Science & Ethics is a bimonthly radio show airing on Radio Free Hillsdale 101.7 FM. The following has been adapted from an interview with Dr. Laura Niklason, MD, Ph.D.
Dr. Laura Niklason is a professor of anesthesiology and biomedical engineering at Yale University. Ongoing research in Dr. Niklason’s lab involves optimizing the development of an engineered lung, work Time magazine cited as one of the “50 Best Inventions of 2010.”
In 2012, a synthetic blood vessel that you developed was grafted into the arm of a kidney dialysis patient. Could you walk us through this revolutionary project?
About 20 years ago I was in the operating room caring for a patient in the hospital who need a heart bypass operation. For those operations we typically take a vein out of the leg of the patient and put it on the heart to serve as a bypass conduit. Unfortunately this patient did not have a suitable vein; the surgeons looked into both of his legs and in his arm and eventually had to take a blood vessel out of his stomach to serve as a bypass conduit. That was one of the triggers for me to begin developing methods whereby we might take human cells, blood vessel cells, into the laboratory, and coax them to grow into new arteries.
To do that we take the cells and grow them in a bioreactor, which we designed to provide a lot of the cues necessary to stimulate normal blood vessels to grow. We’ve exposed the cells to certain growth factors, certain biochemicals, and to mechanical environments, like stretch, that simulate the beating heart. We found, after many years of plugging away, that we can generate functional blood vessels by growing these cells in the lab.
In the implementation of these technologies, how do you distinguish between therapy and enhancement?
When you’re training as a physician, you learn about two fundamental concepts. One is “normal” – or if you’re talking about animal biology, you might say, “wild-type.” What is the standard phenotype, the standard function of the species or the individual that is under study? We also learn that there is a range; normal isn’t a single data point. Where the middle of the range is, and how far those boundaries of normalcy extend, can be the subject of discussion, but in medicine, we have an understanding of what normal is.
Therapy is designed to take a human body that’s functioning below the normal range and bring it up into the normal range. With enhancement, the goal would be to bring them outside that range of normality into something that we do not commonly observe in the “wild-type” human.
What do you think are the medical developments that will shape the way we do medicine in the future?
I’m most excited about an emerging discipline that I would call the molecular engineering of the cell or cellular functions. For example, we can change a receptor on the surface of a cell: whereas that receptor used to recognize stimulus A, we coax it to recognize stimulus B. When it sees this stimulus B, it can activate the whole pathway in the cell that normally was activated by stimulus A.
This ability has profound impacts for various types of cell therapies, cancer therapies. For example, immunologists are taking immune cells out of the patient and changing surface receptors so that the receptors see and ultimately kill tumor cells in that patient. We’re about thirty years into the molecular biology revolution, and we’re just scratching the surface of how we’ll be able to use these molecular tools which we now finally have in hand.
How do you understand the roles of the humanities and the natural sciences in guiding human life?
I think it’s artificial to cleave those two – to draw a very bright line between the humanities and the social sciences and the physical sciences. Because, for example, the physical sciences really change our view of what is possible in the world, and therefore change how we have to think about what is ethical. If something in the world is not possible, then it’s a non-question of whether or not it’s ethical. But as science makes more and more things possible, our concept of what is ethical and what is moral necessarily changes.
Ms. Johnson is a senior studying philosophy. Ms. Quinones is a senior studying biochemistry and journalism.