals capable of regenerating lost body parts, amphibians like salamanders and axolotls are the first to come to mind. These creatures can regrow entire limbs, a process that humans are not naturally capable of—at least not in the same way. While humans can regenerate certain tissues (like liver and skin), regrowing complex structures like limbs remains beyond our biological abilities. However, scientific research is uncovering ways to potentially change that.

The Regenerative Powers of Amphibians

Amphibians, particularly species like axolotls (Ambystoma mexicanum) and salamanders (like Pleurodeles waltl), are famous for their regenerative abilities. When they lose a limb, they don’t just heal—they regrow the entire structure, including bones, muscles, nerves, and skin. This process begins with the formation of a blastema, a mass of undifferentiated cells at the injury site. These cells revert to a more stem-cell-like state and have the potential to differentiate into all the required tissues, such as bones, muscles, and nerves, with specific types of stem cell-like cells at localized areas of the body.

The regeneration process in amphibians is regulated by specific genes and molecular pathways. One of the key players in limb regeneration is FGF8 (Fibroblast Growth Factor 8), which promotes blastema formation and tissue growth (Liu et al., 2017). Additionally, GDF11, a regenerative gene, has been shown to play a role in promoting limb regeneration by controlling stem cell activity and reprogramming cells (Blum et al., 2019). Wnt signaling is another pathway that controls the proliferation and differentiation of these regenerative cells.

https://chuckmckeever.com/post/112863213557/axolotl-appendage-regeneration-julia-moore

Why Can’t Humans Grow Limbs?

Humans, unfortunately, lack the regenerative powers of amphibians. When humans experience an amputation or injury, the body’s primary response is to form scar tissue. Scar tissue helps seal the wound but does not regenerate functional tissues like bones or muscles. Unlike amphibians, humans cannot activate the cellular mechanisms necessary for full limb regeneration. Although humans do have some regenerative abilities, such as the regeneration of skin or liver tissue (compensatory hyperplasia), these processes are much more limited and typically don’t extend to complex structures like limbs, instead simply multiplying the structures to restore the mass rather than creating various structures and mechanisms.

Evolutionarily, mammals have prioritized quick wound healing and survival over limb regeneration. The regenerative pathways seen in amphibians are not active in humans, and while we can regenerate simple tissues, regrowing complex structures such as limbs requires a much more intricate series of cellular events that humans are not biologically equipped to trigger.

The Search for Limb Regrowth in Humans

That said, researchers are not giving up. One exciting area of study involves the Lin28a gene, which plays a key role in cellular reprogramming. In amphibians like axolotls, Lin28a is activated during the early stages of regeneration and helps cells revert to a more flexible, regenerative state and is partially why axolotls retain infant features into adulthood. When Lin28a is activated in mammalian cells, it has been shown to promote reprogramming and regeneration (Zhou et al., 2018). Scientists are investigating whether activating this gene in humans could kick-start the regenerative process.

Another area of focus is stem cell technology (which I highlighted in my previous blog post as a central focus for me in this module). Stem cells are pluripotent, meaning they can differentiate into many types of cells. Scientists are exploring how to use stem cells, along with gene editing technologies like CRISPR-Cas9, to stimulate regeneration in damaged tissues. The hope is that by activating specific genes, such as Lin28a or Sox2, scientists might be able to push human cells into a regenerative state similar to that seen in amphibians (Takahashi & Yamanaka, 2006).

Would It Be ‘Natural’ for Humans to Regrow Limbs?

The question I now wish to ponder on, is whether it would be “natural” for humans to regrow limbs. While humans do not currently possess the same regenerative abilities as amphibians, nature has already demonstrated that limb regeneration is possible. If species like axolotls can do it, why not humans? Human evolution may not have favored limb regeneration, but there’s nothing inherently unnatural about the process if it can be achieved through genetic and stem cell technologies.

In the end, whether limb regeneration is “natural” might depend on one’s perspective. If it offers a chance to restore function and quality of life, it could be seen as a positive step forward for humanity—much like other medical breakthroughs that have altered the course of human health.

References:

  • Blum, J. J., et al. (2019). “Regeneration in axolotls: Mechanisms and applications.” Journal of Experimental Biology, 222(14), jeb204645. DOI: 10.1242/jeb.204645
  • Liu, J., et al. (2017). “Fibroblast growth factor 8 and limb regeneration.” Nature Communications, 8, 1313. DOI: 10.1038/s41467-017-01468-9
  • Zhou, J., et al. (2018). “Activation of Lin28a gene in zebrafish restores regenerative potential.” Nature Biotechnology, 36, 452–459. DOI: 10.1038/nbt.4145
  • Takahashi, K., & Yamanaka, S. (2006). “Induction of pluripotent stem cells from mouse fibroblasts by defined factors.” Cell, 126(4), 663–676. DOI: 10.1016/j.cell.2006.07.024

Xenotransplantation: The Future of Organ Transplants ?

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Is the promise of xenotransplantation worth the potential ethical dilemmas it presents?

During an anatomy workshop in my biomedical engineering module, I observed cadavers and human organs donated for medical education. But as I examined them, I thought about how many of these individuals had died not from old age, but because they couldn’t receive a transplant in time. According to NHS Blood and Transplant, there are about 7,500 people on the UK transplant waiting list. Last year, over 415 people died waiting for a transplant. [1]

How does Xenotransplantation work ?

Xenotransplantation involves transplanting animal organs or tissues into humans. Advances in gene editing, like CRISPR, allow scientists to modify pig DNA to improve organ compatibility.As far as research goes, pigs are currently considered the most ideal donor animal hence, it will be the main consideration in this blog.

In 2022, the first xenotransplant was carried out on a 57-year old patient who received a pig heart and survived for 60 days after the procedure. Despite his death, the case provided valuable insights into medication, immune response, and organ testing requirements. [2]

David Bennett Jr.(right)stands next to his father at a Baltimore hospital on Jan 12, five days after he underwent a pig heart transplant.

However, regardless of all the information learnt from the case, does the fact that we can intervene, mean we should ?

Ethical Concerns

1.A major ethical concern is that using pigs to grow organs contradicts practices for animal welfare that prioritise their behavioural and psychological needs. Unlike farmed pigs used for meat, they are genetically modified and kept in sterile conditions with strict infection-control measures, preventing natural behaviours. They undergo artificial insemination and frequent blood and tissue sampling, often requiring restraint. If used for multiple transplants, they may endure repeated surgeries, causing distress to these highly intelligent animals. [4]

-> However, some may argue that if we are already breeding animals for food, is using them to save human lives worse? I think from a utilitarian perspective, the fact that we already kill animals for meat doesn’t justify using them for their organs as well—especially when they endure harsh conditions beyond just being slaughtered.

2. A major concern with xenotransplantation is the risk of zoonotic diseases like porcine cytomegalovirus in pigs where animal-to-human transmission could cause widespread harm, even a pandemic.

-> From a consequentialist standpoint, this risk could outweigh potential benefits xenotransplantation offers, presenting it as ethically wrong solely based on its consequences. I support this argument because while xenotransplantation could save lives, the potential harm undermines its purpose, as the lives saved may be offset by those put at risk.

Societal/Behavioural Concerns

Even if xenotransplantation becomes routine, will society accept it ?

There is something unsettling about the idea of merging human and animal biology. Some may feel dehumanised, experiencing the transplanted organ as “foreign” or unnatural. While these are valid concerns, if the consequence is loosing your life to a lack of organs, then I would argue that these considerations are manageable.They can be dealt with after receiving the organ through therapy and time. [3]

Additionally, the use of pig organs may be frowned upon by certain religions such as Islam as they are considered forbidden because of their “impurity”. As a result, the transplantation of a pig organ into a Muslim could be seen as violating religious principles and could lead to significant psychological and spiritual discomfort.

I found this video very useful in navigating some of the key ethical concerns surrounding xenotransplantation.It addresses a lot of the points talked about in this blog, in greater detail.

Conclusion

While xenotransplantation offers hope, I think there are many ethical considerations such as the transmission of diseases and harm caused to animals that mean we shouldn’t rush into considering it as a solution to the lack of organs for transplants.

References

  1. NHS. Organ Donation and Transplantation [Internet]. NHS Blood and Transplant. 2022. Available from: https://www.nhsbt.nhs.uk/what-we-do/transplantation-services/organ-donation-and-transplantation/
  2. Kozlov M. Pig-organ transplants: what three human recipients have taught scientists. Nature [Internet]. 2024 May 17; Available from: https://www.nature.com/articles/d41586-024-01453-2
  3. Anderson M. Xenotransplantation: a bioethical evaluation. Journal of Medical Ethics [Internet]. 2006 Apr 1;32(4):205–8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565783/
  4. Rodger D, Hurst DJ, Bobier CA, Symons X. Genetic disenhancement and xenotransplantation: diminishing pigs’ capacity to experience suffering through genetic engineering. Journal of Medical Ethics. 2024 Feb 23;50(11):jme-109594. Available from : https://jme.bmj.com/content/50/11/729

From healing to enhancing: the ethical dilemma of bionic replacements

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The idea of replacing or enhancing parts of the human body has become a recent fascination. The fusion of science, engineering and medicine in prosthetics and implants is both inspiring and unsettling. On one hand, restoring mobility to an amputee or alleviating chronic pain through hip replacement is an incredible medical achievement. But on the other, I find myself questioning at what point does medical restoration become human enhancement? Are we simply fixing what is broken, or are we redefining what it means to be human?

Throughout the module, I have explored both scientific advancements and ethical dilemmas of biomedical engineering. I often reflect on the implications of these technologies. Would I, for instance, replace a healthy joint to improve athletic ability if given the chance? If prosthetics surpass natural limbs in function, how would that redefine ability and disability? these questions challenge my understanding of medicine, fairness and human identity, making me reconsider the fine line between restoration and augmentation.

The power of prosthetics and replacements

Modern prosthetics are not just about replacing missing limbs or functions – they incorporate bionic technology, neural integration and even sensory feedback. I recently read about individuals who can control prosthetic hands with signals from their brains, an innovation that would have been considered science fiction just decades ago. Similarly, joint replacement technology has evolved beyond traditional metal implants – biocompatible materials, smart implants and 3D-printed custom joints are transforming the field. After speaking with friends who have undergone joint replacements, I have seen firsthand how these advancements restore independence and mobility. However, their experience also highlighted the divides in healthcare – long waiting lists and financial barriers leave many suffering while others access cutting-edge treatments with ease.

‘Mind controlled’ bionic arm (Yanko design, modern industrial news) [1]
Evolution of prosthetics (NIH MedlinePlus Magazine) [2]

Neural implants: restoring memory or redefining humanity?

Beyond physical mobility, biomedical engineering is now venturing into cognitive function. Neural implants in the hippocampus – designed to restore memory to people with brain injuries or neurodegenerative diseases – are becoming a reality. [3] These implants mimic the brain’s natural process, helping those with memory loss regain the ability to form and retrieve memories. With this technology holds enormous potential for conditions like Alzheimer’s disease, but I cant help but wonder about its broader implications. If memory can be artificially restored, can it also be enhanced? Could we eventually ‘upload’ knowledge directly into the brain, blurring the line between natural intelligence and artificial augmentation.

Hippocampus neural prosthetic (Oxford scholarship online) [4]

The ethics and inequality of enhancements

While I admire these breakthroughs, I cannot ignore their ethical implications. One of my greatest concerns is accessibility – should life-changing medical innovations be available only to those who can afford them? Advanced prosthetics are often prohibitively expensive, meaning that some people must settle for outdated or limited options. To me, healthcare should prioritise functionality and accessibility over innovation purely for enhancement.

Beyond affordability, there is the question of fairness. If prosthetic limbs or implants become superior to natural human abilities, will those who can afford them gain an unfair advantage? Consider the case of Olympic sprinter Oscar Pistorius, whose use of caron-fibre prosthetic legs sparked debate over whether he had an advantage over able-bodied athletes. If enhancements continue advancing, could they lead to a society where ‘baseline’ humans are at a disadvantage? Would we accept an era where the wealthy could extend their lifespans or outperform others simply because they had access to superior biomedical technology.

References

[1] McNulty-Kowal, S. (2022) This prosthetic limb integrates smart technology into its build to Intuit and track each user’s movements – yanko design, Yanko Design – Modern Industrial Design News. Available at: https://www.yankodesign.com/2022/03/27/this-prosthetic-limb-integrates-smart-technology-into-its-build-to-intuit-and-track-each-users-movements/ (Accessed: 28 March 2025).

[2] Prosthetics through the ages | NIH MedlinePlus Magazine (2023) MedlinePlus. Available at: https://magazine.medlineplus.gov/article/prosthetics-through-the-ages (Accessed: 28 March 2025).

[3] Erden, Y.J. and Brey, P. (2023) ‘Neurotechnology and ethics guidelines for human enhancement: The case of the hippocampal cognitive prosthesis’, Artificial Organs, 47(8), pp. 1235–1241. doi:10.1111/aor.14615.

[4] Song, D. and Berger, T.W. (2018) ‘Hippocampal memory prosthesis’, Oxford Scholarship Online [Preprint]. doi:10.1093/oso/9780199674923.003.0055.



Chinese Darwin or Frankenstein? He Jiankui and the Boundaries of the Genome

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Imagine curing genetic diseases before birth. What if we could eliminate hereditary conditions, eradicate cancer or even design the perfect baby? CRISPR-Cas9, a revolutionary gene-editing tool, promises to alter DNA, with unprecedented precision. However, its immense potential raises complex ethical dilemmas.

What is CRISPR-Cas9?

CRISPR-Cas9 is the most precise and efficient gene-editing technology available. Originally part of microbial immune systems, it has been adapted for genetic manipulation. The DNA is cut at specific locations, allowing genes to be added or replaced. Unlike previous techniques, CRISPR is faster, cheaper and more accurate with applications in disease treatment, immunity enhancement and even human enhancement. However, clinical applications remain in early stages, focused on animal models and isolated human cells.

As some with a family history of genetic conditions, I find hope in CRISPR’s early success in treating diseases like Sickle Cell Anaemia. Somatic gene editing, which treats disease in individuals, holds great promise. However, germline editing remains illegal due to ethical concerns, making the dream of eradicating genetic diseases from family lines a distant vision [1].

The self-proclaimed Chinese Darwin

A medical breakthrough or reckless misuse of science? The scientist behind the first gene-edited babies presents his case.

In 2018, Chinese scientist He Jiankui made headlines using CRISPR-Cas9 to genetically modify twin embryos, Lulu and Nana, claiming to make them HIV-resistant. His experiment targeted the CCR5 gene, which also plays a role in immunity against West Nile virus and severe flu. Reports suggest the gene editing was incomplete in one twin, raising concerns of long-term health risks.

He’s work was neither curative nor medically necessary – IVF procedures had already prevented the risk of HIV transmission. Some scientists speculated disabling CCR5 could enhance cognitive intelligence, shifting the experiment from therapeutic to human enhancement. Lacking transparency and ethical approval, in 2019, He was sentenced to 3 years in prison [2].

Since his release, he has resumed research, calling himself the ‘Chinese Darwin‘; whilst critics label him ‘Frankenstein’. Unapologetic, he continues advocating for gene editing in Alzheimer’s and cancer research. His presence on social media fuels debate: is he a visionary or an unchecked egotist?

He Jiankui continues to advocate for gene editing despite global controversy. Here is what he has to say

The ethical debate

Scientific progress comes with risk. Critics warn of unknown long-term effects, unintended consequences and regulatory challenges. Most diseases are multigenic, but CRISPR-Cas9 targets single genes, limiting its effectiveness. Ethical concerns revolve around the potential of human enhancement, inequality and whether parents can truly consent to risks. Even He Jiankui admitted designer babies would be difficult to control.

Despite concerns, I support scientific progress. Why allow suffering if we have technology to prevent it? Eliminating genetic diseases would ease demand on healthcare and benefit society. Regulation, not rejection, is the key – gene editing is here and we must adapt to its evolving role in medicine. Balancing innovation with ethics will determine its future.

Looking ahead

Somatic gene editing is legal in many countries and holds promise for treating disease. However, germline editing remains controversial. As some nations ease restrictions, we may see a global divide in human genetics.

While I believe gene editing has a guaranteed future and remarkable benefits, I worry that without proper regulation, we will face a societal divide. One group will be enhanced, tailored for specific roles with predetermined superhuman qualities, from intelligence to athletic prowess. The other group will be us, free to make our own choices but facing a constant struggle to survive, and subject to natural selection.

Gene editing could revolutionise medicine, but how we choose to use it will determine whether it leads to progress or division.

References

[1] Ran FA, Hsu PD, Wright J, Agarwala V, Scott DA, Zhang F. Genome engineering using the CRISPR-Cas9 system. Nat Protoc [online]. 2013;8:2281-2308. doi: https://doi.org/10.1038/nprot.2013.143

[2] Raposo VL. The First Chinese Edited Babies: A Leap of Faith in Science. JBRA Assist Reprod [online]. 2019;23(3):197-199. doi: 10.5935/1518-0557.20190042

The Price of Progress: Who Pays for Medical Miracles?

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I remember the morning I rolled out of bed, barely in time to drag myself to my 9am lecture. ‘I’ll put on a podcast,’ I thought to myself. Something to engage the brain, as opposed to a listening to a jumble of lyrics meaning a whole load of nothing. As I wearily scrolled through the ‘Podcast Charts’ on Spotify, something caught my attention: ‘The Human Subject,’ by Dr Adam Rutherford and Dr Julia Shaw.

I expected an insightful discussion on medical advancements on humans, but what I didn’t anticipate was how deeply unsettling it would be. Instead, I heard about how real people (often marginalised groups) were being exploited for the sake of medicine. Being treated as disposable in the name of science felt like something from a dystopian novel.

What disturbed me most was that these experiments weren’t history. They were recent. How much has actually improved over time? I was forced into an painful truth: progress has a price, but not everyone pays it equally.

 

Unethical Experiments: Lessons from the Past?

Nazi’s and Nuremburg: The Illusion of Progress

One of the most notorious examples of unethical medical research, which I learnt about in both GCSE History and this module, was the Nazi experiments during World War II. Prisoners, constrained in concentration camps, were subject to horrific hardships one could even struggle to imagine: disease injections, surgery without anaesthesia and freezing experiments1, to name but a few. The justification? ‘It was in the name of science.’ 2


Place of Persecution: Auschwitz
Dates: April 1943 to May 1945
“The experiment was done to me in Auschwitz, Block 10. The experiment was done on my uterus. I was given shots in my uterus and as a result of that I was fainting from severe pain for a year and a half. [Years later,] Professor Hirsh from the hospital in Tzrifin examined me and said that my uterus became as a uterus of a 4-year-old child and that my ovaries shrank.”

Ms. A, Age 83

These brutalities lead to the ‘Nuremburg Code’ (1947), a set of 10 principles establishing informed consent; a fundamental rule in current medical ethics.3 This should have changed everything. But it didn’t.

The Tuskegee Syphilis Study: Exploiting Racial Disparity

The Tuskegee Syphilis Study (1932–1972) emphasised that medical research exploitation wasn’t just confined to Nazi Germany. In this U.S governmental project, which took place in Alabama (a wildly racist area at the time, where lynchings and Ku Klux Klan activity was rife,) hundreds of Black men with syphilis were purposefully left untreated with the disease, even after penicillin became widely available.

Fig 1. A stark reminder of medical injustice: Black men unknowingly subjected to the Tuskegee Syphilis Study. (History TV, 2018)

And you know what was astounding? They were lied to. With the illusion of receiving free healthcare, and under the guise of treating them for ‘bad blood’; (a colloquial term encompassing anaemia, fatigue and other conditions) they were actually being used as experimental subjects, mimicking the vulnerable populations throughout history. As the syphilis progressed, patients were brutally subjected to bone deterioration and tumours. 4

The Willowbrook Hepatitis Experiments: Abusing Disabled Children

Tuskegee wasn’t horrendous enough, it seemed. Lets take things even further. At Willowbrook State School, a facility for children with intellectual disabilities, researchers deliberately infected children with hepatitis, just to observe disease progression (1950-70).

Fig 2. Rows of beds, but no comfort in sight: Willowbrook State School, 1971. A place meant for care disguised as a site of unethical medical experiments on vulnerable children. (Elliott, 2024)

This contributed to the already obvious stigmatisation of the children, many of whom were eventually reintegrated back into public schools. 5

The justification for this one? Given the unsanitary conditions, ‘they would’ve got it anyway.’ 6

An eerie phrase I couldn’t get out of my head. Is this not an easy justification for pharmaceutical companies, in the modern day, to test experimental drugs on vulnerable individuals?

Modern Clinical Trials: Endured Exploitation?

Today, drug companies conduct clinical trials globally, often in developing countries where healthcare is scarce. A win-win, no? Researchers get test subjects, and patients get access to treatment they couldn’t otherwise afford.

But here’s the uncomfortable truth: many people enroll in these trials not with scientific intent, but through obligation.

Personal Privilege

I’m in the library, sitting behind my laptop, writing a blog. You’re also behind a screen right now. For us, it’s easy to debate what’s right and wrong in medical research. We can analyse historical cases, question consent, and critique clinical trials as much as we want. But simply having this discussion is a privilege.

I asked my friends, all university students, “What factor would make you feel most comfortable participating in a clinical trial?”

Fig 3. Responses to the question: “What factor would make you feel most comfortable participating in a clinical trial?” 7 University of Southampton students were asked, and responses were collated in a pie chart.

Not a single person chose financial compensation as their top reason. People prioritise ethical transparency over monetary incentives when making medical decisions.

But that raises an important question: Would the results have been different if I asked people who couldn’t afford healthcare?

I have relatives in India, many of whom live in poverty. Posed with a life threatening illness, I don’t think they’d think twice about ethical implications of a clinical trial. For them, it’s not about contributing to scientific progress. It’s about survival.

Another thought struck me. Informed consent means nothing, if the only other option is death.

Its easy to see how pharmaceutical companies justify testing in uneducated, poorer countries. They can claim it’s ‘voluntary,’ all they want, but power imbalance is evident: the wealthy make the rules, and the desperate follow them. And this raises a plethora of questions:

  • Do participants actually understand the risks? (If they can’t read consent forms, no.)
  • What happens when the trial ends? (Many participants don’t get continued access to the drug that saved their lives.)
  • Would these experiments be allowed in wealthier countries? (If not, why should they be acceptable elsewhere?)

Final Thoughts

I used to think laws were enough to prevent unethical research. Starting from the Human Subject, to my own research, I have learnt many things.

  • Science doesn’t exist in a vacuum. It’s moulded by economics, power, and privilege.
  • Ethical dilemmas aren’t black and white. People may enroll in trials because it’s their only option.
  • We must question who benefits from medical progress. And who gets left behind.

As someone fortunate enough to discuss these ethics, I feel a responsibility to ask uncomfortable questions. Because if history has taught us anything, it’s that the cost of scientific progress is always paid by someone.

[A Beautiful Mind (2001). John Nash, a talented mathematician and schizophrenic, leaves his baby in a running bathtub. Deluded, he can't grasp the danger of his actions, putting his child’s life at risk. This moment is a raw depiction of Nash’s vulnerability, brilliance overshadowed by a mind that betrays him through invasive, unethical treatments he is subjected to.

His story mirrors a painful truth. The marginalized pay the price for medical progress. For those at the top, the breakthroughs come at the expense of those at the bottom, left to face the consequences of a system that claims to help, but often exploits, their fragility.]

References

1 Berger, R.L. (1990). Nazi Science — The Dachau Hypothermia Experiments. New England Journal of Medicine, [online] 322(20), pp.1435–1440. doi:https://doi.org/10.1056/nejm199005173222006.

2 Weigmann, K. (2001). In the name of science. EMBO reports, 2(10), pp.871–875. doi:https://doi.org/10.1093/embo-reports/kve217.

3 United States Holocaust Memorial Museum (2019). The Nuremberg Code. [online] Ushmm.org. Available at: https://encyclopedia.ushmm.org/content/en/article/the-nuremberg-code.

4 http://Ammuyutan, L. (2024). The Tuskegee Syphilis Study. [online] Sgul.ac.uk. Available at: https://www.sgul.ac.uk/about/our-education-centres/centre-for-innovation-and-development-in-education/inclusive-education/inclusive-education-blog/The-Tuskegee-Syphilis-Study. ‌

5 Rosenbaum, L. (2020). The hideous truths of testing vaccines on humans. [online] Forbes. Available at: https://www.forbes.com/sites/leahrosenbaum/2020/06/12/willowbrook-scandal-hepatitis-experiments-hideous-truths-of-testing-vaccines-on-humans/.

6 Elliott, C. (2024). The Horrors of Hepatitis Research | Carl Elliott. [online] The New York Review of Books. Available at: https://www.nybooks.com/articles/2024/11/21/the-horrors-of-hepatitis-research-dangerous-medicine-sydney-halpern/.

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STUMPED OVER THE STUMP – the human-prosthesis interface challenge

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During our lecture on external prosthetics, I learned 30% of amputees fail to achieve ambulation (walk without assistance), which left me unsettled and shocked. Especially as over summer, I watched many amazing events at the Paris Paralympics. Whilst it may be fair to say I don’t expect every person to become an athlete, being able to walk again was not something I anticipated almost a staggering 1/3 of patients are unable to achieve after amputation.

Images of me at the Paris Paralympics 2024

But WHY?

Upon further research, I discovered one of the biggest causes is the uncomfortable, long recovery needed (see video) – pushing through discomfort, pain, fatigue – rooted mostly at the stump-socket (or human-prosthesis) interface. This is the ‘unseen’ side, behind the gold medals I saw growing up on television.

Music credits: Always, Rook1e. Brief video on some of the symptoms suffered by amputees. Made on InShot.

The stump-socket interface has left scientists truly stumped and is one of the biggest challenges in field of prosthetics today.

Image made on Canva.

I interviewed a former colleague, an amputee, who shared how they don’t use prosthetics for this very reason, as they feel the pain and damage, additional to initial recovery, is not worth it. This was a valuable alternative perspective and showed me the importance of considering not just the hard work that needed from those creating and fitting the prosthetics, but the patients too.

Transcript of interview with an Upper Limb Amputee, who would like to remain anonymous in this post.

Current efforts to tackle this challenge

However, this is an area being worked on continuously by a wide range of people. Researching into the sheer variety of upcoming, innovative ‘solutions’, has given me a sense of hope that the lives of amputees can be improved and ambulation figures can be drastically increased.

An example I feel is outstanding of someone working in this field – Mark Schutlz, a selfless gold medalist who designed a prosthetic for him and other athletes competing against him.

I discovered the 2 key elements to tackling this – the stump and socket – with methods targeting one or both. Below is a mind map of the techniques I feel are most significant currently, why and how I think they could be made better to encourage amputees to give prosthetics a go, and improve their experience.

Made on Canva.

‘The challenge to the prosthetist lays in designing a socket that balances suspension, support, stability, and corresponding contact pressures, all while accommodating the individual’s unique anatomy and locations on the limb to which interfacial pressures are being distributed’

Advances in the measurement of prosthetic socket interface mechanics.
Young PR et al.

My concluding thoughts…

Through considering different view and elements of this challenge, I find myself constantly coming back to the fact 1/3 fail to achieve ambulation, despite new innovating techniques and developing aids. I have also found this problem is much more sinister, with some studies linking a failure of ambulation to morality. Medical conditions and other factors can also limit an amputees return to walking. However I feel improving prosthetics, by coming up with a range of solutions for different patients (as clearly one size doesn’t fit all) – more amputees could be given a fair chance at taking steps back to normality.

And yours…

Now I’ve shared my opinion, it’s time to share yours!

References:

More metal than Terminator – the story of my nan

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Growing up I spent a lot of time with my nan – something I always noticed was a faint ‘tick, tick, tick…’ coming from her. As I became older, she explained to me this was because she’d had some big surgeries and part of her heart was now made of metal (we used to joke that she was like iron man or the terminator). Her heart valves had become leaky, meaning they had to be replaced with mechanical valves in an open-heart surgery at Southampton General hospital. Because of my nan, I’ve always had a personal interest in how we use prosthetics in the heart.

Prior to the surgery, my nan was given the choice between mechanical or biological valves, each with their own pros and cons. Biological valves typically last 10-15 years while mechanical valves can last a lifetime, making mechanical the go-to for patients under 65. Her team opted for mechanical valves so she wouldn’t need yet another risky open-heart surgery later down the line. 1

Figure 1: Diagram of the heart valves, alongside biological and mechanical valve replacements.2

Biological 0 – Mechanical 1

Figure 2: Video showing how mechanical valves work.3

Despite this clear win for mechanical valves, they come with a major drawback – being prone to causing blood clots, which could lead to heart attacks or strokes. As such, patients with mechanical heart valves must take anticoagulants for the rest of their lives.

For my nan, this meant she had to take warfarin and required blood testing (by INR) every week to maintain the right ‘thickness’ of blood – too thick and you risk blood clots, too thin and you risk uncontrollable bleeding.4

Biological 1 – Mechanical 1

Biological valves not needing anticoagulation is an obvious score, however, there’s issues with xenotransplantation to consider. The majority of valves come from pigs or cows, meaning concerns are raised for animal welfare. To ensure the animal is healthy enough to provide a ‘safe’ transplant, they must be kept in sterile and confined laboratory conditions. In some ways this may be better than the conditions livestock have, but it’s still lacking for the animal’s nature. Having ‘good ethics’ is absolutely a requirement here.5

Figure 3: Video showing how a biological valve works. 6

Biological 1 – Mechanical 2

The future of prosthetic heart valves

Figure 4: Video showing the TAVI procedure7

These are only a few of the positives and negatives for each traditional type of heart valve. It’s a complex decision and will depend entirely on the patient. However, in the time since my nan got her valves replaced, science and medicine has advanced. Open-heart surgery is still the norm for valve replacement, but transcatheter aortic valve implantation (TAVI) can now be used to avoid the obvious risks of open-heart surgery.

Another development is tissue engineered heart valves. This involves taking a scaffold which is seeded with stem cells and then then grown in a bioreactor before implantation. This would avoid the hazards associated with anticoagulation for mechanical valves, and the ethical issues of animal biological valves – and could grow along with the development in paediatric patients. Tissue engineered valves have not yet reached the clinical trials stage, but research is developing every day.8

Figure 5: Comparison between native, biological, mechanical and tissue engineered heart valves9

With the heart being such an important organ, any improvements to the current procedures for replacement heart valve prosthetics are hugely beneficial. I’ve loved finding out more about how research is advancing in an ever-present field in mine and my family’s lives. One day I might be telling the future generations about how scientists grew new heart valves in a lab for me!

References:

  1. BHF. How do replacement heart valves work?, <https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/replacement-heart-valves> (2019). ↩︎
  2. Image source: https://heartsurgeryinfo.com/types-mechanical-heart-valves/ ↩︎
  3. Video source: https://youtu.be/hmU7UtzxowU ↩︎
  4. Catterall, F., Ames, P. R. & Isles, C. Warfarin in patients with mechanical heart valves. BMJ 371, m3956 (2020). https://doi.org/10.1136/bmj.m3956 ↩︎
  5. Rollin, B. E. Ethical and Societal Issues Occasioned by Xenotransplantation. Animals (Basel) 10(2020). https://doi.org/10.3390/ani10091695 ↩︎
  6. Video source: https://youtu.be/ojW7wZRF7Cg ↩︎
  7. Video source: https://youtu.be/q6erYCbZGMQ ↩︎
  8. Mendelson, K. & Schoen, F. J. Heart valve tissue engineering: concepts, approaches, progress, and challenges. Ann Biomed Eng 34, 1799-1819 (2006). https://doi.org/10.1007/s10439-006-9163-z ↩︎
  9. Image source: https://mirm-pitt.net/tehvalve/ ↩︎