Prometheus and I: building new body parts from stem cells

Stem cells and their use in transplant surgery is the focus of a great deal of hope, and a great deal of hype. Professor Martin Birchall (UCL Ear Institute) has been involved in some very high profile patient operations over the last few years, which have pushed the boundaries of stem cell medicine and modern surgical methods, attracting a huge amount of publicity in the process.

At a Lunch Hour Lecture on 15 November, a large audience came to hear Martin talk about the work he has been involved in, the advances that have been made in regenerative medicine and the current challenges.

At the heart of Martin’s lecture is the Greek myth of Prometheus and man’s age-old desire to emulate the gods and create man. He shows illustrations of Mary Shelley’s Frankenstein and an alchemist creating a homunculus (a little human – something he likens himself to).

He points out the severe shortage of transplant organs, and the fact that immunosuppressive drugs taken by patients who have transplants can reduce their lives by 10 years. Autologous transplants (where tissue is taken from another site on the body) can also cause problems at the site the tissue has been taken from. Prosthetics, popular in the 70s, also have their issues.

Faced with these problems, the appeal of the “off the shelf” organ is significant – but although progress has been made, we’re still not at that point. Martin says that in his university entrance exam in 1979 he was asked to answer an essay question on the promise of gene and stem cell therapy – and that the promise is still yet to be realised over 30 years later.

He runs through the different transplants he has been involved in involving windpipes (tracheas) and a voicebox (larynx), as well as work done by other international teams that has moved the field forward. These operations have very broadly involved the transplant of a donor organ, stripped of many of its cells and seeded with the patient’s own stem cells, with the aim of preventing rejection and getting the organ to function as well as possible.

There are lots of surgery illustrations and videos, and about half way through the talk there is a small commotion at the back of the room and it transpires that someone has fainted. Martin – saying “Amazing! Nobody has ever fainted in one of my lectures before!” – leaps into action and runs up the stairs to give medical assistance, returning to his talk without breaking his stride.

So, back to the lecture. The operations that have taken place using stem cells to better integrate donor tissue into the patient’s body, have so far been rare and exceptional – usually the very last option for the very seriously ill. Although there have been successes, Martin explains that once we enter the realms of operating on groups of patients rather than individuals, it becomes a clinical trial and is therefore subject to the regulations and red tape that entails.

Listening to the lecture, you really appreciate how much innovative work in this area goes on at UCL. Throughout his presentation Martin cites the work of a host of UCL academics and clinicians in partner hospitals – including Dr Paolo De Coppi (UCL Institute of Child Health) and his work on stem cells and amniotic fluid, and Professor Jeremy Brockes (UCL Structural & Molecular Biology) and his work on limb regeneration in newts.

He describes the need to continue to work together in teams across disciplines and to go back and forth between the clinician and the scientist, adding that at UCL “you can walk a mile from where you’re sitting and put together a world-class team”.

The patient stories are very powerful, and even accepting the caution and caveats that Martin gets across during the lecture, you’re left feeling that this is scientific medicine at its most inspiring – tapping into ancient human instincts as well as giving us a tantalising glimpse of how organ transplants will be carried out in the future.