The University of Southampton

Author: Georgia McFarlane

A guide to print your own organs

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Although the title may seem farfetched, we aren’t as far away from this as it may seem. 3D printing is a technology which is rapidly growing, and is perhaps the answer to many problems within science and medicine.

I became fascinated with the possibilities of tissue engineering after a lecture a few weeks ago, which led me to further research some of the current advances and future possibilities in the field.

It has been 70 years since the first organ transplant, which was a kidney. Since then organ transplant has become a common procedure and has saved many lives. However, there is still some problems associated with it. According to a study by Conor Steward, as of the end of March 2022, there was 4,744 patients on the transplant list in the UK. This long list is costing lives everyday, 3D bioprinting can speed up this process and save lives every day.

So how does this work?

There are three key steps in the process:

  1. Pre-bioprinting – A Digital file is created to input into the printer, telling it what to make. This is often made using MRI and CT scans of the organ you want to print. The cells are then mixed with a bioink, and imaged to ensure they are suitable for the procedure.
  2. Bio-printing – the cell and bioink mixture is placed into the printer, along with the digital file. It is then mixed with a hydrogel as it prints, which is essential in created the structure, as it acts as a scaffold.
  3. Post-printing – to further enhance the structure, the cells are cross linked. This may be via UV light or the application of an ionic solution, depending on the structure.

But where are these cells coming from?

Something that shocked me, whilst learning about tissue engineering, was the range of different sources of cells, and the ethical problems associated with some of them.

The cells may come from a donor, which is known as allogenic cells. There is the possibility here to violate two of the most important laws in biomedical research – confidentiality and consent. In addition to this, one of the problems that strikes me is that it does not reduce the possibility for rejection.

Perhaps one of the most controversial sources is Embryonic stem cells. This involves using embryos to derive stem cells for. However it brings up one of the most pressing questions in biomedical ethics – what is the moral status of an embryo.

However, these ethical issues can be overcome by using stem cells from the patient, that is undergoing the procedure. Cells from your own body are referred to as autogenic cells.

When this comes to mind, you may think of taking stem cells from the patients bone marrow, which is widely used. However I was fascinated to hear how umbilical cord blood can be stored, in the case that a person may need stem cells for any reason in the future. Imagine the possibilities of having your own stem cells, ready for use, in case you ever need them!!

3D bioprinting beyond transplantation

Before researching the use of 3D printing, I thought the only use for these organs was transplantation, however as a scientist, I was fascinated with how they are used for research.

The possibilities of the technology are endless, with studies creating beating hearts, pancreases to cure diabetes, and even a new ear to restore hearing! But in addition to this, we can print tumours or disease models to understand the behaviour of cells!

One study that caught my attention was using 3D printing to create mini tumours, in order to create a more personalised and potent treatment for cancer patients. Scientists at the Seoul National University College of Medicine, formulated a range of bioinks from patients with glioblastomas, which the most common type of brain tumour. A range of chemotherapy and drugs where then tested on these tumours, to allow the scientists to understand how best to treat these tumours. The applications of 3D printing in terms of drug development, is something I am excited to see develop in the future.

Where can it go wrong?

Despite avoiding some the ethical dilemmas associated with xenotransplantation or clinical organ donation, 3D printing brings its own range of moral questions associated with it. In order for the techniques to be readily available, there needs to be tight regulations put in place first.

One problem that strikes me, and many others, is the accessibility of these organs and even personalised medicine. With a technique so new, it will take some time to become widely available, so who gets it first? A problem that has arose a lot within medical ethics, is the use of these products for performance enhancement. This may be particularly prevalent within sports, however it applies to everyone. If you had the money to afford these technologies, you would be able to live a longer life or enhance your quality of life. This sounds great, right? But on the other hand, there is the patient stuck in hospital waiting for an organ transplant, with a life ahead of them with a strict drug regime to avoid the risk of rejection. Is this fair?

In order for the technique to work, particularly to begin with, laws would need to be put in place that the technique should only be used for medical practice, in terms of organ transplant. However personalised treatment plans may be a different issue, as it would be highly beneficial in terms of medical practise, however still separates society.

Personally, talking a utilitarian view point, I believe that the benefits of the techniques are huge, and therefore outweigh any possible socioethical issues that may arise. However as stated above, I don’t think it should be used primarily for performance enhancement, until the technique is widely accessible to everyone, as it creates a larger divide in society than there already is.

An alternate reality: Where is genetic editing taking us?

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Imagine a world with no disease, where we can alter our genes to become the best version of ourselves. Maybe you want to be the most fit, have great health , or be the smartest. But at what cost are we willing to get to this?

Recently I watched the documentary Unnatural Selection on Netflix, which delved into the world of genetic editing, and touched on some of the dangers that may arise because of it. One particular issue it focused on what biohacking, which is when people use aspects of biology to change their body in some way. CRISPR, a new genetic editing technology, would allow people to do this easily at home. However, by making changes to the ones genetics, they are altering the the genetics of their offspring, which could possibly have detrimental effects in the future.

So, what is CRISPR?

CRISPR is one of the most versatile gene editing methods, so simple it is often described as cutting and pasting our genes. CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats. Essentially it works by removing a portion of a gene, and letting natural DNA repair systems take over.

Hundreds of studies are currently happening, in terms of how the technology can be used therapeutically, to treat a wide range of diseases, from HIV, blindness, and sickle cell anaemia.

Markus Mapara, MD, from Columbia University, used the CRISPR technology on a patient with sickle cell anaemia, a blood disorder. It is estimated that the disease affects 1 in every 2000 people in the UK, making it one most common genetic disorders in the UK. The genetic mutation causes the body to make an abnormal form of haemoglobin – a protein essential for red blood cells to deliver oxygen around the body. Currently the standard treatment is a bone marrow transplant, however this introduces the risk of infection and rejection. CRISPR is a new promising treatment that may be able to change the outcome for these patients.

So what’s the problem?

In a technology with such promising outcomes, it is hard to imagine why it may be a problem. But for ethicists, it has raised huge concern.

As I mentioned at the start, one of the main concerns brung up in the documentary was biohacking. The documentary goes into the story of Josiah Zayner, a formed NASA scientist. He injected himself with this technology, to grow his muscles. He stated that his motivation was to prove that CRISPR worked, and show the possibilities of gene editing. He believes that people should be able to get involved in science at home, and it shouldn’t just be down to scientists in labs. In addition to trying to grow his muscles, he also performed a full microbiome on himself, including a faecal transplant. The documentary Gut Hack goes into further detail of this, and the outcomes.

To most of us, this seems terrifying – injecting ourselves to permanently change our genes, without knowing the outcome. So why do biohackers do it? They all have different motivations, however the is a general consensus that they are frustrated with the slow progress and tight regulations around these technologies. They believe that they should be more accessible.

This moves onto another problem with the technology – accessibility. A problem that strikes those working on these technologies, is whether the people that need it, will be able to access it. The costs of the technology may be a barrier for those wanting the technology to cure disease. Rather those with money may be using it for enhancement purposes – to make them faster, be able to concentrate longer, be fitter, be smarter etc. However, this will only create a larger divide in society.

This leads of onto the issue of eugenics. Ethicists have concerns that IVF clinics may be able to access this technology, and use it to alter embryos. This was done by a Chinese scientist Jiankui He, who genetically altered the DNA of three embyros, who then developed into babies, including two twins. He was aiming to make the children immune to HIV, however this was deemed irresponsible and he was jailed for 3 years. (https://www.theguardian.com/science/2023/mar/06/forthcoming-genetic-therapies-serious-ethical-questions-experts)

So what’s the outcome?

The topic is very much up for debate within the science, political and ethical world, however I am going to conclude my current thoughts on the technology.

Looking from a utilitarian point of view, I am inclined to believe that the benefits of the technology will one day be more beneficial than the risks. However, I think a lot more regulations need to be put in place before this can happen.

The problem with making it easily accessible is biohackers, however with a lack of accessibility we create a societal divide and lean towards the world of eugenics. My idealist view would be to make it accessible through health care, and not make it a technology that is readily available to the public, however as the documentary Unnatural Selection discusses, this is a very idealist view.

Here is a short video clip of the documentary: