SC7: The ethics of using stem cells in tissue engineering

Written by Gad Sabbatier (Clerk), Hossein Riahinezhad (Chair), and Laura McKiel (Editor)

Two weeks ago, we watched a documentary “Supercells: from stem cells to artificial organ” about trachea transplantation to illustrate the topic of our weekly science club.

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The documentary was about a young Russian woman, Yulia Tuulik, a former dancer with the bolshoï ballet, who needed a tracheotomy because of a car accident in 2011. A multidisciplinary team of surgeons, scientists, and industrialists lead by Paolo Macchiarini, a world known surgeon, implanted a bioengineered synthetic nanofibrous trachea seeded with bone-marrow derived stem cells prior harvested on the patient. Cells were seeded on the scaffold using a rotational bioreactor for 48 hours, and then suspended and observed every two hours in aseptic conditions. The patient underwent this “first-in-man” transplantation surgery on June 2012 at Krasnodarsk in Russia. The documentary has shown how this surgery was publicized by the media, and the success of the surgery after implantation.

Yulia Tuulik unfortunately died on September 2014 because of chronic inflammation, chronic coughs, and choking; Paolo Miccharini was found guilty for misconduct in 2015. This documentary is impressive, very well explained, and continues to be very popular on the web (4.5 stars on Amazon – outstanding comments in 2017), but fails to explain the death of the patient.

At the end of the movie, we discussed the limitations of the documentary. In the following, there is a summary of our discussion.

  • Everyone agrees that the relationship between doctors and the patient was constructive. It was shown in the movie that team of doctors visited Yulia on a regular basis before surgery and Mr. Green, CEO of Harvard Bioscience (who designed the bioreactor for cell seeding on synthetic trachea), showed the bioreactor to the patient and explained the basic science of what they want to do. Jed Johnson, CTO of Nanofibers Solutions and material designer of the synthetic trachea, was not involved in the surgery.
  • We also discussed about differences between scientists and surgeons, and the need to teach surgeons how to work with biomaterials that are produced by scientists. Based on part of the movie, Dr. Macchiarini tested the stiffness of the synthetic trachea by putting a bottle on top of it and checking how easy it was to handle and suture. On the other hand, scientists are more careful and design different experiments to measure mechanical properties of an implant. We are wondering if scientists should design materials which completely fulfill the surgeon’s expectations, or surgeons should be properly trained to use that material. We agree that it is necessary to train surgeons regarding handling of the material, storage, and some of the characteristics of the material that could lead to improvement of the surgery and patient outcomes.
  • Since the surgery was done in Russia, the regulatory process that authorize the surgery using this synthetic trachea seeded with stem cells and transplant it on human might have been different from the United States (FDA) or the European Union.
  • The patient was young (34 years-old) and in very good physical health (dancer), which played a key role into the choice of the patient for a successful first-in-man surgery.

Overall, this procedure showed that tissue engineered trachea transplantation may be premature and need more investigation.

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