Deep Futures

Deep Futures Episode 2: Medicine - Anthony (Tony) Atala

Luke Masella: I remember when I was told that I was in kidney failure, the doctors were not really sure what to do. So that was kind of a scary thing to hear as like a 10-year-old kid. I remember like asking my mom after the doctors left, I asked her, I was like, “Does that mean I'm going to die?”

Annalee Newitz: This is Luke Masella. Luke was born with spina bifida, a malformation of the spine that affects the nervous system.

Luke: And they actually told my parents I probably would never walk.

Annalee: He managed to start walking at a typical age, which was very promising.

Luke: But as I started to get a little bit older, my bladder was more affected by the spine condition. It was pushing fluid from my bladder back up into my kidneys, which is called reflux.

Annalee: When he was 9 or 10, things took a turn for the worse, and Luke’s doctors were stumped.

Luke: I was really sick. I had like no energy, really lethargic, and it was like a struggle for me to get out of bed every morning. It went from trying to figure out what's going on to like I'm in full out kidney failure now.

Annalee: Luke wasn’t a good candidate for kidney transplant, because the problem wasn’t in his kidneys, it was his bladder. Luke, not even in the 5th grade, was facing a lifetime on dialysis.

Luke: Luckily it didn’t turn out that way.

Annalee: The reason it didn’t turn out that way is because Luke's urologist knew this guy.

Anthony (Tony) Atala: I'm Anthony Atala, and I'm the director of the Wake Forest Institute for Regenerative Medicine.

Annalee: And Tony Atala had kind of a crazy idea: to make a new bladder, by hand, using Luke’s own cells. Twenty years later, that crazy idea has evolved into something that sounds like pure science fiction: 3D printing human organs—on demand.

Annalee: I’m Annalee Newitz, and this is Deep Futures, a show about building a better tomorrow.

Annalee: On today’s show: The Future of Medicine.

Tony: If I had to start all over again, knowing what I know now, I would have never started with an organ as complex as the bladder.

Annalee: You wouldn't guess from Tony’s humble demeanor that he's one of the most respected scientists in the country. Born in Peru and raised in Florida, Tony got his M.D. at the University of Louisville and came to Boston on a research fellowship at Harvard Medical School.

Annalee: When Tony met Luke, he was working as a surgeon at Boston Children’s Hospital. Some of his patients were kids who desperately needed organ transplants, and a few even died while they waited. And even today, this isn’t just a problem faced by kids. There’s a severe organ shortage for everyone, and it’s only getting worse.

YouTube News Clip VO: “Every 10 minutes someone is added to the organ donor waiting list—a list that continues to grow.”

Tony: So it’s about 100,000 people on the waitlist right now for transplants, about 80 percent are waiting for a kidney. There are a lot of patients out there that have end-stage failure and cannot get an organ, so much so that the American Hospital Association has declared this a public health crisis. There's just not enough organs to go around.

Annalee: Even if someone is lucky enough to get a donor organ, there are tons of possible complications. Organs can be rejected by the body and attacked by the immune system, which treats the implant like a foreign invader.

Tony: Those patients need to be on anti-rejection medications pretty much for the rest of their lives in many instances, and there's a failure of some of these organs to survive the rejection.

Annalee: While they’re waiting for a transplant, many patients have to go on dialysis—and that can be really expensive.

Tony: This is a procedure where three times a week the patient gets hooked up to a machine where the blood is filtered through the machine instead of through the kidneys. The average cost right now for a patient to be maintained on dialysis through end-stage kidney failure, all costs involved; medications, social costs, healthcare costs, is about a quarter of a million dollars per year per patient.

Annalee: Tony knew there had to be a solution to the organ shortage problem. He and a research team at Harvard thought that something called regenerative medicine might be the answer.

Reptilicus VO: “Professor Martin, would you explain exactly what regeneration is?” “Regeneration is ability of living tissue to heal itself….”

Annalee: Regenerative medicine is the science of repairing damaged organs and tissues by regrowing or replacing them using the patient’s own cells. The idea is to give humans the power to regrow organs, kind of like a lizard regrowing its own tail.

Amazing Spider Man VO: Dr. Curt Connors (The Lizard) “...Many of these wonderful creatures are so brilliantly adapted that they can regenerate entire limbs at will. You can imagine my envy.”

Annalee: And it has the added benefit of creating an organ that the patient’s body won’t reject. In the beginning, there were a lot of skeptics.

Tony: I'll never forget that the very first time I put together an abstract to present at a national meeting regarding this technology, which was flatly rejected, and I did meet the program director, and I went up to him and I said “Hello”, and then I said, “Oh by the way, you know, I did submit an abstract to this meeting and it was about this work we're doing, but it got rejected. I don't understand why it got rejected.” And he turned to me, he said, “Well, that’s easy, that’s because it can't be done.”

Annalee: Except it could be done. By the time Luke needed a bladder, Tony’s procedure was still experimental but it was definitely ready for prime time.

Luke: I think I was like the ninth or 10th person to have it, and he explained to us that they would take a piece of my bladder out like a biopsy, and then they would extract the cells from it, and use those cells to grow me a new larger bladder in lab, and then a couple of months later I would come back in and then part two, which was the hard part of the surgery, as they explained it, was putting that bladder in me. I remember thinking, all right, “I'm in.”

Annalee: Luke just wanted to get back to playing sports. He didn’t realize just how cutting edge the idea was, and Tony, he kept his cool, but he admits in his low-key way that he was anxious too.

Tony: You never know until you put into a patient, you never know what the final outcome will be. So definitely, these experiences are anxiety producing, to say the least.

Annalee: When it was over it took Luke some time to figure out how to manage his new medications, but soon it was clear that Tony’s crazy idea had worked. Like, really well.

Luke: I started wrestling competitively, and I ended up by my senior year, becoming the captain of the wrestling team and really, it was just being able to do the normal things, you know, like a middle school and high school kid does, like hang out with friends and play sports and go to parties, like fun stuff like that.

Annalee: Tony and the team at Boston Children’s Hospital had successfully built Luke a new bladder out of Luke’s own cells. For real. It wasn’t just a technical breakthrough, though, it was a life saved. Today Luke is a healthy, active 30-year-old—he can live on his own and he still loves sports.

Luke: Most people I tell about this surgery, they’re like, “When did you have that, like a couple of years ago?” I was like, “No, when I was 10, like back in 2001 I had the surgery.” I'd say the majority of people can't believe that that kind of technology was around in 2001. So I think there's still a lot of people that aren't aware that that kind of regenerative medicine is in the stages of being close.

Annalee: So how do regenerative medicine researchers like Tony Atala actually make an organ anyway? Tony told me that 20 years after Luke got his bladder, such organs are still crafted mostly by hand. The way he describes it, these handmade organs almost sound like something you’d buy on Etsy.

Tony: So you can imagine a piece of cloth, and that you're basically suturing it to the right shape.

Annalee: Imagine one of those papier-mâché projects that kids do in elementary school. You know, the ones where you make a mold out of wire and then coat it with paste and strips of newspaper? It’s the same thing with these organs, except instead of wire, you use a biodegradable scaffold in the shape of the organ you want, and you coat it with layers of cells. Once the cells have grown for a while, they start to organize themselves around the scaffold, naturally taking the shape of the organ you want.

Annalee: Surgeons implant the whole thing into a patient’s body, and over time, the scaffold biodegrades, leaving nothing behind but the new organ. It’s undeniably cool, but there’s a problem. We can’t hand-make organs for the hundreds of thousands of patients who need them. Tony figured there had to be a way to automate this process.

Annalee: That’s where 3D printing comes in.

Annalee: Nineteen years ago, Tony and his team converted an actual inkjet printer—yes, just like the kind people use to print college term papers back in the day, and they turned it into a device that prints human organs. That DIY setup has now evolved into a legit, hundred-thousand dollar apparatus about the size of a filing cabinet, called the Integrated Tissue-Organ Printer—ITOP for short.

Tony: If you think about your typical desktop printer, where you where you have the inkjet cartridges going back and forth, back and forth to print onto paper, in a way that's very similar to what we do with a with our tissue printer. Just picture an inkjet cartridge, but instead of using ink, you're using cells with a gelatin substance in there, and then you have the nozzles go back and forth, back and forth, over and over again, two dimensionally to create three dimensional structures. Really, it's just like your typical desktop inkjet printer, but of course a lot more sophisticated.

Annalee: It sounds like what we see in the opening credits of Westworld, that HBO show set in a dystopian future where the bodies of humanoid robots are 3D printed on demand.

Annalee: Tony loves comparing his work to science fiction—and lots of other people see it that way too, especially after he 3D printed the scaffold for a kidney live at a TED Talk in 2011.

Dr. Atala’s TED-Ed Talk VO: “So these gloves are a little bit small on me, but here it is; you can actually see that kidney as it was printed earlier today”

Tony VO: That kidney was a prototype, kind of like a beta release. They haven’t actually put one in a patient yet, and that’s still a long way off.

Tony: Many people think oh wow, this is amazing, right? It's so magical. You just push a button and the printer just prints this organ. But you know, nothing could be further from the truth.

Annalee: While scientists have been able to grow organs like skin, bones, and less complex organs like bladders and intestines, we can’t yet make what are known as “solid organs”—hearts, livers and kidneys. And that means those waiting lists for kidney organ donations aren’t going to get shorter in the next few years. We’re going to need more like decades before 3-D printed kidneys are widely available. But we asked Tony to step into our time machine—

Annalee: —and imagine a future where it would be possible to print out a kidney or a liver for a kid like Luke.

Annalee: In this future, every hospital would be stocked with small, portable ITOP organ printers.

Tony: A hundred from now one can foresee a patient showing up to a doctor. They have organ failure, they have a x-ray study done, and then they have a printer right there at the facility that creates the organ for that specific patient that gets implanted fairly quickly. One scenario could be that you go into an operating facility where you're asleep, and the printer is at the bedside, and the printer just goes ahead and prints the structure. Of course, science fiction today, but, 100 years from now, certainly a possibility.

Annalee: And once your new organ is printed, doctors might use robots to implant it into your body laparoscopically. In the most advanced hospitals—and this is where things get really nuts— there might even be a printer that could grow the organ inside your body without any surgery at all.

Tony: That's one of the things that we're working on right now. We've actually published some work, experimental of course, showing that we could use a printer that prints right on the patient. So the strategy is, then can you just make that happen in a totally non-invasive manner? And that's definitely one of the goals for the technology long-term.

Annalee: Some researchers believe that one day we might be able to swallow a pill that contains all the elements needed to repair an organ, and we’ll use machines outside the body to guide that pill’s contents to the right spot and activate it. Just last year, scientists in China used a similar technique to repair a deformed mouse ear.

Mickey Mouse VO: “This is it, Goofy, our very own chance to make a scientific discovery of a lifetime.

Goofy VO: “Well, what are we waiting for?

Annalee: And remember that quarter-million-dollar price tag for kidney failure today? Tony says in the future, with organ printing, that cost could come way down.

Tony: One could foresee creating a structure that could replace functionality in a kidney for less than $100,000. That's not bad compared to the fact that you're having a recurring cost of a quarter of a million dollars per year on the other side.

Annalee: But I wondered, could we take things one step further? Could we use an ITOP of the future to just trade up? To swap our existing organs for overpowered ones like the Six Million Dollar Man?

Six Million Dollar Man VO: “We can rebuild him, we have the technology. We have the capability to make the world’s first bionic man. Better. Stronger. Faster.”

Annalee: Do you ever think about that, like. if someone in this future came in with a kidney that had failed, would they maybe get an organ that was like a hyper-kidney or a super kidney that worked better than a regular kidney?

Tony: Goodness, we're having a hard time just making sure we're creating an organ that's going to perform the same as yours. So it's not really a super organ, it’s just creating a normal organ at this point. In reality, the organs we have are pretty darn good, you know, they know what to do. The challenge is they don't take abuse very well. Really, the organs we have are very, very well designed, I guess 100 years from now you can say, “I know that genetically I'm predisposed to getting this particular condition, can we fix that now?” And that's definitely a possibility.

Annalee: That's so amazing. So it sounds like really the promise of this technology in 100 years would be, not so much having super organs, but just having replaceable organs.

Tony: Yes, absolutely. 100 years from now, it would be great to have these replaceable organs on demand.

Annalee: On demand organs, I love the sound of that. [Laughs]

Annalee: As much as I wanted super-organs, Tony made me realize that our organs and tissues are already pretty amazing. They do incredible things, like filtering our blood and turning tamales into glucose and allowing us to make medical discoveries. The problem isn’t that our organs suck, it’s that they don’t last, and that’s why having replacement organs would be a true superpower. This is biotech that could one day extend our lives by centuries. In a future of regenerative medicine, nobody will ever have to live with a damaged kidney again. A new one will be waiting for them at the hospital, ready to make them healthy.

Annalee: Thanks so much to Tony Atala of the Wake Forest Institute for Regenerative Medicine. If you want to see his kidney printer in action, we’ll drop a link to his TED Talk in the show notes.

Annalee: Next time on Deep Futures, I’m talking about the future of cities with space archaeologist Sarah Parcak, who’s about as close you can get to being a real-life Indiana Jones.

Sarah Parcak: And then there’s that scene in the map room where, you know, Indy, of course, gets the special headpiece of Ra and puts it on the staff and he measured and the light comes through and boom, he knows exactly where to dig. And that just seared itself on my brain, in a very sort of deep and sacred space.

Annalee: You won’t want to miss it. Subscribe to the podcast, and if you liked this episode, leave us a rating or a review. It helps other listeners find the show.

Annalee: Deep Futures is an original podcast made in partnership by Campside Media and Mailchimp. The show is hosted by me, Annalee Newitz. Our associate producer is Natalia Winkelman. Research help from Callie Hitchcock, fact-checking by Aleah Papes. Sound design and mixing by Mark McAdam, and our executive producers are Maya Kroth and Matt Shaer. Beep-boop-boop-boop!