Regenerative Medicine Applications in Organ Transplantation
A new book discusses the advances that have been made in the role of regenerative medicine in organ transplantation.
The advent of organ transplantation was undoubtedly one the proudest achievements of modern medicine. Even more awe-inspiring is the sheer number of patients whose lives have been saved by these extraordinary methods. Alas, the wild success of surgical transplantation has highlighted its most tragic limitation: the chronic shortage of suitable organs. Adding fuel to the fire is the demand for these donor grafts, which is rising continually. The consequences, regrettably, are predictable as thousands of patients die annually while on the waiting list for a new organ, such as a kidney or a heart. This shortage has been a problem since the earliest days of transplantation and every surgeon is intimately aware of it. For those fortunate patients who are able to receive a lifesaving organ, there is, of course, the other problem: a life-long commitment to a strenuous immunosuppressive regimen. Immunological rejection is the chief obstacle to successful graft function and is virtual anathema to every transplant operator working today. Nevertheless, recent advances in the fields of regenerative medicine and tissue engineering suggest that modern medicine stands on the brink of a watershed transition into a new age of organ transplantation. Indeed, this new book by Professor Giuseppe Orlando and his colleagues makes a formidable case for a potential paradigm shift that could spell the end of both the chronic shortage and immunological rejection.
Regenerative medicine, although sometimes an elusive concept, is reasonably described by its goal to restore form and function via the exogenous introduction of biomaterials and cells, which act in two ways: directly replacing structural and parenchymal tissue, and inducing the body’s own healing and replenishment mechanisms that are often absent in serious injury. Clearly, there is much overlap between this approach and organ transplantation, which also seeks to restore and replace. Keenly aware of the parallels, Orlando devotes the beginning chapters of this book to expounding this connection. Orlando goes on to describe the current understanding of stem cell biology, biomaterials science and organogenesis. The remaining segments illustrate in impressive detail the state of the art in organ bioengineering (i.e., the fabrication of new organs ex vivo with the goal of eventual implantation).
The contributing authors brought together for this edition are all renowned authorities in their respective fields, which extend from the basic and clinical sciences to biomedical and nanoscale engineering. The organ systems covered include the liver, heart, lung, intestines, pancreas, and bone, to name a few. The overarching thesis, which ties together every chapter in this book is that the potential applications offered by regenerative medicine represent the new ‘holy grail of organ transplantation’, a phrase aptly coined by the editor.
Given the broad scope of this book, its careful approach can sustain a wide readership encompassing both students (undergraduate and graduate) and professionals of not only the health sciences, but engineering as well. Furthermore, this book can serve as both an introductory text for those who wish to gain entry into the fields of bioengineering and organ transplantation and as reference material for established scientists and clinicians seeking to enhance their current understanding and investigations. Indeed, the book is crafted in a way that forms a bridge between transplantation surgery and bench-side investigations in regenerative medicine. For example, the section of the book that deals with the heart begins with a review of the current status of heart transplantation. It goes on to describe heart regeneration from two perspectives: the stem cell approach and the bioengineering approach. Thus, the medical student or resident pursuing a career in thoracic surgery would benefit a great deal from reading the entire section. The biomedical engineer seeking to adapt his/her cardiac device projects to realistic clinical constraints would similarly benefit from a perusal of these chapters.
Unique highlights from this book include the historical perspective offered by Joseph P Vacanti, Jean-Bernard Otte and Jason Wertheim in the first chapter. They cite examples of various advanced organisms such as the salamander and the sea cucumber regrowing appendages, suggesting a fascination with bioregeneration long before the rise of regenerative medicine as a major scientific field. Interestingly, the editor has elsewhere raised the question of why the mammal, which exhibits formidable regenerative abilities in utero, loses this capacity after birth and why simpler organisms throughout the plant and animal kingdoms retain this ability . The authors trace transplantation and surgical reconstruction of each organ system to their respective origins and, in doing so, highlight that the endeavor to restore functional tissue long predated the rise of tissue engineering and regenerative medicine.
Another notable section of this book deals with the possibility of immunosuppression-free transplantation offered by the regenerative medicine paradigm. As Sir Roy Calne, Emeritus Professor of Surgery at the University of Cambridge (UK), notes in the preface, the introduction of cyclosporine immunosuppression following transplantation represented a watershed in organ transplantation due to the dramatic rise in survival rates. If regenerative medicine enables transplantation to circumvent the need for immunosuppression via the manufacture of transplantable organs using autologous cells and scaffolding obtained from the patient, then we truly are on the brink of the next watershed in organ transplantation. The chapters presented in this context offer a rich scientific discourse on the nature of tolerance and on concepts such as immunomodulation and immune cloaking (i.e., shielding antigenic graft proteins from immune surveillance).
Fortunately, the technical and biomedical jargon that permeates most of the text is tempered by important ethical and economic considerations presented at the end of the book. The era of regenerative medicine is coming and these chapters offer a small measure of preparedness for the inevitable. Nancy MP King, author of the ethics chapter, is a renowned bioethicist whose contribution to this edition is invaluable. She touches on several pertinent issues including the rights of human subjects during clinical trials and blurred distinction between research and treatment, which can lead to not only unreasonably high expectations of benefit from experimental intervention, but to unreasonable discounting of the risks involved with such interventions.
Judging by the goal of bridging the fields of organ transplantation and regenerative medicine, the editors and contributors in Regenerative Medicine Applications in Organ Transplantation ultimately succeed in providing an immersive discourse on the topic. Given the implications that a chronic shortage of organs has on public health and society, this book is a valuable resource for students and professionals seeking to do something about this problem by taking advantage of cutting-edge developments in one of those most dynamic scientific disciplines existing today, namely regenerative medicine.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
Written by Ivan Martin
Departments of Surgery & of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland; firstname.lastname@example.org
This article was originally published: Regenerative Medicine 9(3), (2014).