Noting some of the more selfish and sinister practices of humans seeping into the 3D printing ecosystem and even having been on the receiving end of some of it personally, some days it can be hard to look for the good and find the joy. Disappointing experiences are a part of life, though, as is tragedy and life goes on, even when it doesn’t.
Looking for inspiration among those consistently working for the greater good I turned to the field of 3D bioprinting — a discipline that undoubtedly promises so much for humanity in myriad of ways. The ultimate goal of 3D printing compatible organs for patients in desperate need of transplant has been cited over and over and over again since the first breakthroughs in the field around the turn of the century, and is, indeed a noble aim that a number of esteemed research and development (R&D) laboratories across the globe claim to be working towards as they develop new animate printing techniques with living cells for a wide range of specific applications.
The ability to precisely create, manipulate and sustain living tissues will signify a true paradigm shift in the provision of personalised health care and extending life for many. I say ‘will’, because while creation and manipulation has largely been proven there is still a question mark over sustaining the tissues once they have been formed. Efficacy still has to be proven over time too.
I was lucky enough to hear Gabor Forgacs give a presentation on his pioneering work in the field of bioprinting recently, and to speak with him one on one subsequently. The man, who is the founder of Organovo and Modern Meadow, quite simply, is a genius; and passionate; and honest in his approach and opinions I found.
He pretty much dismissed the hyped headlines about 3D printing complete organs: “We can NOT print a whole organ – if anyone tells you they can, they are lying.” Qualifying this he assured it was not impossible in the long term to consider, but that no one is even close to that right now. He also gave his own opinion: “I personally do not believe that we will ever be able to print (or use any other engineering technology) to produce exactly the organ required.” To back this up, he cited evolution taking many millions of years to arrive at this very beautiful, extremely efficient organ — the human heart. Whether you believe in evolution or not, you cannot argue the fact that the heart is extremely complex, and resilient. Did you know that yours will beat, on average three billion times in your lifetime? But then Gabor threw a curve ball when he asked: “Who says it is the best design?”
Thus, he explained, while today’s biogengineers are brilliant “we can’t build a [functioning] replica of the heart, and I don’t think we ever will. BUT, what we can do, is use our engineering ingenuity, and biological understanding to put something together that will function like — or even better than — the human heart. Using your own cells so it won’t be rejected – that’s where I see bioprinting going.”
Having dealt with his vision of the future of bioprinting, almost as a chore, Gabor was keen to get back to the present. This is where his passion quite obviously lies — making a difference now. In this regard he outlined a number of areas where bioprinting is proving capable of doing just that, even if it doesn’t sound as exciting printing full body parts.
Primarily he believes that using bioprinted tissues as a transition step in the development of new drugs — between pre-clinical trials (on animals) and full clinical trials (on humans) — is a huge advantage for both the patients and the drug companies. He cited how often the biggest stumbling block in drug development comes at this stage in the process because “animal tissue is not characteristic for human behaviour.” Thus, even if a new drug has shown positive results in animals (a huge ethical question of its own) there is less risk but absolutely no guarantee that it will transition successfully to human trials. As a result the risks for patients participating in the trials are still high and the losses, if it fails, can be massive for the drug company (circa $500 million, if the trial is a complete failure, is fairly average) and that does not take account of the time wasted either.
Gabor believes that “THIS is what 3D bioprinting can offer resolution to now.” If you utilise engineered human tissue between pre-clinical animal trials and human clinical trials it can illustrate a human toxic response for a new drug ahead of clinical trials and save the drug development project huge amounts of time and money, but, more important than that, it prevents the drug test having an adverse affect on a patient and/or offering false hope.
And the ultimate goal here is to eliminate animal testing completely, the ethics of which is questioned by many — to the point of violence in extreme cases. Even more so when the experiments are conducted on animals for testing beauty products.
As Gabor explained, TODAY Organovo, right now, can print human liver tissue with architecturally, compositionally and functionally correct make-up. When this is interfaced with a drug when taken orally it is capable of demonstrating a toxic response and thus point to a toxic response across the rest of the complex human system. “It may not be the application everyone is getting excited about but it’s real and, actually, the implications are HUGE for humanity,” concluded Gabor on this subject.
And, in the near term, Gabor believes that the small scale bioprinting that is possible now will support some reconstructive surgeries. He cited blood vessels at this point, and the number of patients globally suffering from clogged arteries and requiring bypass surgery, with one famous ex-president as his specimen. There are four arteries from other parts of the human body that are compatible with bypass surgery. One Bill Clinton has used all four — if he needs a fifth, he’s dead. That’s it. Four strikes and you’re out ….unless you use bioprinting!
Gabor reports that Organovo is close to achieving this application of bioprinting part of an artery for bypass surgery and believes it will ameliorate the problem significantly.
I don’t know about you, but having experienced a grandparent and an Uncle that have both undergone bypass surgery, and learning that potentially my kids may have a better outcome — I think that’s huge!
Returning to the bioprinted liver tissue potential, Gabor went on to explain that this could still help patients with significant liver failure that are waiting for a donor not knowing if they would live of die. Once again dismissing the entire organ idea, he posited how by taking a small piece of liver — what he called an “organoid” and implanting it, there was an increased chance of improving and extending the life of the existing bad liver, potentially providing enough time to find a donor.
With more than 100,000 people waiting for a kidney transplant in the US alone, where only 1 in 6 will get one, this is an encouraging, albeit partial, solution to a very serious situation that is only going to continue to get worse. Any hope has to be better than no hope?
And since my meeting with Gabor, Organovo has announced yet another avenue of exploration for bioprinting, in collaboration with L'Oreal USA, the largest subsidiary of the world's leading beauty company. Many would argue that there is a huge chasm between extending life and concocting beauty products, and I would have to agree. That said when it comes to the ethical question of testing on animals, printing human skin for "product evaluation and other areas of advanced research" has a certain appeal, whether you are an animal rights activist or not.
I totally get the testing angle, but the "the research and application of reconstructed skin" has a slightly more sinister ring to it, and has me recounting the prediction of one Chris Barnatt in the second edition of his book, "3D Printing", which I have just reviewed in the resources section of this website, when he said:
“For foolhardy individuals with the money, by 2040 or 2050 cosmetic face printing and body reforming is also likely to be on the cards."