The University of Southampton

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The Moral Dilemma of Limb Regeneration: We Have the Technology, But Should We Use It?

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Limb regeneration is a field of research that captured my attention after Dr. Nicholas Evans’ lecture on tissue engineering. The thought of regrowing lost limbs or even organs, was once something only seen in science fiction (like Dr. Conners in The Amazing Spider Man) however thanks to the advancements in tissue engineering and regenerative medicine, it is now becoming a reality. The basic idea of limb regeneration is to stimulate the body’s own regenerative abilities to grow new tissue, bone, muscle, nerves and blood vessels. Many animals are already capable of this such as a salamander.

The process of limb regeneration starts with the formation of a blastema which is a mass of undifferentiated cells capable of enacting growth and regeneration into organs or body parts. The cells have been reprogrammed to become pluripotent. Once the blastema is formed, the cells differentiate into the various types of tissue that make up the limb. They are guided by a complex network of signalling molecules and gene expression patterns. The process is similar to the normal embryonic development of a limb but, it is much faster. While the possibility of regrowing limbs is exciting, it also raises some ethical concerns.

Developing new medical technologies and procedures is expensive and regrowing limbs is no exception! This raises the question of who would have access to this technology? Will it only be made available to the wealthy or to those with good insurance? This could further widen the gap between social classes so is this really necessary?

Another concern is the impact of limb regeneration on the existing prosthetics industry. Prosthetics have come a long way in recent years and many people have benefitted from the advancements in this field. However, if limb regeneration becomes a reality, what happens to the prosthetics industry? Will there still be a need for prosthetics or will they become obsolete? This raises questions about the economic impact of limb regeneration.

Perhaps the most significant ethical concern is the question of whether limb regeneration is even ethical in the first place. Some argue that it is playing God and that scientists and doctors should not be meddling with nature in this way. On the other hand, others argue that it is perfectly ethical as long as it is used for good and not for frivolous reasons like armed forces around the world creating super soldiers.

Despite these ethical concerns, there are many potential benefits to limb regeneration. For example, it could greatly improve the quality of life for amputees, allowing them to regain or gain lost functionality and independence. It could also decrease the use of prosthetics as I said earlier, which can sometimes be uncomfortable and difficult to use. Limb regeneration could also lead to advancements in other fields such as organ regeneration. I believe that the potential benefits exceed the ethical concerns as there are numerous applications of such a process and it would have a significant impact on human health and well-being.

In the end, the decision of whether or not to pursue limb regeneration is a complex one that requires careful consideration both the potential benefits and the ethical concerns. Limb regeneration is an exciting field of research that has the potential to revolutionise medicine and drastically improve the lives of many. With the points I have brought up and with your own opinion, I now ask you, should we use it?

Hip replacement – the past, and the future.

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Recently I have had the privilege to come to Prof. Douglas Dunlops’ clinic, where I have gained a lot of understanding on orthopaedic surgery. One thing that interested me the most was looking at the development and evolution of hip replacement strategies, and where it can lead us in the future, hence why I have decided to write this blog.

From the beginning

Sir John Charnley was the first to research and develop total hip replacements. He aimed to create a total hip replacement using a synthetic substance between the femur head and the socket, instead of using the natural synovial fluid. After failed attempts with PTFE, Charnley eventually used Ultra-high-molecular-weight polyethylene (UHMWPE) for the first time in 1962. After five years of observing his patients Charnley announced the method as safe, allowing other surgeons to use his patented design and officially making the first functionally total hip replacement. After Charnley’s patent lapsed over 100 kinds of hips were licences, one of them being the EXETER. Its success arose from its tapered stem, allowing it to be easily popped out and replaced, but even-though 92% of them last over 30 years, hip prosthetics still seem to fail.

Less history, more science

Prof. Douglas Dunlop gave me a lot of insight on all the reasons why hip replacements fail, but one that stood out to be the most and seemed to reoccur was corrosion. The same way the natural femoral head of the hip joint erodes with time, the synthetic joint can cause wear and tear of the cartilage, leading to the formation of a shallow socket and osteolysis. On top of that, physical shearing forces slowly remove the protective film on the metal surface, and any taper interference will corrode the metal further.

Prof. Dunlop also showed me an x-ray of an elderly patient who had undergone multiple hip replacement surgeries. The shallow socket of the patient caused by hip displasia required for the the prosthetic to be ‘screwed’ into place along with cement loosening. Each time the stem was replaced, the femur had to be reamed, increasing the risk of fracture, prosthetic loosening and infection. This patient had a 3M Capital hip, which prompted the national joint registry due to its poor performance. At the time, the Southampton General hospital was also using a CPT Zimmer brand prosthetic with a fracture rate of 3.4%, giving them a low rating on the registry. In order to overcome this issue, Prof. Dunlop, alongside researchers at Southampton University came up with a solution.

The future of prosthetics

35 years ago, another patient at Southampton General had a similar issue. Her prosthetic migrated and became loose, leaving behind a gap in the bone. In 2003, bone graft from the bone bank was used, but eventually that also failed as screws loosened and the femoral head migrated. It was clear to me that any other attempt at revision would also be unsuccessful, but Prof. Dunlop told me about a new cutting edge technology that has the potential to change prosthesis for ever.

To overcome this issue, 3D custom implants were used, and held in place using stem cells. Not only is the shape of the implant a precise shape for the patient, but the stem cells act as a ‘glue’, allowing for bone formation and encouraging regeneration of the surface layer of damaged cartilage. The removal of old prosthetics may leave behind scar tissue, therefore stem cells may be the only solution to a patient where biology has failed. Upon further reading I have discovered that Dr. Daniel Wiznia of Yale University has developed a similar approach, and deduced that stem cells are a credible strategy and have considerable potential in the future of prosthesis.

Moving away from monoblock stems and exchanging them for a stem with an exchangeable ceramic head seemed to me like a very impactful advancement, but after hearing about the use of 3D printing and stem cells, it has become clear to me that scientists are not done there. It is fascinating to see how the approaches to prosthesis have changed in the last 60 years, and leaves us to think where it can lead us in the future. By writing this blog I aim to show just how fast science is progressing and how successfully scientists are coming up with solutions to clinical problems.

I got the opportunity to listen to Prof. Dunlop talk about his work
Source of information on Sir John Charnley

The Revolution of 3D Printing in Prosthetic Limbs

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Introduction

In recent years, remarkable advancements in the field of prosthetics have been sparked by the development of 3D printing. This technology has revolutionised the way in which we can provide more customisable, affordable, user-friendly prosthetic limbs. One of the biggest advantages of such technology are found in its capability to be accessible to so many where, according to NGO LIMBS, only 5% of almost 40million amputees have access to prosthetic devices(1). This blog aims to expand on the incredible inclusion of 3D printing in the world of prosthetic limbs and how it has the potential to transform lives.

Bone Health Preservation

3D printing allows for custom-fit sockets which have the benefit of using digital scans of patients to develop prosthetics which are more efficient in reducing friction and evenly distributing weight across the limb. This means that bone is less likely to be lost as a result of the prosthetic, which can sometimes occur when the prosthetic socket is not an accurate enough fit. Another benefit of this technology, is its capacity for easy adjustments and remodelling to ensure a consistently well-fitted prosthetic, decreasing the chance of any complications leading to disuse and resultant bone health consequences. Additionally, the 3D printing of prosthetics often uses thermoplastics which are much lighter weight and therefore place much less pressure on the bones. Resultantly, bone density is more likely to be preserved and fractures are more likely to be avoided, aiding the maintenance of bone strength.

Disadvantages and Solutions

Although there are benefits to the use of thermoplastics in prosthetics, they are a less strong or durable option when compared with other materials used in prosthetics, such as carbon fibre. This means that it generally has a shorter lifespan and is more likely to need replacing and therefore may be significantly less suitable for use in lower-limb prosthetics. This may particularly be the case for patients who have more active, high-impact lifestyles, or those with higher body weights.

Therefore, a more suitable use for 3D printing technology in prosthetics, as proven thus far, may be in upper-body limbs and in children. This combats complications of exerting too much pressure on the lighter-weight thermoplastic, and enhances the technology’s potential for durability. This may be a particularly beneficial advance in technology for children and growing adults. This is due to, as before mentioned, the precise adjustability of 3D printing. Additionally, it is a far cheaper option for prosthetics as traditional prosthetics can cost thousands to replace as children are out-growing them. The organisation, e-NABLE began a project whereby many constructed and donated 3D printed prosthetic hands to children for free to aid research in the area.

Summary

The amazing affordability and accessibility provides an abundance of potential for 3D printing in the field of prosthetics. Although there may currently be limitations as to what field of prosthetics this technology might be best suited to, there is hope that technological advances in thermoplastics or finding more suitable materials may lead 3D printing to be the future of prosthetics.

(1) – https://www.sculpteo.com/en/3d-learning-hub/applications-of-3d-printing/3d-printed-prosthetics/

Grow your own body! The power of regenerative medicine

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A lecture by Dr.Evans on tissue engineering stemmed my interest into the topic of regenerative medicine. After further exploration of the topic, I came across the story of Hassan. A 7-year-old Syrian boy, who was diagnosed with Epidermolysis bullosa (EB), a rare genetic disorder that caused him to lose nearly all of his skin. He had lived his entire life with the condition, suffering from blisters and severe skin loss. Fortunately, Italian scientist Michele De Luca and his team were able to grow a complete skin transplant, which was then grafted onto Hassan, curing his disease and allowing him to live a pain-free life. This inspiring story made me realise how revolutionising regenerative medicine can be, leading me to research more into the difference it makes in peoples lives.

A photo of Hassan, enjoying his life post-skin transplant

What is regenerative medicine?

From my own initial knowledge, regenerative medicine was simply finding ways to help the body heal itself, little did I know that it was much more than that.

Regenerative medicine is a branch of medicine that aims to develop treatments that help the body to replace damaged tissues. It has a proven track record of success, with therapies achieving 75-90% success rates, an incredible step forward in the health field. What I learnt was that there are many different techniques used in the sector, examples being stem cell therapy, tissue engineering and biomaterials.

What is the most common therapy used in regenerative medicine?

The most commonly used technique is stem cell therapy, which was unsurprising to me as stem cells have been the focus of many different types of scientific research in recent years, due to their unspecialised nature and ability to repair and restore cells.

Stem cells can differentiate into several different types of cells such as nerve cells, bone cells and muscle cells, these can then be used to promote tissue regeneration. They can be located in different places of the body, such as the bone marrow, umbilical cord and in adipose tissues. The stem cells are harvested from a donor or the own patients body, and then separated from other cells in the laboratory. When the preferred stem cell is chosen, it is injected into the patients body at the site of the damaged tissue, and the cells migrate to the area to begin regeneration.

Following Hassan’s story, we can see how useful stem cell therapy can be, as stem cells can also be used in skin transplants to create a source of new skin cells that can be transplanted onto the patients skin, promoting healing and regeneration of the tissue. Doctors and scientists are continuing to explore new ways to harvest the regenerative power stem cells have, improving the treatment of skin injuries and conditions.

Prospective stem cell treatments

Stem cell research is a rapidly evolving field, with many potential future stem cell treatments being researched. Some of the most promising research areas include organ regeneration, stem cells have the ability to regenerate damaged or diseased organs such as the liver or heart. Researchers are investigating how stem cells can be used to create functional replacement organs for transplantation. Another interesting research are is into anti-aging therapies, where stem cells have the potential to reverse age-related damage and regenerate healthy tissue. Researchers are looking into using stem cells to treat age-related diseases like osteoarthritis and macular degeneration.

While many of these potential stem cell treatments are still in the experimental stage, the preliminary results have been encouraging. As research in this field advances, we can expect to see new and innovative applications for stem cells in the treatment of a wide range of diseases and conditions. If these treatments were to be successful in the future, it would completely reform the medical field and save/improve the lives of millions of people across the world.

A heart derived from pluripotent stem cells being cultured in a bioreactor delivering a nutrient solution to replicate the environment a heart would need  (Bernhard Jank, MD, Ott Lab, Center for Regenerative Medicine, Massachusetts General Hospital)

Issues arisen from regenerative medicine

While current treatments and future turnouts derived from regenerative medicine are both incredible and life-changing, there are some set backs.

One of the main concerns is the safety of stem cell therapies, there is a risk of the cells differentiating into the wrong type of cell, which could lead to adverse effects such as tumours or other tissue damage. As the cells have been transplanted from outside the body, there is also a risk of infection or rejection of the transplanted cells by the immune system.

Another main concern is the ethics of stem cells taken from embryonic cells, due to the embryo needing to be created and destroyed for the extraction of the stem cells. However, this issue is currently being addressed by using alternative sources, with the use of induced pluripotent stem cells being tested currently.

Not only are there ethical and safety concerns but stem cells can also be very expensive. Due to the cost, it may limit access for some patients and be discriminatory against people who may not be able to afford the treatment.

Final thoughts

Throughout my research on this topic, I have formed an opinion that supports the use of stem cells and regenerative medicine. Although there are some cons of the treatments, I feel as though the pros outweigh them, as current treatments used today are saving lives, and with continued work from scientists and doctors worldwide, even more can be saved. Hassan would have been in constant pain without these treatments, but now he can live a long and happy life thanks to them. Not only can the benefits be seen through Hassan’s story, but also in the lectures in tissue engineering and stem cells by Dr.Evans.

“Stem cells are the future of medicine, but they are also the present. We have only just begun to scratch the surface of what these amazing cells can do, and the possibilities are truly limitless.” –

Dr. Robert Lanza

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?

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.

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.

For the Greater Good – The Ethics behind Medical Research

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The phrase ‘for the greater good’ has been used to justify many actions over hundreds of years including some horrific events occurring in Germany and Poland during World War II which eventually led to some revolutionary scientific discoveries that hugely benefited the medical and science worlds; but do the ends really justify the means and is it okay to turn a blind eye when sourcing medical material if the work conducted leads to improving and saving the lives of many?

I am very passionate about both history and medicine and after our ethics and law lecture focused on bioethics and in particular highlighting some of the events and ethical dilemmas that occurred during World War II that led to great medical discoveries, I knew I wanted to look deeper into this topic and see just how far some people might go for the greater good, in the name of science.

Nazi Medical Experiments

It’s well known that prisoners of war are often not treated with basic human dignity but what surprised me is the shear volume of prisoners both in the past and present who fell subject to non-consensual medical experiments at the hands of known medical professionals all to advance the science world.

Max Clara

Max Clara was the first Nazi Physician I came across who’s medical work lead to the discovery of Clara cells, which line the airways of the lungs. These cells have since been labelled as key to protecting the airways from environmental exposures and have been a focus when researching respiratory diseases but the initial discovery did not stem from an ethical route. Clara and his team conducted experiments on Jewish prisoners both dead and alive with no consent given for these experiments. Clara believed that the medical material would otherwise be going to waste and so the best outcome would be to put it to good use and experiment on the prisoners.

Modern Day Non-Consensual Experimentation

Xinjiang internment camps

This all might seem like historic events but ethical violations occur in todays worlds. The Chinese government has set up 85 ‘re-education’ camps since 2017 in order to suppress the Uighur Muslim minority in Xinjiang with more than 1.8 million muslims imprisoned. In 2018, a former worker came forward and revealed some of the horrific events she witnessed including prisoners that were gang raped, tortured and forced to undergo medical experiments including live organ transplants and drug testing in ‘Nazi-like’ procedures. It’s known that the way in which Nazi physicians conducted their experiments is not condoned but their work still produced great scientific discoveries. With this in mind, does that mean that although the way in which China is treating their prisoners is not condoned, if good scientific research/ discoveries result from the imprisonment, will it be accepted by the scientific community and more-so the world?

Do the ends justify the means?

In the case of Max Clara, I believe the ends certainly do not justify the means. the justification that the material would otherwise go to waste it just not sufficient in my eyes. Even after death, I believe the human body should be treated with respect. In countries like England, organ donation and human experimentation after death has to be approved by either the donor or their appointed family and so why should the wishes of a prisoner differ, especially a prisoner who still has their life?

After doing extensive research into this topic I have discovered that a lot of current medical information has stemmed from extremely unethical sources but the issue at play is at what point do you draw the line and say ‘no, I cannot accept this research regardless of the implications it will have on people due to the foundations of your experimental research?’ At what point do you say ‘no, for the greater good is just not an acceptable justification for your research’.

Xenotransplantation: A medical breakthrough or an ethical dilemma?

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During one of our lectures, our professor brought up the topic of ‘humanised pigs’ where human stem cells are injected into pig embryos to form human organs, and this piqued my interest.

The process of transplanting cells from one species to another is known as xenotransplantation, and has the potential to solve the shortage of organs for transplants. According to the NHS, currently 6963 patients are waiting for an organ transplant and 3396 patients have received one. Unfortunately, my uncle was not one of the lucky ones, and he passed away. Because of him, I felt compelled to conduct further research in the field of xenotransplantation. Could a xenotransplantation have potentially saved my uncle’s life? And if so, would he have agreed to it if given the chance?

The idea of genetically modifying animals to serve as organ donors for humans is both fascinating and controversial, and therefore I had to explore it further.

The history of xenotransplantation

Xenotransplantation timeline made using Adobe Premier Rush.

How is xenotransplantation performed?

Pigs are ideal candidates because of their size, ease of breeding, and anatomical and physiological similarities to humans.

Pig cells are genetically modified using gene knockouts or gene-editing technology like CRISPR-Cas9 in order to reduce the risk of rejection by the human immune system.

This is done by removing pig genes that will trigger immune responses when transplanted in humans and by introducing human genes to make the pig organs more compatible.

Once the genetically-engineered pigs are grown, the desired organ is removed and transplanted into the patient.

Immunosuppressive drugs are administered and the patient is monitored for the rest of their lives.

What are the ethical issues and concerns in xenotransplantation?

Is the breeding of animals for the purpose of using them as a supply of organs ethically acceptable? Is it more ethically justifiable to use animals for cosmetic and drug research (e.g. development of vaccines and cancer treatments)?

There is much debate surrounding the use of animal organs in humans, raising concerns about their exploitation:

  • It violates animal welfare; it is unethical and cruel as they are capable of suffering and feeling pain
  • Animals can not give consent; genetically modifying pigs to harvest their organs violates animal rights and we are using them for our own benefit without their explicit consent.

Some may argue about the possibility of organ rejection and the risk of cross-species infection, but if you ask me technology advances rapidly and by using CRISPR-Cas9 to genetically modify pigs, antigenicity can be reduced and viruses like PERVs- porcine endogenous retrovirus, can be inactivated, lowering the risk of transmission.

Although, it is important not to neglect other possible alternatives in addressing organ shortages like tissue engineering, lab grown organs, 3D bioprinting and stem cell research.

The way I see it, while there are significant ethical considerations, the potential benefits of using animals for human transplantations can’t be ignored. If this could possibly mean saving my uncle’s life, how could I not support it? What if you had a close relative who needed an organ transplant, would that change your perspective on xenotransplantation?

Taking into account everything I have learnt so far from my research, I believe that xenotransplantation is moving closer to becoming a viable and life- saving option for patients in need. As it progresses, it is essential to maintain a balance between the scientific advances and ethical considerations to ensure the welfare of both humans and animals. Whether we like it or not this is a medical breakthrough!