Photo courtesy Inter­na­tional Anes­thesia Research Society

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.