The University of Southampton

Tag: engineering replacement body parts

Commercial Autogenic Cell Therapy Evolution at a Glance.

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The lectures I recently received about tissue engineering piqued my interest, specifically with the commercial availability of autogenic cells such as CarticelTM and as I looked further the development of such products was very interesting.

The 4 generations of autogenic chondrocyte implantation (ACI):

First Generation:

A 1st generation ACI procedure is shown in the video below where you can see the harvesting of periosteal tissue from the tibia, suturing of the periosteum into the knee joint, securing with fibrin glue and finally the injection of chondrocytes below this periosteal patch. Genzyme is a company which delivers this service and has reported success rates of 70-90%. Problems with this procedure include overgrowth of the implanted cells which can degrade joint function and cause pain; however this can be easily fixed by the shaving away of excess cartilage. Procedures of this type cost around $40,000, far too expensive for many people, especially in countries without nationalised healthcare such as America where insurance may not cover the procedure.

Second Generation:

Carticel is an example of 2nd generation ACI. A biopsy of cartilage is taken from lesser weight bearing areas so that chondrocyte cells can be isolated and expanded over a period of 4-6 weeks. The expanded cells are reinserted into the damaged joint to form new, healthy cartilage. On their website, Carticel states that their product is intended for the repair of “symptomatic cartilage defects of the femoral condyle caused by acute or repetitive trauma, in patients who have had an inadequate response to a prior arthroscopic or other surgical procedure”. According to the Bioinformant, Carticel autologous chondrocyte implantation costs between $15,000 and $35,000. This cost raises ethical questions because a large subset of people who would benefit from this procedure cannot afford it.

Third Generation:

Spherox is a company which offers 3rd generation ACI with a £10,000 price tag, however the Royal Orthopaedic Hospital (ROH) in Birmingham has provided this procedure and it is now eligible for patients on the NHS according to the ROH website. Spherox works in a different way to Carticel, by taking chondrocytes and producing spheroids of neocartilage composed of expanded autologous chondrocytes and their associated matrix. A sample of healthy tissue is taken from the patient in keyhole surgery and the sample is grown into chondrocyte spheroids. When the spheroids are implanted into the patient’s knee cartilage, they bind to the defective tissue and produce new cartilage tissue. For NHS patients in the UK, Spherox has far fewer ethical concerns regarding cost because the price of the operation is less than the cost caused by such injuries if left untreated to both the NHS and the patient’s quality of life.

The Future:

4th generation ACI therapy has not yet entered mainstream medicine, however various trials are underway. Some research is investigating the role of gene therapy in cartilage repair producing “temporarily and spatially defined delivery of therapeutic molecules to sites of cartilage damage”. According to this paper, the use of elastin as a scaffold is being investigated, as well as the use of a nonviral gene delivery system to allow mesenchymal stem cells to produce osteogenic growth factors.

The Ethics of Replacement Body Parts: Is It Ethical to Enhance Our Bodies?

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Medium.com

Recently I have been reviewing and watching content regarding our rapid advancements in technology which has given us the ability to replace body parts with prosthetics or other artificial devices. However, with this ability a significant ethical question arises of whether it is ethical to enhance our bodies beyond their natural capabilities. I drew inspiration for this post from the video by the Pew Research Centre included at the end.

One of the key ethical concerns surrounding replacement body parts is the question of what it means to be human. Humans have historically viewed themselves as distinct from other animals because of our unique combination of physical, emotional, and intellectual capacities. The introduction of artificial enhancements to our bodies could blur the lines of what it means to be human, and could even lead to the creation of new, non-human species. This raises important questions about how we define humanity, and what the implications of altering our bodies could be for our identity as humans.

ScientificAmerican.com

Another ethical issue that arises with replacement body parts is the potential for inequality. While the technology for artificial replacements has become more accessible in recent years, it still remains out of reach for many people, particularly those in less developed countries or who do not have access to proper healthcare. If only a select few individuals are able to afford or access these enhancements, it could lead to a new form of inequality where those who can enhance their bodies are more advantaged than those who cannot.

There is also the concern that replacement body parts could become a form of social pressure. If certain enhancements become popular or even necessary to keep up with societal norms, it could create an environment where people feel pressured to modify their bodies even if they do not want to. This could lead to a lack of individual autonomy and could even be seen as a form of discrimination against those who choose not to enhance their bodies.

However, there are also arguments in favour of replacement body parts and enhancing our bodies. One of the primary benefits is the ability to improve the quality of life for individuals who have experienced physical limitations due to injury or illness. By replacing a lost limb or enhancing an impaired sense, individuals can regain their independence and improve their overall well-being.

Archive Photos//Getty Images

Additionally, the development of replacement body parts has the potential to drive medical innovation forward. The same technology used to create prosthetics and artificial enhancements could also be used to develop new treatments for a variety of medical conditions however it would inevitably also be used military purposes as well.

To summarise the ethics of replacement body parts and the idea of enhancing our bodies is a complex issue with no easy answers. While there are certainly concerns about the potential implications of modifying our bodies, there are also clear benefits to individuals and society as a whole. As we continue to advance in technology and medical innovation, it will be important to carefully consider the ethical implications of these advancements and to work towards a future where everyone has access to these life-changing technologies.

Restoring My Old Self- Is tissue Engineering Really the Key?

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From beginning this module, I was exposed to various different topics all under the field of engineering replacement body parts ranging from ethics in research to orthopaedics. However I was surprised to find myself knowing nothing about tissue engineering until the lecture we had on it had taken place. Which was what had inspired me to do some research on the topic.

WHAT IS TISSUE ENGINEERING

Falling under the field of regenerative medicine, tissue engineering bares the goal: to assemble functional constructs that restore, maintain, or improve damaged tissues or whole organs.

It could potentially be used in surgeries in which necrosis (premature cell death in tissues) occurs. It has very considerable potential, for which scaffolds from human tissue are thrown away because of necrosis, and in combination with a patients own cells, could make synthesized organs that won’t be rejected by the immune system.

Because tissues are groups of cells grouped together, its obvious there would be certain cells needed so that tissue engineering can be brought about, the types are:

  • Adult/fetal cells
  • Adult/fetal stem cells
  • Pluripotent stem cells

And these cell sources can be divided based on their origin:

  • Allogenic cells- from a human donor
  • Autogenic cells- the donor and recipient are the same
  • Syngenic cells- from an identical twin
  • Xenogenic cells- from an animal
Allogenic cells
– Adult cells- currently have greatest clinical use
– Using fibroblasts which come from banks (of human donors)
– Available commercially Have a high growth potential		Autogenic cells
– Involved biopsy of cartilage (examination of sample cells from a patient to determine presence/extent of disease)
– From which chondrocytes are isolated and cultured, then implanted (with a biomaterial) back into a damaged joint to form a functional cartilage
– But its controversial and has mixed results
Syngenic cells
Aren’t used commercially		Xenogenic cells
– Aren’t used commercially at all
– Hybrid embryos are allowed to be created
Table summarizing the 4 origins of cell sources

TISSUE ENGINEERING IN PRACTICE

 A science paper published on the National Institute of health mentions: “currently, tissue engineering plays a relatively small role in patient treatment. Supplement bladders, small arteries, skin grafts, cartilage, and even a small trachea have been implanted into patients, but the procedures are still experimental and very costly. “

This means, they have been successful in implanting small tissues into patients, however it comes at a price. On the other hand, more larger organ replacements like the heart and lungs, although have been successfully synthesized in the lab, have yet to be successful in replacing the organ in a patient. But steady progress has been made.  

From another point of view:

A different means in which tissue engineering can provide a useful solution in is plastic surgery:

  • another paper published by the National Institute of Health mentions:

“As a group, reconstructive surgeons are facing more challenging composite defects than ever before coupled with internet and media savvy patients with increasing expectation.”

 And goes on to say:

“Among these approaches, the most attractive concept is tissue engineering.”

 Indicating in order to overcome the increasing expectations of patient’s expectations, and the number of potential patients in the future, by using the concept of tissue engineering. They can meet these demands, and “restore both form and function” to the area in which surgery takes place.

CONCLUSION

To conclude, tissue engineering has brought about potential solutions to various issues in both the medical and cosmetic field. Ranging from lack of potential donors in both of these fields (which means they won’t have to standby and wait for donors in transplant surgeries), to overcoming the severely high demand to of potential patients in the future expecting full restorations in reconstructive surgeries. Meaning, tissue engineering could become a key in which modern medicine can be revolutionized.

Getting back on your feet- I Mean Literally

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As comparison to now and a few decades ago, the field of bioengineering has come a long way, especially in the field of prostheses. Throughout our engineering lectures thus far, what particularly struck me was the week in which we had covered prostheses and limbs in our lectures. This was because they have such a huge number of applications in which can be used to help people return to living a normal life (at least as best as they can).

As someone who is passionate about the field of sports medicine, what triggered me to do further research into what prostheses were like in earlier ages- like the 90s in comparison to the ones now, specifically ones specialised for athletes.

  • The picture on the left is what prosthetics had looked like during the mid-90s. Earlier prosthetics were often made of wood, leather and metal that limited movement.
  • The image in the middle displays what prosthetics look like now. It shows that advances in material and design have enabled prosthetic limbs we use now to be more functional and comfortable. Making use of lightweight yet very durable materials like carbon fibre and thermoplastics.
  • The image on the right is what a specialized prosthetic for athletes looks like now, they make use of a device with a curved blade, which provides a good balance between flexibility and strength to withstand high- impact activities like sprinting and jumping.

From these design and material advances, more endeavors have been made to aid people in somewhat returning to a normal life (as well as attempts to make less expensive alternatives for those who can’t afford certain prosthetic’s), and furthermore provide less fortunate people an opportunity to at least recover from trauma.

A research study, taken by the University of Southampton, published in the journal of Global health. Talks about how they’re helping countries like Cambodia plan future prosthetics and orthotics.

It mentions: “thanks to a grant from Global challenges Research Fund, the University’s People Powered Prosthetic group and Exceed Worldwide, a Non-governmental Organisation (NGO) which trains specialist staff and provides P&O services- like supplying prosthetic limbs, braces, wheelchairs and community support- were able to access and, for the first time, analyse routinely collected data from existing electric patient records in an aggregated and anonymous way”

This indicates that by determining patterns in the cause of injury and disease from which amputations are required. Together with cross referencing data from the data from current patients, applications of prosthetics can be made specifically for these people, which can provide opportunities to return to work and sustain both themselves and their family.

CASE STUDY- AN ATHLETES POV

From another perspective- of someone with congenital (birth) defects- more specifically an athlete would be Richard Whitehead (a Paralympic gold medalist in London 2012, and silver medalist in Tokyo 2020). He was born with a congenital condition with which had left him with a ‘double through knee amputation’ meaning he was born without the bottom half of his legs.

Even with this condition, he went on to set a world record for athletes with double amputation (which took place at the 2010 Chicago marathon). Unfortunately, he was unable to compete in the marathon at London 2012 as there was no category for leg amputees, and was refused permission by the IPC to compete against upper limb amputees.

Because of this he turned to sprinting to compete at the 2012 Paralympics. Here was where he obtained gold in the 200m T42 Athletics event, setting a world record time of 24.38 seconds. And later on in 2013 was appointed the first ever patron of Sacroma UK, a bone and soft tissue cancer charity.

CONCLUSION

From just the past few decades (as mentioned before) technological advances, aiding both design and material advances have allowed us to consistently come up with new and innovative ways to get people back on their feet both figuratively and literally. And its yet to show and slowing down in its rate of improvement.

Overall, from cases such as Richard Whitehead, who had taken his condition as something that will not stop him from reaching his dream. As well as other cases like the people from the research study who were provided with a means to recover from traumatic events like natural disasters. It’s clear to see that prosthetics have become an integral part in the lives of these people. And taking these examples, as starting points for more research, more persistent endeavours can be made from which, more ingenious solutions can be introduced and applied to treatment for potential patients in the future.