The University of Southampton

Engineering Replacement Body Parts 2023

UOSM2031

How can prosthetics be adapted for different lifestyles?

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During a lecture and workshop focusing on prosthetics, I was intrigued by the design and functions of prosthetic limbs. Whilst watching the lecture, I spent some time wondering how the body communicates and works with the prosthetic to provide a function so similar to those of a natural limb in different everyday activities. Going into this research I didn’t have much prior knowledge and I perceived prosthetics to be limb replacements, but didn’t know their wider use. Upon seeing and interacting with a lower limb prosthetic in the workshop, I decided to further research this concept. 

Types of prosthetics

At the start of my search, I found there were many ways a prosthetic limb could work. Firstly, it can be powered by the body moving itself, e.g. where a cable may be placed on the shoulder and extend to a prosthetic hand. As the shoulder moves, the prosthetic moves. Secondly, it may have buttons, e.g. pressing a button on a prosthetic hand will cause the hand to grip an object. More recently, myoelectric powered prosthetics have been developed. This links muscles in pre-existing limbs to generate electrical signals and pulses via electrodes placed on the skin.

Example of myoelectric prosthesis.

Prosthetics for different lifestyles

I then wondered how a prosthetic like these could be used in different scenarios and lifestyles, e.g with different hobbies. During my research I found the website Arm Dynamics which discusses the creation and execution of many prosthetic attachments for those with varied everyday lives.

Ways prosthetics have been adapted for different activities.

Being an active gym goer I wondered how prosthetics could be used efficiently at the gym to complete exercises with correct form and came across Max Okun. Max is a personal trainer who was born without a left arm and forearm, but living with this through his life wasn’t going to stop him in his passions. It did however cause him injury as he was overusing his right arm, to counteract this pain, instead of surgery, he decided to use exercise to build up his muscles. It was therefore important for the engineers creating his prosthetics to ensure whilst Max was doing the exercises he was not causing further injury. 

Max Okun Patient Profile from Arm Dynamics on Vimeo – This video shows Max using his prosthesis.

My reflections.

Researching this stream of engineering made me very grateful to be in a generation of such intelligent creators. As someone with fully functioning limbs, I think it is easy to take for granted how our brains are able to seamlessly communicate with our body parts. Even with tasks such as writing this blog, I require little to no thought in using my fingers. I can go bowling and tap dance without worrying about my mobility. I look forward to seeing what comes next in prosthetics and where it can go. Sitting this module has inspired me to look for careers that can aid in this development.

Spinal Motion in Post-Surgical Scoliosis

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Scoliosis is an abnormal lateral curvature of the spine, causing misalignment. In order to be considered true scoliosis, the curvature, measured by the Cobb angle, must be more than 10 degrees. Spine specialists recommend different treatment options depending on this angle, with more severe and progressive cases resulting in surgery.

Examples of a mild, moderate, and severe case of scoliosis

Spinal Fusion

Spinal fusion, which has been the standard surgery for scoliosis for the past century, involves realigning and fusing the curved vertebrae with screws and rods. Although this procedure has good outcomes, with low complication and re-operation rates, it can diminish spinal mobility and flexibility. This means that those taking an interest in sports who undergo spinal fusion, for example, can lose their ability to perform. As someone with scoliosis myself (although mild), and having previously competed in tennis tournaments, this got me thinking about alternative spinal surgeries that do not have a negative impact on mobility.

An example of a patient before and after spinal fusion

“The desire to maintain spine motion has fuelled the development of various growth modulation procedures. The goals of these procedures are to correct the spinal deformity and maintain motion.”

Scott. J. Luhmann, M.D.

Vertebral Body Tethering

As of recent, non-fusion spinal surgery has been used on those with scoliosis to correct curvature, while preserving flexibility and mobility. One method is through vertebral body tethering (VBT). This is where anchors (coated in hydroxyapatite, the substance that bones are composed of) are anteriorly attached to the vertebrae on the convex side of the scoliotic curve, with a flexible tether (made from polyethylene-terephthalate) connecting these anchors. The foundation of the procedure is that the tension from the tether slows the growth on the convex side of the spine, giving time for the concave side to catch up and driving the spine into the correct alignment. Due to the flexibility of the tether, and the absence of bone fusion, this allows for better spinal mobility post-surgery. Because VBT works via growth modulation, the most suitable candidates are those who have yet to reach skeletal maturity or are experiencing progressive scoliosis. This therefore means that VBT is less generalised than spinal fusion, and due to it being a new approach, there is some uncertainty with its long-term outcomes. Possible complications surround the fact that the tether may break through prolonged stress, though this does not pose much of an issue once spinal correction has completed. Early reports into the post-operative results of VBT do however demonstrate a high success rate and low revision rate.

Image showing what a scoliotic spine would look like before and after VBT
Video of the VBT procedure

Posterior Dynamic Correction and The ApiFix

Another non-fusion surgery for scoliosis is posterior dynamic correction, which occurs with the use of the ApiFix. The ApiFix is a self-adjusting rod, implanted on the concave side of the spine using a posterior approach, serving as an internal brace, and helping straighten the spine. The device can expand and so accommodates skeletal growth and additional correction. It is fastened to the spine with a single-level fusion (meaning only two vertebrae are being fused), with a total of only three screws needed. The rod features two polyaxial joints in which the vertebrae are fused, providing a greater degree of motion than spinal fusion. The ApiFix is most suitable for those with single spine curves and a Cobb angle between 35 and 60 degrees. Because this device and the procedure is novel, questions have arisen about its success rates. For example, possible complications include rod breakage and osteolysis (destruction of bone tissue). Early reports into the post-operative results of posterior dynamic correction with the ApiFix do however display its success and provides preventative measures to decrease failure and re-operation rates.

Image showing a scoliotic spine before and after posterior dynamic correction with the ApiFix
Video of the ApiFix procedure

Final Thoughts

As I researched into the topic of surgical treatments for scoliosis, I was pleased to find other options as well as spinal fusion that can help preserve the individuals spinal mobility and flexibility. I believe that it is important to offer various treatments, while considering patient suitability, in order to improve the patient’s condition while not having a negative impact on their lifestyle. With the nature of these procedures, it has given me insight into how individuals requiring scoliosis corrective surgery have to negotiate between greater spinal motion with some uncertainty in long-term outcomes, or a long-lasting solution with diminished spinal motion. Personally, I would decide to go with the former option, with spinal fusion becoming a last resort if long-term outcomes are not successful. Nevertheless, I am excited to observe the follow-up results of these newer procedures and the advances technology will have on scoliosis corrective surgery.

Chimera Concerns

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World First:

The first human/animal chimera was a human/rabbit chimera documented in Cell Research 2003 where the scientists from Shanghai Second Medical University fused human skin cells with rabbit eggs and allowed them to develop in laboratory dishes for several days before their human embryonic stem cells were harvested. This raises many ethical issues, specifically with embryonic stem cell harvesting as many people see the destruction of the embryo to retrieve these cells to be ending a human life, and some scientists even argue the research is not necessary in the first place.

Primate Chimeras:

A simplified diagram of the processed used to produce the human/monkey chimera cells.

The negative reaction to the 2003 paper did not deter a team of researchers from China, Spain and the USA from creating the first human/monkey chimera in 2021, who injected human epithelial pluripotent stem cells (hEPSCs) into macaque blastocysts.

This video shows the growth of one of the chimeric embryos, with the human cells highlighted in orange where you can see them migrating and undergoing mitosis.

Images of the chimera cells under different staining

In over half of the injected embryos TD+ human cells were found within the embryonic disc which is responsible for detaching embryonic cells from the blastocyst walls and forms a trilaminar embryo- an important step in embryonic development.

Ethical Considerations:

As it stands at the embryonic stage of development there are already ethical concerns with regard to the harvesting of embryonic stem cells from these chimera embryos, as some consider this to be killing a living organism, however if these cells were allowed to grow and able to produce an adult organism the concerns become even more sinister- organ farming.

Growing human organs in animals for the sole purpose of transplanting them into awaiting human patients is a conflicted topic for many reasons. Jehovah’s Witnesses famously refuse blood transfusions, and many more would likely object to receiving an organ grown inside an animal. The possibility of growing human organs using the patient’s own cells may persuade more, but many would still object to receiving an organ grown inside of an animal. Furthermore, there are research limitations on primates due to their similarity with humans, but it is this very similarity which could make them one of the best candidates for organ farming.

On the other side of the fence, you could argue that harvesting organs from animals like monkeys and pigs is no different than farming any other sort of animal product, with the added benefit of saving lives. One of the considerations with chimera organ harvesting is which animals we create chimeras from. Monkeys are typically thought in the west to be too intelligent to eat, and many religions disallow the consumption of pork so would likely refuse organs from one too, however pigs and monkeys are typically viewed as the best vessels for growing human organs. If the animal used is already farmed en masse, how bad is it really?

According to the HRSA website, there are 104,234 people in the US on the national transplant waiting list as of 24/03/23, and 17 people die every day waiting for an organ transplant. over 42,000 organ transplants were performed in the US in 2022. If human/monkey chimera technology advanced to the point of transplanting mature organs into human recipients, it could help to alleviate the organ crisis we face in the world today.

Human/animal chimeras for organ harvesting could save thousands in the future, but is it worth sacrificing animals to play God?

The Science Of Science Blogging

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The Science of Science Blogging: Separating Fact from Fiction

“The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge.”

Stephen-Hawking

Throughout my early scientific career, I have observed that reliable published scientific papers often have perplexing scientific-terminology. So, what’s the solution? Blogs? A form of comprehensible literature, however, they introduce bias. The author is advocating their opinion, providing opportunities for unreliability. Whilst in this blog, I will not directly discredit other authors, I will provide guidance for reading blogs using controversial topics.

Engineering Prosthetics: A More Accessible World?

We currently have Myoelectric Prosthetics, which use muscles from residual limbs of amputees to control appendages. Advancing technology strives towards fully-integrated prosthetics (requiring only the nervous system to function). I see this concept as enormously advantageous to society, improving the lives of 57.7 million amputees worldwide. I recently watched a video about an amputee called “Johnny Matheny” and I felt captivated by his excitement towards a future where amputees don’t feel disadvantaged.

Johnny Matheny

Did my opinion alter yours? The data, case study and emotive language was skewed towards one point of view, however my opinion is more complex. My opinion failed to debate and evaluate the ethical, societal and legal concepts. Ethically speaking, creating a fully functional limb out of carbon-fibre could almost be considered as a weapon (which frightens me) and conversely, the concept could be militarised causing international tensions. Moreover, limb loss occurs in the military hence an unfair expectation to re-enlist as a chimera of man and machine after already losing a limb for their country may occur. Furthermore, I feel as though in events such as the Paralympics, the success of the athletes would be more reliant on the technology of their prosthetics rather than personal skill which I deem as de-humanising our society.

Click to watch Johnny Matheny

Ethical Considerations of Embryonic Stem Cells: A Delicate Balance

In my opinion, embryonic stem cells should definitely be utilised as they are pluripotent, hence could benefit billions. As an individual with impaired eyesight, the future prospect of replacing damaged photoreceptor cells to cure blindness is attractive to me.

However, my opinion has failed to focus on the ethical opposition. Some element of my moral conscience believes that it’s inhumane to fertilise the egg and then proceed to deconstruct a material that has the capacity to become a sentient being. Aristotle’s eudaimonia virtue ethics valued the preservation of life, and similarly my moral compass burdens me with the thought, should embryonic stem cells be illegal due to lack of embryo consent? “Section-10(2) of the Human Rights Act specifically prohibits involuntary medical or scientific experimentation”, so should this law be inclusive of embryos? Moreover, Jeremiah 1:4-5 says “Before I formed you in the womb I knew you, and before you were born, I consecrated you.” This quote suggests that spiritually, we were pre-determined before the act of egg fertilisation, and hence even though the embryo isn’t sentient, God had a plan for them. As an individual raised as a catholic, I don’t take this quote as literal, but more as a metaphor on the importance of all life. Therefore, I still believe the benefits outweigh the moral dilemmas.

To Conclude…

Overall, I have taken a consequentialist/utilitarian view as I believe the benefits to society outweigh the ethical issues, yet I experience some internal confliction. With blogs, the passion/opinion of the author may be persuasive and result in bias/propaganda. Also, blogs may be oversimplified, hence to form your own opinion, multiple sources must be viewed.

Watch Paul Fairchild justify his use of stem cells:

Born to save another, is that my only purpose: The Bioethics of Saviour Siblings

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As a teenager, the movie “My Sister’s Keeper” initiated my interest in saviour siblings. It portrays a young girl who tries to gain medical emancipation from her parents when urged to donate a kidney to save her leukaemia-stricken sister. After further research, I discovered that the movie addresses the ethics of saviour siblings. Consequently, it prompted questions, like whether it is right to do whatever is necessary to save a child’s life at the expense of infringing upon the rights of another?; and ultimately, is creating a saviour sibling ethical in the first place?

For those unaware, a saviour sibling is a child conceived through IVF. An embryo undergoes pre-implantation genetic diagnosis such as HLA typing to create a genetically compatible individual who can provide stem cells, blood, or organs to a sibling requiring them to live. Although creating a saviour sibling appears to be a noble endeavour, when addressing the ethics; three arguments are considered.

1. Saviour siblings as commodities:

This perspective stems from the idea that saviour siblings are a continuous and potentially expendable resource, contradicting Immanuel Kant’s maxim, “Never simply use people as a means, but always at the same time as an end”, and subsequently opposes the view of ethics as “right”. However, some argue that Kant’s assertion, in this case, doesn’t distinguish between having a child as a saviour sibling and having a child for another objective, like completing a family or saving a marriage, as the child is still a tool for serving a purpose. Thus, from a Kantian perspective, what is wrong is to create saviour siblings for a specific reason and then just discard them afterwards.

2. Saviour Siblings could lead to designer babies.

No!! Designer babies are not Gucci babies! They refer to genetically engineering pre-implantation embryos to influence the traits children will have. The creation of saviour siblings could be seen as a step towards pre-determining a child’s purpose and characteristics, illustrating a desire for perfectionism in a child by a parent rather than wanting them for who they are, thereby limiting their development as individuals. Furthermore, like the genetically “perfect” society in the sci-fi movie Gattaca, this argument allowed me to consider the path to negative eugenics that creating saviour siblings could create, selecting favourable traits to the detriment of people who cannot compete, and with the development of gene-editing tools like CRISPR-Cas9, such societal perfection and extreme segregation could be a misguided future reality.

3. The welfare of the saviour sibling

This argument considers the physical and emotional well-being of the saviour sibling. Alnasir et al. 2020 argue that regarding saviour siblings, the principles of beneficence and nonmaleficence of medical ethics are violated; since their creation and donation process carries no medical benefits for them but does impose potential harm, as they risk not only a painful invasive transplantation procedure but also abandonment and long-term detriment to their self-worth; if their donation is unsuccessful since their identity and value originate from being a cure to their older sibling.

Final thoughts

The conception of saviour siblings is an ethically controversial practice to which there is no clear answer; fortunately, this delicate process is regulated by the Human Fertilisation and Embryology Authority, authorising the creation of saviour siblings as per approved set conditions. Overall, this topic expanded my learning and prompted the conclusion that though it appears impossible to grasp the full extent of saviour siblings, the answer is that there may be no good answer, but as humans and a society, we must make decisions and applicable regulations for a virtuous future for those born to save another.

Enhancing Functionality and Quality of Life in Upper Limb Prosthetics

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Introduction

Sensation is a crucial aspect of everyday life; it allows us to feel texture, pressure, and temperature of objects that we interact with.

Now imagine trying to pickup a delicate object without being able to feel it in your hand, how hard do you need to squeeze your fingers to hold it without the object falling out of your hand? Or are you gripping too hard that you might break it? This lack of sensory feedback is a major concern of prosthesis users and here we will explore the methods of sensory feedback.

Here is Dr. Ian Williams discussing developing a prosthesis with sensory feedback:

The role and history of sensory feedback for prosthesis users

The idea of restoring sensory feedback in prosthesis has been around since 1917 when Rosset patented a mechanism (Patent No. DE301108) that relays finger pressure via pneumatic or mechanical means. Many others followed, like the Vaduz prosthetic hand in the 1940s (Patent No. 2567066) which provided voluntary-closing hand and a “bladder” which was connected to the residual limb in the socket to provide force feedback. However, amputees still struggle with using these prosthetics as the user can’t tell what their prosthetic is doing without having to actively look or pay attention to what their prosthetic is doing. This is due to the lack of proprioception. (1)

Vaduz Hand, From Bulletin of Prosthetics Research, BPR 10-6, 1966.

Different types of sensory feedback

There are several methods that attempt to incorporate sensory feedback for upper limb prosthetics that try to provide users with sensory information. (1)

  • Electrostatic feedback
    • Electrostatic feedback involves the use of electrical signals to stimulate the skin and provide sensory feedback.
  • Mechanotactile feedback
    • Involves the use of mechanical pressure or vibrations to stimulate the skin and provide sensory feedback about the position and movement of the limb.
  • Sensory substitution
    • Involves providing sensory information through a different modality than the missing limb such as using visual or auditory feedback to replace the sense of touch in the hand.
  • Invasive feedback
    • Involves the use of implanted sensors to provide feedback about the prosthetic limb.

Additionally something else that needs to be taken into account is the time it takes for the feedback to reach the nervous system and be processed. Therefore, different feedback methods need to consider time delay when designing their systems. (2)

My insights and reflection

Sensory feedback plays a crucial role in bridging the gap between human limbs and artificial limbs. There are undeniable benefits in introducing sensory feedback in prosthesis such as enhanced functionality and improved quality of life including, providing a sense of proprioception to amputees. However, there are still several challenges faced in restoring sensation.

These include:

  • Expanding the range of sensations
    • Allowing the user to feel textures, temperature and also pain.
  • Personalisation and adaptability
    • Everyone is different and the ability to accommodate for a fit, growth and usage of the prosthesis is a huge challenge in meeting individual needs.
  • Affordability and accessibility
    • At this moment advanced prosthetics are prohibitively expensive and only a small handful of people around the world have the opportunity to have even basic sensory feedback.

An ethical and tricky question to consider is: Should we have artificial pain? This is a whole topic that could also lead to another post, but briefly, it has benefits for being a warning mechanism for potential harm, providing a realistic experience and better decision making. However ethical concerns arise if it is morally justifiable to subject users to distress, the level of pain intensity and how are you able to stimulate pain.

References

1.           Antfolk C, D’alonzo M, RosĂ©n B, Lundborg G, Sebelius F, Cipriani C. Sensory feedback in upper limb prosthetics. https://doi.org/101586/erd1268 [Internet]. 2014 Jan [cited 2023 Mar 24];10(1):45–54. Available from: https://www.tandfonline.com/doi/abs/10.1586/erd.12.68

2.           Sensinger JW, Dosen S. A Review of Sensory Feedback in Upper-Limb Prostheses From the Perspective of Human Motor Control. Front Neurosci. 2020 Jun 23;14:345.

George Best- at his worst

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GEORGE BEST- at his worst

Combing my piqued interest in ethical values from the lectures and my love for sports, upon learning about ‘organ harvesting’ and the Alder Hey case study, which looked at the use of organs in consensual ways, my mind instantly went to the case study of George Best. A world renound football player who wasted his donated liver on an alcohol addition he struggled with for over 40 years.

The three images display George Best throughout his life

Back to basics

Organ transplantation is no light conversation- especially when it comes to who is ‘deserving’. The NHS have a highly strategised offering system and the average wait time for a liver in the UK is 3-4 months. Which is exceptional considering the average person can live with liver cirrhosis for an average of 12 years. More information on the causes of liver cirrhosis can be found here.

Under the NHS, there is no requirement to stop drinking before a liver transplant- even if the liver failure is alcohol induced. This to me, is absurd. The NHS should aim to fix the problem at its origin- not waste valuable resources.

How would you feel, knowing that your loved ones liver went to someone who drank themselves back into the situation that brought them to the operating table in the first place?

More on George

George Best was one the first of his kind- the first true football ‘superstar’ in the 1960’s. However, by the 70’s the first glimpses of the alcoholism that would consume him for the rest of his life. By 2000, George Best had been diagnosed with severe alcohol induced liver damage. In 2002, Best received a new liver at public expenses (on the NHS), which received huge controversy. Less than a year later, Best was spotted openly drinking. Three years later he started drinking again and died soon after.

A short documentary commentating on the final years of George Best and his struggle with alcohol

Fair vs Right

Looking from different perspectives:

Liberation: Seeks to maximise freedom and the individuals rights. Therefore, the choice is the patients alone.

Paternalistic: Aims to chose a course of action in the patients best interest, but without the patients consent. For example, required rehabilitation prior to the organ transplant.

Utilitarian: Focuses on optimal outcomes via right or wrong. Requires the outcome that produces the greatest good for the greatest number. In this case, going ahead with the organ transplant would save a life and therefore have the greatest benefit.

Taking an ethical stance, I believe it is always right to treat those in need. No matter the cause of illness of injury. Saving lives and enabling a more enjoyable life are the priority. However, I do not believe it is fair to treat those incapable of maintaining their new functioning organ, as described with George Best. If those facing psychological difficulties are unable to receive a liver transplant, is it right we provide for those incapable of staying off the booze?

Moving forward?

I found researching this case incredibly insightful. George Best is not the first person to raise such an ethical dilemma, and he certainly wont be the last. In fact, those who require liver transplants in the future will only rise due to the impacts of COVID-19 and the increased alcohol consumption it has brought. My hope is that the increasing numbers of those suffering with alcoholism will force health care organisations globally to take longer-lasting action, such as, putting measures in place to combat the individuals struggle with alcohol before operating.

Neuroprosthesis – Where do we draw the line?

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After a long day of lectures, my housemates and I decided to watch a couple of episodes of Black Mirror on Netflix. This is an series based on the dangers of technological advancements in a dystopian near future. The scary aspect of Black Mirror is that the rationale and vision for these technological advancements portrayed in the series is highly compatible with our own. Even with good intentions such as curing disease and reducing crime, brings its own consequences.

We watched an episode whereby all your memories were recorded so that you could watch them back or could be used by police and authorities. In the show, it was originally designed to help with those suffering with Alzheimers, but now has evolved into something more sinister than intended. It brought up an ethical debate within our house on whether or not we would do it, as well as the topic of free will.

We discussed that very few have an issue with prostheses to help with motor functions such as hip and knee replacements, prosthetic legs, and even replacement organs such as a pacemaker. However, what about prostheses in the brain? I am a Neuroscience student and realised there were very few examples of neuroprosthesis so, naturally, I was intrigued. The brain is one of the only organs in the body where we cannot get a transplant, and this is only explored in science fiction.

Crminal (2016) – A convict is implanted with a dead CIA agent’s memories to finish an assignment
Total Recall (1990) – A company that implants realistic false memories, and chooses one set on Mars where he is a Martian secret agent
Get Out (2017) –  A family transplants people’s brains into others’ bodies, granting them preferred physical characteristics and a twisted form of immortality

What are the current technological possibilities?

Elon Musk is currently developing a technology called ‘Neuralink’ that will give people with quadriplegia the ability to control computers and mobile devices with their thoughts. Fascinating!

https://neuralink.com/ – Read more about their approach and applications

Here is a podcast discussing the current breakthroughs in commercialising Brain-Computer Interfaces using a minimally implantation method and a soft electrode device. They explain how they received lots of support in the early stages of research, showing it to be an area of interest for investors. Their approach is to build on existing research and translating that into clinical practice.

Craig Mermal on working at Precision Neuroscience – Neural Implant Podcast

Next Steps…

If our liver stopped working, we could use stem cells, and get a transplant, and there is even research regarding a 3D-printed liver. What about the brain? For an Alzheimers or Multiple Sclerosis patient, would you consider using stem cells or an implant to replace parts of the hippocampus or myelin for neurons? Yes, most likely. What about someone with Schizophrenia, would you replace their frontal or temporal lobes? What about depression, autism, ADHD or OCD? By definition, they have an illness or a disorder.

Where would we draw the line?

Discussion point:

Imagine someone in the army or someone who has experienced trauma. Prosthesis is a way of improving someone’s quality of life, so how far can we go? Would we attempt to make people less emotional, smarter, remove traumatic memories, and stop people from experiencing fear? This would certainly improve their capabilities as a soldier, improving their quality of life and removing the risk of developing PTSD, experienced by many soldiers.

Is this improving their quality of life or eradicating a vital part of their identity?

How would society change if this was the norm?

Here are 2 episodes of Black Mirror that show the applications of neural implants that go beyond treating neurodegenerative disease…

My final thoughts:

I believe that neuroprosthesis should be encouraged as it could change millions of lives for the better. Only with strict regulations can these advancements benefit society and help those suffering with physical and mental health problems. I don’t belive that society will be benefitted from technology enhancing memory, intelligence or physical capabilities in those who don’t require serious help or assistance.

WILL STEM CELL POTENTIALLY SURPASS OUR POV ON ETHICS

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Over the past few weeks I’ve had the privilege to learn about the various topics and categories of what we know as engineering and topics. From our lectures, 2 topics had especially stood out to me, and these were stem cells, and Bioethics. And they went surprisingly hand in hand.

What are stem cells?

Stem cells utilise the ability of differentiation to the max by possessing the gift of differentiating into any of the cells in our body, asymmetrically or symmetrically. Just from this you can see they have the potential to make many strides in modern medicine, in fact there have already been papers regarding their use in surgeries already. 

An example of stem cells potential in surgeries can be their use in deep tissue repair following burns to the face.

A paper from Ncbi states: current treatments with skin replacement aren’t capable of generating fully functional skin, and mentions “ administration of growth factors has occurred, it comes with many consequences- in summary : “ using stem cells in treating burns is justified here, as stem cells are able to secrete these growth factors in a sustained manner”(Kareem NA, et al (2021))  Allowing me to believe they’re a more beneficial alternative to current components in surgery. 

My own research on other articles concerning stem cells, left me with a lasting impression on how they can revolutionise modern medicine in the future. HOWEVER, I was reminded of our ethics and law lectures, and while stem cells are viewed in such an amazing light, they can easily be abused and researched with the wrong intent. 

Jeremy Bentham. (1748-1842) the one who created the Theory of consequentialism

After reading multiple articles I noticed that the intent of research always originates from the researchers own moral compass. Which correlates to the theory on consequentialism, it defines the right action in terms  of promotion of good consequences, concerned with maximising the good outcome.

Ensuring the benefit of humanity isn’t perceived as exploring our potential evolutionary consequences. 

FROM A RELIGIOUS POV 

Christianity- found in a paper published by the University of Notre Dame 

“Clearly, the church favours ethically acceptable stem cell research” however later states “we must respect life at all times especially when your goal is to save lives”. Telling me that, we want to respect life as much as possible so in the future, when research has developed further, we don’t overshadow our morals as human beings by exploring humanities limits through human subjects. 

Islamic perspective: an article on Georgetown explains that “ they’ve prohibited using embryonic stem cells which have the potential to develop into a life in research as it entails their destruction during the process of procurement”. 

Explaining that if using stem cells in the lab involves developing a life form to be used for experimentation, it cannot be condoned as morally right because in the later stages of development is when they believe this life form is endowed with a soul. 

WHAT DOES ALL THIS MEAN FOR US IN THE FUTURE

In my opinion Stem cells will help solve various problems in medicine in the future, these include the issue of waiting for donors for a transplant, or an alternative to animal experimentation. I believe that those conducting research using stem cells only view it as a means to benefit us without compromising our moral compasses as human beings. 

CONCLUSION 

To conclude, the use of stem cell research provide an essential role both now and in the future for counteracting various problems in the medical field, ranging from unforeseen diseases yet to sprout, to limbs lost during accidents causing trauma. However this only applies if they’re used for the specific benefit they have in mind, and there is a thin line between using stem cells as a means for improving our quality of life, and using stem cells to explore the capabilities of us as humans.

What makes us human?

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Humans are incredible. We can create new technologies, reshape the world, and even engineer ourselves. Being a biomedical sciences student with a love for genetics, I was utterly fascinated in our ethics workshop when the topic of genetic engineering arose. Our genome defines everything, from how our organs develop to little things like whether you have attached or unattached earlobes. But if we start editing this, are we still human?

The basics

After first being described in 1987 by researchers at Osaka University, CRISPR (clustered regularly interspaced short palindromic repeats) were found in the DNA sequences of E. Coli, which naturally occurs in bacteria as an antiviral tool. 18 years later, in 2005, the Cas9 nuclease was first described; with that, the CRISPR-Cas9 system was created.
CRISPR-Cas9 acts as a ‘cut and paste tool’ for our genome.
How to edit a gene (simplified):

  1. Identify a genetic sequence you want to edit, for example, a sequence that causes disease.
  2. Program the CRISPR system with the gene and combine it with cells.
  3. The Cas9 nuclease protein can locate and cut the gene out, allowing the target gene to be edited or removed and replaced.

This system works precisely and enables specific genes to be, targeted and edited. But as ever, with new powers comes new responsibilities.

Diagram of the CRISPR-Cas9 system

The power

I have seen the effects of a genetic condition first-hand. Both my sister and mum have a condition called Stickler Syndrome, caused by a mutation in one gene, COL2A1. This one mutation causes all the collagen in their bodies to be faulty. This has led to many complications but most prominently within their eyes. They have faced retinal tears and detachments due to the lack of collagen in their sclerae. Their COL2A1 gene could be edited with genetic engineering, and their bodies would produce working collagen.

Despite affecting me personally, I believe CRISPR-Cas9 will change the world when applied correctly and ethically. Not only a world without disease, but it could lead to so much more. For example, humans that are resistant to cancer or ageing.


This video explores all the amazing future applications of CRISPR-Cas9.

The responsibility

As with all novel scientific developments, with must discuss bioethics. The key ethical issue with genetic engineering is that it would be applied directly to humans. After the Nazi Nuremberg trials, international bioethics guidelines on medical experiments on humans were set out within the scientific community. Despite only editing a specific gene, predicting the effect on the rest of the patient’s genome is difficult. As well as this, we are unable to know how this genetic editing will affect future generations.

Not only are there ethical issues with experimenting on living people, but there is an issue with where we draw the line. If we can make ourselves free of genetic disease, what stops us from editing our genome to make us more beautiful or intelligent?

Conclusion

To conclude, genetic engineering is a positive thing for humanity. What makes us human is the desire to continue to improve our lives and the lives of others. Genetic diseases, cancers, and other related issues cause unnecessary suffering. If we have the technology to prevent this, we should.
Humanity has been evolving for 300,000 years and will continue to for years. Genetic engineering is the next step in human evolution. However, I believe that we should only use CRISPR-Cas9 for healing, not for aesthetics and that it should be tightly regulated to prevent abuse of this powerful system. I cannot wait to see what else we will achieve with genetic engineering.