In View: People in Transplantation
Transplantation: You are heading the world's largest institute on Regenerative Medicine. What motivated you to go into medicine?
AA: I greatly admired the local doctor who made house calls and was very important to our family. My goal from an early age was to grow up and help people like he did. As a physician and a researcher, I am driven by the needs of patients. My work in regenerative medicine focuses on harnessing the cells’ natural ability to heal in order to develop new treatments.
Transplantation: Alexis Carrel together with Charles Lindbergh performed key experiments in organ preservation and certainly benefited from approaching the same problem from different angles. What is the key to success in shaping and synergizing excellence in a team effort?
AA: Alexis Carrel and Charles Lindbergh were both strongly committed to a common goal. I have found that having people who are working toward something they are committed to and believe in, makes for a very effective team. As you mention, Carrel and Lindbergh came at the problem from different angles. Likewise, we have a multi-disciplinary team that include experts in areas such as molecular biology, genetics, cell biology, physiology, pharmacology, biomaterials, imaging and nanotechnology. Collaboration—with each team member offering a unique perspective—can be highly effective.
Transplantation: Technical skills (in addition to clinical judgment) have traditionally been key for the successful surgeon. How will the achievements of Regenerative Medicine shape the work of the future surgeon?
AA: In my view, the main impact regenerative medicine will have on the future of surgery is that it will provide physicians more options for our “tool kit.” Technical skill and clinical judgment will still be key, but physicians will have new options for patients.
Transplantation: Miniature human organoids have been developed and may be utilized for drug discoveries or toxicity testing. What is the current role and the future potential of this application?
AA: In addition to using miniature human organoids to test toxicity, our team and others have worked to develop systems that link organs together—basically a “body on a chip” that allows the testing of effectiveness of potential treatments on the body as a system. Currently, we are taking this concept a step further and looking at tumors and how they can metastasize to other body organs. This could potentially lead to the ability to test how each patient's tumor will respond to treatment before initiating therapy. This approach is yet another example of the movement towards personalized medicine.
Transplantation: Solid organs are complex structures that contain tissues of diverse origin. Both 3D printing and the application of stem cells provide excellent opportunities on the way to replace organs. Where do you see the main challenges and when could we see clinical applications?
AA: Some of the major challenges with engineering solid organs are growing the millions of cells that will be needed to engineer these organs and ensuring that the organs will have an oxygen supply until they integrate with the body. As you indicate in your question, in some cases, stem cell treatments may be the answer to restoring organ function so that a full replacement is not needed. We now have some of these therapies in clinical trials. Because this is such a vital need, we are pursuing multiple strategies, including the bioprinting of organs and organ “wafers” that could help boost function. As with most scientific endeavors, a timeframe for success is really impossible to predict.
Transplantation: The clustered regularly interspaced short palindromic repeats (CRISPR) interference technique appears to bear great potential in modifying the genome of human or animal cells. What applications can you envision combining this novel approach with techniques of regenerative medicine?
AA: One area of focus is to genetically modify stem cells for use in cell therapies. For example, teams are already looking at using CRISPR to develop a cell treatment for blood diseases such as sickle cell disease. Our own team is looking at using gene editing as part of a treatment for various disorders.
Transplantation: Regenerative medicine and organ transplantation are complementary in many ways. How do you see an optimized communication and cross-fertilization of those areas?
AA: This communication is key! At our institute, researchers and transplant surgeons work together on new strategies in organ engineering. In all areas of our work, we realize the importance of having clinicians on research teams, both to alert us to clinical needs, and to help devise and evaluate potential solutions.
Transplantation: What advice do you have for young clinicians and researchers entering the field of regenerative medicine or transplantation?
AA: Because regenerative medicine is interdisciplinary, there is a role for many different perspectives and skills. Therefore, it is important for young clinicians and researchers to pursue their specific field of interest first, and to then apply that skill set to the regenerative medicine field in general.
Transplantation: What excites you outside of work?
AA: I am fortunate that regenerative medicine is more than a job to me—it is my passion. I also enjoy spending time with my family and being involved in my children's activities.