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Latest revision as of 12:39, 18 January 2013
Introduction
Dr. Anthony Atala is the W.H. Boyce Professor and Chair of the Department of Urology and Director of the Institute for Regenerative Medicine at Wake Forest University. He is also a surgeon and a pediatrician. Atala obtained a psychology degree from the University of Miami, a medical degree from the University of Louisville and did a fellowship at Harvard Medical School. Its was in Harvard in 1990 he began research on how to successfully create and implant a functioning human bladder. His motivation was that there was a shortage of organs (in this case the bladder) and not enough donors to meet the high demand. Patients had to resort to alternative methods of treatment that had bad side effects e.g. ileal conduit and orthotopic neobladder procedure. Being a pediatrician, he believed that these methods which cause more harm that good to children with 70 and 80 year life expectancies was not right and he sought to create an alternative.
"Nothing is more devastating to a surgeon,than knowing you're not necessarily doing what's best for the patient, but that is your only choice." [4]
Major Accomplishments
- Dr Atala and the institute of regenerative medicine are the first in the world to create and implant engineered bladders that are functioning well in patients
- He has also identified and characterized a new class of non-controversial stem cells which can be obtained from amniotic fluid and placenta. The cells could be used as an injectable therapy or to grow replacement tissues and organs in the laboratory that could be implanted in patients and unlike embryonic stem cells, these cells dont form tumors when they are transplanted[1]
Awards
- Christopher Columbus Foundation Award
- Samuel D. Gross Prize, awarded every 5 years to a national leading surgical researcher by the Philadelphia Academy of Surgery
- Barringer Medal from the American Association of Genitourinary Surgeons
- Gold Cystoscope award from the American Urological Association for advances in the field
Ten applications of technologies developed by Dr Atala have been used clinically. He has written several books such as Principles of Regenerative Medicine, Foundations of Regenerative Medicine, Methods of Tissue Engineering, and Minimally Invasive Urology and has applied for or received over 200 national and international patents.
Current Projects
The use of 'printing' to manufacture organs. It makes use of a modified desktop inkjet printer, but instead of using ink, cells are placed in the cartridges. The printer has a 3D elevator that goes down one layer at a time each time the printhead goes through. After about 45 minutes the newly printed, whole organ is made. The organ can then be taken and implanted.
The Artificial Bladder
Brief Timeline
1990: During his fellowship at Harvard Medical School he began working on how to build a functioning artificial bladder
1996: Fashions bladder shaped molds seeded with cells
1998: Lab-grown bladder successfully transplanted into a dog. He observed the dogs progress for a year before deciding to put the bladder through human testing
1999: Implanted artificial bladder into 7 volunteers between the ages of 4 and 19. All the patients were suffering from urinary incontinence
2003: The patent for the process was licensed to Tengion Inc.. A company dedicated to providing solutions through regenerative medicine. Dr Atala is said to be the scientific founder of Tengion.
2006: The Lancet, a British medical journal, reports on the first time that complicated artificial organs have been successfully implanted in humans. This was 7 years after the implantation and the report stated the volunteers were healthy and leading normal lives
2009: Phase II clinical trials initiated and completed by Tengion for the artificial bladder (Neo-bladder Augment)
The Creation of An Artificial Bladder
A very small piece of the bladder is cut off from the patient usually smaller than the size of a postage stamp. It is very important that the biopsied bladder piece be free from disease. A biodegradable scaffold is molded in the shape of a bladder, this is after a CT scan has been performed on the patient to check the precise dimensions. The cells obtained from the bladder piece are grown outside the body for 7 to 10 days. These cells are urothelial cells. After that are seeded or 'painted' onto the scaffold. This is now put into and oven like device at body temperature and 95% oxygen for about 6 weeks. After this time the organ is ready to be implanted into the patient.
Importance of the Artificial Bladder
The need for artificial bladders is brought about by a scarcity of donor organs to treat a large number of various bladder diseases such as:
- Bladder Cancer
- Urinary Incontinence
- Interstitial cystitis
The National Institute for Continence says that there are about 25 million adult Americans that experience transient or chronic Urinary Incontinence [7]
The National Cancer Institute also estimated there would be 73,510 new cases of Bladder Cancer and 14,880 deaths in 2012 alone [6]
From these figures we can see the potential market for the artificial bladder and the diseases it can provide a permanent solution to.
Advantages & Current Limitations
- Regenerate native function and structure. This is important because current methods of bladder disease treatment involve the use of intestinal cells which are not 'specialized' to perform the relaxing and contracting functions of the bladder
- Eliminate the risk of organ rejection because the patient is using cells obtained from their own body
- Reduce or eliminate other adverse effects of existing procedures such as osteoporosis. Currently the orthotopic neobladder procedure which makes use of intestinal cells causes the body to absorb calcium and other substances that the bladder would originally get rid of (causing osteoporosis).
- Provide efficacy advances versus existing alternatives.
Right now, the biggest hurdle faced by Tengion is getting the artificial bladder approved by the Food and Drug Administration
Evolution-From the Lab till Now
The team, which began its work in 1999, followed the last patient for almost two years. In undergoing the experimental procedure, the patients skirted the typical side effects of grafts that would otherwise have been made with their own intestinal tissue.
The rebuilt bladders, though, were up to three times more elastic and better at holding urine, the researchers report. In all seven patients, kidney function was preserved, the study said. The patients must still empty their bladders regularly with a tube but can avoid leaking in between.
In a talk given during a TED conference, he aired a clip of one of the recipients of the artificial bladder 5 years earlier. The video showed that the volunteers in the 1999 study had reduced leaking from their bladders and given them an improved quality of life.
"Now that I’ve had the transplant, my body actually does what I want it to do,” she said in an interview last week at her uncle’s house in Haddam, Conn. “Now I can go have fun and not worry about having an accident." -16-year-old Kaitlyne McNamara (Artificial Bladder recipient) [8]
Tengion has completed phase 2 trails for the Neo-Bladder Augment, although its has not been approved by the FDA yet. They announced plans in April 2012 to commercialize Dr Atalas' work on the artificial bladder
Funding
- Dr Atala received a $1 million grant from the Department of Defense in 2008 to research potential methods of restoring severed limbs of soldiers
- In 2000, he was awarded the $100,000 Christopher Columbus Foundation Award given to a living American who is currently working on a discovery that will significantly affect society
- Tengion received $50 million dollars in series B financing for the Neo-Bladder Augment clinical trials and development
References
[1] "Facts & Statistics." Home. NAFC. Web. 12 Apr. 2012. <http://www.nafc.org/index.php?page=facts-statistics>.
[2] "National Cancer Institute." Bladder Cancer Home Page. Web. 12 Apr. 2012. <http://www.cancer.gov/cancertopics/types/bladder>.
[3] "Speakers Anthony Atala: Surgeon." Anthony Atala. Web. 12 Apr. 2012. <http://www.ted.com/speakers/anthony_atala.html>.
[4] "Tengion : Regenerative Medicine Brought to Life". Web. 12 Apr. 2012. <http://www.tengion.com/index.cfm>.
[5] "Wake Forest Physician Reports First Human Recipients of Laboratory-Grown Organs." - Wake Forest Baptist Medical Center. Web. 12 Apr. 2012. <http://www.wakehealth.edu/News-Releases/2006/Wake_Forest_Physician_Reports_First_Human_Recipients_of_Laboratory-Grown_Organs.htm>.
[6] "National Cancer Institute." Comprehensive Cancer Information -. Web. 13 Apr. 2012. <http://www.cancer.gov/>.
[7] "American Institute For Urinary Incontinence." Home. Web. 13 Apr. 2012. <http://www.nafc.org/for-health-proffesionals/featured-health-professionals/american-institute-for-urinary-incontinence/>.
