INTERVIEW BY TIM SMALLILLUSTRATION BY SILVIO MANCINI
Alan Russell is the founder of Pittsburgh’s McGowan Insitute for Regenerative Medicine, the biggest multidisciplinary center for regenerative medicine in the world. Combining such disciplines as biotechnology, chemistry, tissue engineering (biological, not the stuff you blow your nose in), and stem cell research with cutting-edge technology, Russell’s 250-person strong legion of researchers is creating a whole new approach to medicine itself, an approach that will allow us to cure every single disease in the entire universe, and will enable us to, one day, regenerate every cell of our body. The idea is very simple: if a lizard can grow its tail back, why should we think that humans can't propagate a limb from a stump? Or a damaged muscle? Or cerebral cells? Or maybe whole organs? Why not? Russell foresees a paragidm shift in the medical field that’s kinda like what happened from Newton to Einstein in physics. So, get ready to say goodbye to insulin. And to live untill you’re 150.Notbad, right?Vice: How and when did you come up with this whole crazy idea of regenerative medicine?
Alan Russell: Truth be told, the idea has been existing from centuries, since Greek mythology. Do you remember Prometheus? As a punishment for offending the Gods, he was sentenced to have his liver eaten by an eagle every day, and his liver would regenerate each night so that the eagle could keep on eating it again the next day, for eternity. It’s interesting how the Greeks chose the liver, since it's one of the most regenerative organs, thug not as much as blood—that regenerates itself at an impressive rate. The idea that the body is capable of regenerating itself has been dreamed for centuries. but it's only during the last 10, 15 years that we can realize what we’ve always dreamed of.
Could you explain this to me? Imagine I'm a ten-year-old.
It’s quite simple. If you break a bone, you put it in a cast, and the bone heals. This happens because your body already has the power to heal itself. The cast is only an instrument you use to keep the bone still so it can heal on its own. Now we are able to work on new technologies and new instruments that will allow us to put the body in the condition to heal itself. Artificial hearts, artificial livers, artificial lungs are just three of the many things that can interface with the body and send out signals, like “don’t do any more damage, recreate the tissue.” Another way of doing this is to use these new materials that degrade inside the body. Think about stitches, for instance. If you cut yourself and they give you stitches, then you have to get them removed and they leave a scar. But think of stitches made of a material that can degrade inside the wound, all the while telling the surronding cells, “Don’t leave a scar, produce new tissue.” You would never have a scar again. And the last area we’re actually working on is with cells. We can use cells to make them communicate with other cells, telling them to behave in a specific way that is useful to the patient.
Pretty cool.
It’s very simple, as I said. Did you know that a salamander, or a newt, can regenerate an amputated limb in a couple of months? Same thing goes for deer and their antlers. They fall every year, and every year they grow back again, very quickly. But how does this work, biologically speaking? When we understand this, we’ll be able to apply it to humans with regenerative medicine. It doesn’t matter whether it’s going to be a material or a stem cell to allows us to do this. Regenerative medicine is an end, not a means to an end.
People are living longer but their mental and physical capacities start to rapidly deteriorate at a certain point. And it all costs so much. How can regenerative medicine help with this?
If you look at the reasons of this drastic raise of the social cost of health care, you can argue that all we’re doing is spending a huge amount of money at the beginning of the patient’s old age, using incredibly expensive techniques, with a very marginal increase in quality of life and life expectancy. What we’re trying to do, instead, is couple early diagnosis with a new series of treatments that could really alter the course of the disease, if not cure it completely. The result would be a dramatic drop in the social cost of health, and a huge improvement in the quality of life of the patient.
My gran suffered from diabetes since… since I was born, really. I remember realizing that diabetes is an incurable disease. If you are diagnosed with diabetes, well, you just have diabetes until you die. That's it. All this sounds pretty obvious now, but it was very shocking for me at the time.
Absolutely. You’re totally right. And every year, in the US, 80,000 patients suffer from a finger or even a limb amputation because of it.
My gran had her toes amputated.
It happens really often. So try and imagine if there was a single injection that could cure diabetes. Even if that injection would cost a million dollars, that would save society—and the patients—an incredible amount of money, [not to mention] avoiding every complication that comes with the disease, and improving life quality in a dramatic way. And this injection might not even cost a million dollars.
I’ve seen some pictures, which we can’t publish due to doctor-patient confidentiality, of open wounds that heal in a few weeks without leaving a single scar. Can you tell me how that works?
Again, it’s very simple. I assume you know that every organic tissue contains a lot of cells, right? But we often forget about what exists between cells. Think about it this way: imagine an organ, or an organic tissue, as a city. Where do you live?
Milan.
Ok, let's say Milan is a liver. And every building is a cell. In order to function, these buildings need to be connected to each other with streets, sewers, power grids, and so on. This whole infrastructure is clearly very, very important, but up till now biologists focused mostly on cells—buildings. With this old approach to biology, we had these beautiful brand-new buildings connected by old malfunctioning sewer systems. Just like it happens in a lot of cities. Let’s say I have to remove half of your liver. Half of Milan. Where would you start to rebuild it?
I played SimCity, so I know you start with the infrastructure.
Exactly. You would start by setting up the sewers, the power grids, and the streets—that way buildings will come easy. But this has never been done before in biology. For many years, scientists and researchers started by implanting cells first, to try and exploit their regenerative skills inside the human body. So, to take this long metaphor to conclusion, we developed these materials that work as infrastructure between cells. Our body is already capable of creating new cells on its own. But when you lose the tissue, you lose the whole infrastructure with it. We implant it where it should be, and let the body “fill it up” with cells.
And what exactly is this material?
It’s called extracellular matrix [ECM]. It’s created by applying a particular chemical process to organic tissue that removes every cell and DNA from the tissue. I also call it “bio-active scaffold,” since it’s like the scaffolding that we use to build a house, only with the blueprints embedded inside it. You can isolate ECM from different tissues, taken from different animals—it doesn’t even necessarily have to be human. And since you remove both cells and DNA, you have no risk of rejection. Our bodies can reject cells but not the signalling molecules that tell cells what they’re supposed to do. Plus, since it’s organic, it degrades inside the body completely in six weeks. And while degrading, it sends the signals I was telling you about before.
How does it actually look? Is it like a sheet of material that is laid upon a wound?
It can have many shapes. It can be a gel.
What is the connection between this research and a very controversial topic such as stem cells?
First of all, allow me to readjust your statement. If you’d take a survey of every person on this planet, asking them if they think that using stem cells is a good idea, you’ll get a 75 or even an 80 percent positive reply. There are very few things in this world that can boast such a high support percentage. So I wouldn’t say that it’s a “controversial topic.” I understand that it’s very loaded with political, ideological, and religious issues, but this is just a small part of the debate. Then there’s a second observation that I would like to make, and it is that when people say “stem cells,” they generally think directly about embryonic stem cells—the politically incorrect ones. But like I said, regenerative medicine is not a means, it’s an end. There are thousands of different cells we’re experimenting with, and embryonic stem cells are just one type.
Boy, do I have egg on my face. Please go on.
I can say that regenerative medicine will surely not wait for church officers to make up their minds. That said, though, I haven’t said that we haven’t discovered which cell type works best according to the special instance, and if you can’t compare different types of cells then you’ve got a problem on your hands. Maybe there is a vaguely controversial aspect to part of the job we’re doing, but it’s only a minimal part. There are already hundreds of thousand patients who have been cured with adult stem cells, that live and walk and breathe thanks to them. Regarding how stem cells are connected with the material we were talking before, well, the signals that are released by MEC work as magnets for stem cells.
And now you can also create stem cells artificially.
It’s another interesting aspect to the research we’re doing. It’s all happening so fast that often, in the very moment in which we locate a problem, someone else discovers a solution. But it is true: we can create stem cells, starting from human skin.
Now that we’re talking about skin, is it true that you are capable of rebuilding third-stage burn victim skin using a gun that shoots spray cells?
It’s called Skin Gun. It’s a device that spatters skin cells, just like a spray can. We are very excited about it. It will allow us to grow perfectly healthy skin on a serious burn victim without having to transplant skin taken from other body parts.
Wow. Have you ever encountered any resistance from the traditional medical community?
No, never.
And what about pharmaceutical industries? Their business model is based upon profit from drugs that don’t cure diseases, but alleviate the symptoms. Is there any resistance at all towards a kind of research that would eventually get rid of all these drugs?
It’s pretty clear that if we’ll cure diabetes, we won't need insulin. So yes, some pharmaceutical industries will be really interested in finding a way to distribute these treatments. And I don’t think that all these industries do what they do just for the profit. I think they do it to help the patients, and during this process, they end up making money out of it.
Come on, you really think that they are not essentially motivated by profit? I mean, they are huge companies with budgets and balance sheets, that operate in a market and are used to doing business their way.
I have never met one single researcher of a pharmaceutical company that does what he does to make his boss rich. They are moved my same desire: finding a way to help patients. Now, due to how our society is structured, the only way of distributing these treatments is in a free market. Obviously, one of the restraints they will have to face is cost. If a drug costs too much, they need to find a way to make it cheaper. But if you’re asking me about their motivation, it’s absolutely noble. Let’s take you, for instance. You write for a living. But do you write to make your publisher rich? Or do you write because you want to tell stories you find relevant? Probably the second thing. And, in the meantime, your publisher gets rich. That’s how it works.
OK fine, so they’re not heartless capitalists. But if regenerative medicine really revolutionizes both public and private health systems, there will be big economic consequences.
That’s for sure. It’s a true revolution. A new paradigm. But think about when the army only had the navy. Then somebody invented the airplane. People who worked in the navy did not disappear. The airplane became the main thing, and deeply changed the way we used both infantry and navy, but it did not replace them.
Which disease are you going to cure first?
I believe it’s going to be an internal organ. The liver or the heart. I don’t want to say too much, but I think that heart diseases will be cured very soon. The use of stem cells to treat heart attacks is having an incredible turnout.
What about amputations? I’ve seen some amazing images that showed fingertips growing back again. Do you think that the re-growth of amputated limbs is something we’re going to see before we die?
We’ve already done fingers! Five people already had the treatment that allowed them to regenerate the tip of an amputated finger. Clearly there’s a huge interest towards the possibility to regenerate a whole finger, or maybe a hand. I think we could see that in our lifetime. You’re not thirty yet, are you?
No.
Then you’ve got a better chance than I do!
One last thing—a stupid one, maybe. If all this is possible, what about generating additional limbs? Like four arms? Or maybe, let’s say, wings?
Well, I have a picture of a baby with seven limbs. These things happen in biology, accidentally. If they happen by chance, this means that there is some biological potential. I don’t know why someone would like to have three arms, but it’s possible, for sure.
Oh. So it wasn’t that dumb a question.
No. There are people with four arms.
I guess what was stupid on my part was to think that it was a stupid question in the first place.
You know, biology is very powerful. If you can think of something, it's almost certain that it already exists.