Today, regenerative medicine is able to "grow" an organ under laboratory conditions for further transplantation to a patient. Previously, it was possible to do this with the trachea, urethra and bladder, and recently this list has been added to the vagina and nose.
Atlantico: The nose and vagina are on the list of body parts that can be repaired using the patient's cells. What organs can be "grown" now?
Jérôme Guichet: Many of them are grown in the laboratory from cell tissues. Cartilage for the treatment of arthrosis, bones in case of fractures, the bladder, skin for patients with severe burns - all these organs have been the subject of detailed scientific research, but so far the work has only in isolated cases reached clinical trials.
In addition, it is worth noting research on gene therapy for the eyes and the study of the effect of bone marrow stem cells on the heart (it is assumed that their introduction will avoid the harmful effects of myocardial infarction). Active laboratory research today covers most of the organs that are prone to degenerative diseases. In some cases, the work reaches the stage of clinical trials among patients.
What options for regenerative medicine exist at the moment, and which of them should be preferred? What are the risks of each of them?
- Either only the cells of the patient himself are used, or only biomaterials, or both, or all of this simultaneously with proteins with regenerative properties. If, for example, we are talking about the restoration of intervertebral discs, this cannot be achieved with the help of cells and biomaterials alone: you need to use both options at once. I think that we have not yet discovered all the available possibilities. New ideas will appear in the future. The goal is to get as close to real regeneration as possible.
What, in your opinion, are the most successful achievements in this area?
“Ultimately, we are not dealing with the regeneration of degenerative tissue: we are removing tissue because cancer is present in it. It is much easier to restore tissue taken from a patient than to cope with a real degenerative pathology. So, for example, we have perfectly learned how to correct bone defects with the help of biomaterials and patient cells. The easiest way to restore are those organs that, in one way or another, already have the ability to self-regenerate. This fully applies to bones, in contrast to the same cartilage, where nature requires significant help.
Promotional video:
What are the prospects for the first achievements?
- This is definitely about expanding the range of possible applications. In particular, this applies to elderly patients with degenerative changes in the joints, cardiovascular diseases, etc. It will be necessary to tackle the restoration of all these tissues: blood vessels, heart, intervertebral discs, cartilage.
This implies confrontation with nature and, therefore, will take a long time. But we have no other way because of the aging population. It is my hope that this groundbreaking research will pave the way for other work on degenerative diseases.
What problems are preventing the full-scale development of the therapeutic application of regenerative medicine today? Could such medicine become inevitable in the future?
- Firstly, it takes money to carry out long-term research and test the assumptions of scientists. The second limiting factor is the existing norms. Science today is moving forward faster than legislation. In addition, the target group of patients must be clearly defined. Regenerative medicine cannot be used as you please, it cannot cure and fix everything.
By choosing the right patients, we can conduct clinical trials under controlled conditions, and the results obtained will advance the science. The last point: we do not have enough knowledge about what the same stem cells are capable of biologically. We need to expand our understanding of these critical issues if we are to be confident in what happens if they are transplanted to a patient.
Today, we are gradually beginning to form answers for pathologies with a serious danger to the patient's life, for example, myocardial infarction. And in such cases, you can really afford certain risks. But if everything is limited to arthrosis, are we ready to accept the possibility of cancer in the future, if now the patient "only" has a knee pain? In the first case, we are talking about the danger to life, and in the second - about improving its comfort.
Today we stand at a crossroads: the population is aging, which generates demand, and scientific laboratories are moving forward very quickly in research. However, in the coming years, we need to be careful not to get things out of hand. This is an ethical issue.
Jérôme Guicheux is director of the French Institute for Health and Medical Research.