ALAN ALDA (NARRATION) It has never been hard to put
together body parts -- in the movies.
MAD SCIENTIST It's alive. It's alive. It's alive.
It's alive. It's alive.
ALAN ALDA (NARRATION) But Hollywood had better look
out, because MIT scientists are getting in on the
act.
ALAN ALDA Does he have the nose?
BOB LANGER Yeah, it's coming.
ALAN ALDA You got it? That's the nose?
RESEARCHER It's right in the dish here.
ALAN ALDA (NARRATION) OK now, we are not, repeat
not, on a movie set.
ALAN ALDA Wait, what is this?
RESEARCHER This is cartilage. It is a scaffold of...
BOB LANGER You see the nostrils?
ALAN ALDA Yuck! Wait a minute! Look, with nostrils
and everything…
BOB LANGER We made a scaffold and there's the little
nostrils there -- and that's pure cartilage.
ALAN ALDA You could make it in big blocks and carve
whatever shape you want.
RESEARCHER Exactly, exactly, that's the whole idea.
ALAN ALDA Would you mind taking this back? I really
don't wanna…I mean it's alive, it's sort of alive.
BOB LANGER Yeah, sort of alive. We just wanted to
give you a flavor for it.
ALAN ALDA Unbelievable! You bring in a nose! I can't
get over that.
ALAN ALDA (NARRATION) In MIT's Langer lab they're
actually figuring out how to make body parts.
RESEARCHER First we make what we call a polymer scaffold,
and that's a piece of synthetic material that we can
make into the form of a sheet, or other three-dimensional
forms.
ALAN ALDA (NARRATION) Now we're making heart muscle,
starting with little clumps of synthetic fibers --
the polymer scaffold, as they call it. Then the scaffold
is bathed in living heart cells. Bob Langer has pioneered
this new field of tissue engineering.
BOB LANGER She's trying to mimic, outside the body,
what actually happens inside the body. She's giving
it the kind of food it needs, the kind of structure
it needs, and even the kind of mixing, you know, that
it may get inside the body.
ALAN ALDA (NARRATION) If you get the conditions just
right, you can grow pieces of living heart tissue.
ALAN ALDA I'm looking at something that's making
heart. Does that sort of strike you, every once it
a while, that you're making these things that used
to be that if you lost it, that would be the end.
BOB LANGER Well that is what we want to do, you know.
It does strike us. What we hope is that some day we'll
be able to have a whole series of replacement parts
for people so that if they find a problem, we'll be
able to help them.
ALAN ALDA It's like an auto part shop, you know.
BOB LANGER That's right.
ALAN ALDA I need a new carburetor and you just go
in and you drive out again. I mean, this is... how
many years away are we from having a part shop for
bodies, I mean where you can really just get what
you need. Is it ten years? Fifty years? A hundred
years? Must be hard to guess.
BOB LANGER Right I think it may depend on the part,
you know. Some of the easier parts like skin or cartilage,
I think you know that's probably five or ten years.
Some of the harder parts like heart, that may be many,
many years away, fifty or, you know, it's hard to
know.
ALAN ALDA (NARRATION) Here, after about two weeks
of growth, are the pieces of new heart.
ALAN ALDA They're under a microscope and then you
can see it on that monitor?
BOB LANGER That's right, we have a microscope here
and then basically they're on the monitor and you
can see them beating
ALAN ALDA The dish shaking, those are separate cells
beating.
BOB LANGER Right. Say; take a look right down here,
for example, or here. And these are individual heart
muscle cells, and they're just beating.
ALAN ALDA Is there any way you could make use of
that right now, in a heart?
BOB LANGER It's too early to do that now, but some
day what I expect is that we could make a sheet of
this, you know, and make cardiac muscle. And some
day, if we have the right type of cells to actually
transplant that onto a patient. You know if they have,
er, if some of their heart muscle's damaged.
ALAN ALDA (NARRATION) Right now they're working with
animal cells, but Bob Langer's hope is not at all
far-fetched. Take a look at one of those pieces of
heart as they give it an EKG, like a regular heart
checkup you might get from your doctor. The new tissue
transmits heartbeats exactly as it should. With tissue
engineering advancing rapidly, the search is on for
a reliable, and ethical, source of human cells to
grow parts from. Three years ago, I visited Michael
West at his company, Advanced Cell Technology. He's
aiming to make any kind of cell required, starting
from the kind of cell we all came from. They're called
embryonic stem cells. Embryonic stem cells are the
first cells that grow as an embryo develops -- precursors
to all body parts. The idea is to grow these stem
cells inside unfertilized eggs, which may pose fewer
ethical problems than using fertilized embryos.
ALAN ALDA Go straight in?
JOSE CIBELLI Yeah, straight in.
ALAN ALDA (NARRATION) The technique is similar to
the one used to clone Dolly the sheep, although I'm
actually working with a cow egg here. First I have
to pierce it, and suck out the nucleus, containing
the cow's genetic material.
JOSE CIBELLI There's a syringe next to your hand
now. Turn it.
ALAN ALDA There it is. Here it comes. Watch this,
watch this, guys. This is good. This is good. Have
I got it?
JOSE CIBELLI Go back a little bit more
ALAN ALDA OK. Got it. Got it.
JOSE CIBELLI Perfect. Right there is perfect.
ALAN ALDA (NARRATION) Next I pick up a human cell
-- this one's an adult skin cell. It could be mine,
or yours, or anybody's. Then I slide the skin cell
into the egg.
ALAN ALDA This is really fascinating to do. But what
are you getting out of this? What do you hope to get
out of this?
MICHAEL WEST Well, the excitement about cloning isn't
that we can make a genetic copy of a sheep or a goat.
It's that it teaches us some really fundamental biology.
That's that every cell in our body has, like the skin
cells, has the full genetic potential to recreate
life, young life. So our hope is that someday, elderly
patients that have heart disease or Parkinson's disease,
we could take a little cell from their body that they'd
never miss and sort of take the cell back in time
and recreate young cells and tissues that can be used
for treating disease.
ALAN ALDA (NARRATION) A tiny electric shock will
stimulate the adult skin cell to start dividing. Somehow
the environment of the egg leads the adult cell to
behave like it's young, and begin to make embryonic
stem cells. They've tried this with both cow and human
eggs, so far with partial success -- the number of
divisions the implanted adult cell has made has been
limited. But it's a start.
MICHAEL WEST The magic is, it's possible to make
this sort of mother of all stem cells, the embryonic
stem cell, that's genetically identical to you. So
then you could make...
ALAN ALDA So I won't reject it then.
MICHAEL WEST Right
ALAN ALDA If you make me a new organ or make me anything
I might need because of the disease I have, I won't
reject it. It's not coming from another person or
another animal.
MICHAEL WEST Exactly. The big unsolved problem, the
reason thousands of people die every day is the lack
of transplantable cells and tissues that your body
will not reject. And this new technology could be
the long sought means of transplanting cells and tissues
that your body will not reject.
ALAN ALDA You're working with very tiny...
ALAN ALDA (NARRATION) Back at the Langer Lab, they're
working on the assumption that human stem cells of
all kinds will eventually be available -- eye cells,
for example.
ERIN LAVICK We're trying to create scaffolds that
have pore sizes as low as ten microns on the way up
to a millimeter.
ALAN ALDA How small are you talking here? A micron
is… what relationship is a micron to a human hair,
for instance?
ERIN LAVICK Right. So a human hair is about two hundred
microns approximately.
ALAN ALDA This is extremely tiny. How do you keep
track of what you're doing? How do you actually build
things that small?
ALAN ALDA (NARRATION) Erin Lavick is going to teach
me how to make a polymer scaffold, like the ones used
to build the heart tissue and the nose. But my scaffold
is going to have the right, fine pore structure to
repair a damaged retina.
ERIN LAVICK This is the polymer dissolved in a solvent.
ALAN ALDA So this is what the scaffolding will be
made of?
ERIN LAVICK Right. You're gonna actually squirt it
on to the slide.
ALAN ALDA All of it?
ERIN LAVICK M-hmm. And then what you're gonna do,
is you're just gonna take that slide and slide it
into the water.
ALAN ALDA Oh there's water there?
ERIN LAVICK Yup.
ALAN ALDA Slide it into the water.
ERIN LAVICK Yeah. Just like that. And so what's happening
is, when you slide it into the water, all of the solvent
starts to come out and go into the water. And that
transfer is what's creating the pore structure, in
this case.
ALAN ALDA (NARRATION) Erin's made thousands of these
scaffolds, gradually refining her methods.
ERIN LAVICK These are some of the scaffolds that
we've made using this technique. And these have all
been dried. And so what you can see is they're very
thin, because you don't want to put something bulky
in the back of a retina.
ALAN ALDA This looks like a piece of paper.
ERIN LAVICK M-hmm. But if you look at it under a
scanning electron microscope, it actually has pores.
ALAN ALDA (NARRATION) The tiny pores, each about
one-twentieth the thickness of a hair, are channels
made by the solvent when it flowed out of the polymer.
Next, working with Erin's colleague Michael Young,
I'm going to seed the scaffold with retinal stem cells.
ALAN ALDA Now I put...
MICHAEL YOUNG Just on…right in the middle of that
big polymer.
ALAN ALDA Just a little drop.
MICHAEL YOUNG Yeah. You can use all of that. That
should be fine. And that's it.
ALAN ALDA So I've seeded a polymer with stem cells.
MICHAEL YOUNG Yes.
ALAN ALDA (NARRATION) Now we're going to see how
the cells like it inside the scaffold. We're working
with mouse retinal stem cells, collected from a newborn
animal as the eye was developing, so they're already
on track to become part of the eye. Human cells like
this aren't yet available.
MICHAEL YOUNG Okay…
ALAN ALDA What are we looking at here?
MICHAEL YOUNG So this is the same type of polymer
that we just looked at and seeded except I did it
yesterday. You can see the pores in the polymer if
I focus. But you can't see any cells, OK? Because
they're very small.
ALAN ALDA (NARRATION) But when we shine an ultraviolet
light on the cells, they burst into life.
MICHAEL YOUNG Now we can see retinal stem cells.
ALAN ALDA (NARRATION) The cells have been modified
to make a fluorescent material as part of their normal
life processes, so bright green spots mean healthy
cells. This is beginning to look like a living retina.
We're going to see what Michael and Erin are doing
with the artificial retina, but first take a look
at a normal eye. The retina's at the back. It has
a thin cover of nerve cells, on top of a thick layer
of light-sensitive photoreceptor cells. They react
whenever light is focused on them. In one of the first
tests, the artificial retina was placed alongside
a retina from a special breed of lab animal that has
no thick layer of light-sensitive cells.
ALAN ALDA So this layer, these channels, that's that
polymer I made in the dish on the slide?
ERIN LAVICK Right.
ALAN ALDA And now you're looking at it sideways and
these are the pores that the cells are growing in?
ERIN LAVICK Right. The darker parts are where the
polymer actually is and then these lighter parts here
are actually the pores themselves.
ALAN ALDA (NARRATION) Here you can see the living
retinal cells sheltering inside the channels of the
artificial retina. This was done just in a dish on
the lab bench, but now here's the next step. This
is a shot looking into the animal's eye. There at
the back you can see the faint shape of the artificial
retina, now implanted. Here's the same shot in ultraviolet
light, showing that the cells in the implant are alive
and healthy. What the researchers think is happening
is that the retinal stem cells inside the implant
are forming new light-sensitive photoreceptor cells,
which connect to the existing nerve cells in the animal's
eye. It's still too early to tell if there's an actual
improvement in vision, but it's a big step nonetheless.
ALAN ALDA If you're starting with a retinal stem
cell, does that mean it has some properties that already
predispose it to becoming a photoreceptor?
MICHAEL YOUNG Exactly. That's what we hope.
ALAN ALDA But it could become some other part of
the eye...
MICHAEL YOUNG Yes, yes.
ALAN ALDA ...if it were placed some place else? Or
under other conditions? What makes it become a photoreceptor,
when you do this procedure?
MICHAEL YOUNG One of the things that we've kind of
hit upon is that the host actually instructs the cells
at some level. So if we put these cells into an animal
who has lost photoreceptors, the majority of these
cells actually become photoreceptors. So the injury
cue we think is critical.
ALAN ALDA The injury itself somehow creates a cue
for the growth of new cells. Now, it's interesting
because that sounds like the body is signaling itself
and trying to grow new cells...
MICHAEL YOUNG Exactly.
ALAN ALDA ...but it's only when you supply the raw
material that the body for some reason is lacking,
or is being inhibited from presenting... What's going
on here?
MICHAEL YOUNG I think… So if you look at lower animals,
frogs, for instance, some fish. They can grow a whole
new retina. You take out the retina, they can grow
a new one, even in an adult. We've lost that ability.
But what we think is still present are some of these
injury cues. So maybe these instructions for fixing
the retina are actually there, but in higher mammals,
for instance, we are simply unable to respond to that.
So we are taking advantage, we hope, of these cues
that are present. And as you say, adding the raw materials
to fix what's wrong.
ALAN ALDA So the cues that are happening could be
vestigial mechanisms, vestigial functions that are
useless to us because we've evolved away from them.
But you can pick up on them and make use of them.
What a fascinating…
MICHAEL YOUNG The cells can. We don't actually know
what these injury cues are. But we know they're present.
ALAN ALDA (NARRATION) If there's a secret to the
new science of bioengineering, this is it. If we just
provide the right conditions, stem cells will do their
thing -- we don't have to know everything about how
complex cellular systems work. So we may be glimpsing
a future with almost limitless possibilities for repairing
or replacing body parts. In our next story, we'll
meet the scientist who wants to put together a whole
system of body parts, functioning like a body, on
the lab bench.
BODY ON A BENCH
ALAN ALDA How long have you been…
ALAN ALDA (NARRATION) This story is about something
called a liver chip.
LINDA GRIFFITH Three years.
ALAN ALDA Three years?
LINDA GRIFFITH Yeah. And we've actually got it there.
And it's not just chipped liver.
ALAN ALDA (NARRATION) You know, at MIT you don't
expect a lot of jokes.
LINDA GRIFFITH You'll see.
ALAN ALDA Oh, chipped liver. Oh, it's a joke. Oh
I get it.
LINDA GRIFFITH A-ha. It's a science joke.
ALAN ALDA It's a science joke. A liver science joke.
That's even better. Do you make them in here?
LINDA GRIFFITH Yeah, we make them right over here.
ALAN ALDA (NARRATION) Linda Griffith is a bioengineer
who's developing a tiny "bioreactor" that behaves
like a liver.
LINDA GRIFFITH So Karel, you got everything all ready
to set one up?
ALAN ALDA Hi. How are ya?
KAREL DOMANSKY So we have our miniature bioreactor
here…
ALAN ALDA (NARRATION) It's called a liver chip because
it uses thin, perforated wafers of silicon -- the
same material computer chips are made with. Here they
use silicon not for its electrical properties, but
because we know a lot about making tiny structures
with it. Once the chip is sealed in its case, a broth
of about a dozen different nutrients and vitamins
is pumped through the perforations. Then comes the
final step, that turns a chip into a liver chip.
LINDA GRIFFITH This is the room where we do all of
our cell culture. So these are sterile cell culture
hoods and incubators for the cells. And Anand is now
introducing the cells into the sterile bioreactor.
ALAN ALDA (NARRATION) As with the artificial retina,
they seed the chip with stem cells -- young cells
on track to develop into liver. As the chip is incubated
over the next few days, the cells will take up residence
in the chip's perforations. It's like having a colony
of livers, living in the lab -- and that's kind of
how the researchers feel about it.
ALAN ALDA How do you keep track of these, do you
give them little names or…
LINDA GRIFFITH They do give them little names, which
I find out when I get the file for a publication or
a presentation, it'll have, "Here's the data from
Mandy, and Mandy was very good, but Tom was really
not."
ALAN ALDA (NARRATION) But now you can work with Tom
and Mandy -- you can test drugs, or do experiments
that would be out of the question with people.
ALAN ALDA Why did you make a small liver instead
of a small heart or a small kidney?
LINDA GRIFFITH Well, partly, just by chance. I happened
to join a lab that was interested in liver and I got
fascinated by the problems in liver. Liver is your
largest organ. It gets almost a third of the blood
flow every time your heart pumps. Liver does an amazing
number of things. It detoxifies drugs. It keeps track
of all the nutrients in your body to make sure the
rest of your body gets exposed to almost constant
amounts of glucose. It makes almost all the proteins
found in your plasma. It synthesizes bile. It does
so many things and it's so important, so that when
your liver gets sick, you have to replace it with
an organ transplant or you die. And so it's such an
essential organ, we got very interested in ways that
we could… My first interest was in how we could we
do replacement livers to implant into people. What
we realize now is that gee, if we understood how liver
works better and how disease processes go on in liver,
we could develop better drugs and prevent the need
for organ transplants in a lot of cases, we hope.
ALAN ALDA Now why do you need this to develop better
drugs? Why can't you use cells from a liver in a dish?
LINDA GRIFFITH Well, cells from a liver in a dish
will do some of the things the liver does. But it's
been really frustrating for years. Hundreds of people,
in all kinds of labs and industries have tried to
get liver to do things like be infected with hepatitis
virus. And when you take liver cells out of the body
they just go, "On strike. I'm not doing all those
things anymore."
ALAN ALDA (NARRATION) Inside the liver chip the cells
are able to behave much more naturally. We moved over
to the electron microscope to take a look.
LINDA GRIFFITH ...so that the sample is in the vacuum
chamber being bombarded with electrons.
ALAN ALDA (NARRATION) First, here's how nature makes
a liver.
ALAN ALDA What's this a picture of?
KATIE WACK This right now is actually a picture of
a section of real liver.
ALAN ALDA (NARRATION) Real liver contains thousands
of tiny blood vessels like this, bringing in and taking
away the many different chemicals which the liver
cells, off to the sides, are processing.
KATIE WACK This is a blood vessel that you're looking
down into, so it's a cross section of a blood vessel.
And they have small holes that sort of act as a filter
to the blood. So the blood moves through here and
small molecules can go through and come in direct
contact with the liver-functioning cells.
ALAN ALDA (NARRATION) Without these tissue structures,
of filter holes and blood vessels, it's tough for
the liver cells to function correctly. Now let's look
at the liver chip.
KATIE WACK So we're looking down on the chip and
each of these channels is sort of like a tunnel where
the medium can flow through and there's a tissue structure
that goes into the channel. So now I'll zoom in closer
into one of these channels, so that you can see what
the tissue looks like.
ALAN ALDA (NARRATION) The fascinating thing is that
the stem cells in the chip grow into structures with
many of the key features of real liver. They build
channels -- like blood vessels -- inside each perforation
in the chip, and they even make the little filter
holes that real liver blood vessels have.
ALAN ALDA What makes it organize itself as though
it were in a real liver with these spaces for the
blood?
KATIE WACK Well, the environment that the cells are
in makes them want to function in the way they do
in the body so that they reorganize into structures
that are like in the body.
LINDA GRIFFITH It's the Colonel's special recipe
that we have in our secret vault at MIT.
ALAN ALDA (NARRATION) And that's not just another
of Linda's science jokes. The chip was designed specifically
to keep liver cells happy -- the right size channels,
the right nutrient flows, and surface coatings they
like to stick to. Linda believes we can do this for
many body parts.
ALAN ALDA You know when you show me these pictures
that are enlarged so much and you were looking at
these almost infinitesimally small places in the body,
and you say things like, And they open and close depending
on various things. Or these little parts of the cells,
these cells are in communication with other cells,
they're sending out... It sounds like there are so
many millions or billions of things going on in the
body -- signals being sent, coming back, sending out,
going out again -- is there a hope that we'll be able
to untangle this puzzle, I mean in anybody's lifetime?
LINDA GRIFFITH Yes. We've started a whole new department
actually at MIT to address exactly these kinds of
problems -- biological engineering -- and bringing
together biologists and engineers and really trying
to do systems level biology, starting at the molecular
level. So it's just really starting to creep out across
universities in America, but I think it'll happen.
ALAN ALDA (NARRATION) Making body parts, like retinas
or livers, in the lab depends critically on acquiring
the right human stem cells -- not the animal cells
they're using here right now.
LINDA GRIFFITH One of the biggest hurdles in this
is where we're gonna ultimately get the cells to do
it on a large scale. And so part of our project actually
is to try to derive stem cell lines that can be cultured
and frozen down out of human tissue.
ALAN ALDA Are these stem cells lines that you're
talking about creating here, are they outside of the
prohibitions placed on stem cell research recently
by Washington? Or are they within those protocols?
LINDA GRIFFITH What we are doing is taking cells
out of the adult body and trying to derive cell lines,
so they're not under the prohibitions. They're much
more readily available to the general researcher.
We can even get some from you if you sign the consent
form.
ALAN ALDA We'll talk later about that.
LINDA GRIFFITH We'll have the memorial cell line.
ALAN ALDA Do you ask most people who come in if they
want to give up their stem cells?
LINDA GRIFFITH If we really like them, and we want
to have them memorialized in the lab.
ALAN ALDA Gee, you mean I could come some day and
visit my cells?
LINDA GRIFFITH You could. Yeah.
ALAN ALDA That would be great. I could maybe have
my own chip here.
LINDA GRIFFITH You know you could maybe have your
whole body on a chip. If what we're doing really works
out, we could take stem cells that circulate in your
blood and make a liver, make a heart, make a brain
out of those cells. That's our ultimate goal. That's
what I want to have done by the time I retire from
MIT.
SEARCH FOR THE PERFECT HEART
ALAN ALDA (NARRATION) On July the fourth, 2001, the
papers announced a new kind of independence -- for
heart patients, available now for the first time.
The implantable, self-contained mechanical heart was
the culmination of at least 40 years of research.
On Frontiers, we've been following progress for almost
10 years. In 1993, we told the story of Mike Dorsey,
whose life was saved by a sort of partial artificial
heart, called a Heartmate, that assisted his own failing
heart.
MIKE DORSEY I was very sick. I'd walk from here to
you, and I'd been out of breath for that time. I couldn't
do nothing. It gets a little frustrating when your
wife comes and takes things from you, you know, and
you can't carry them, you know, she would take them
and carry them in for me. I wanted to do it, but just
wasn't able to do it.
ALAN ALDA (NARRATION) The artificial heart first
hit the world's headlines in 1982. Barney Clarke's
brave struggle to live, and his death after four months,
cooled the early enthusiasm for his implant - the
Jarvick 7. After a few more unsuccessful attempts,
the device was abandoned. But research on mechanical
hearts continued. The most promising were pumps that
weren't intended to replace the heart, but boost it
-- like Mike Dorsey's Heartmate. The designers of
the Heartmate took a novel approach to a major problem
of the Jarvick 7 - blood clots that would form inside
of it, and that could kill when they broke off and
traveled to the lungs or brain. The Heartmate's interior
was roughened so that a thin layer of blood clots
over its entire surface, and sticks there firmly.
Mike Dorsey's problem, one that he shares with thousands
of others, was a weakening of his heart muscles so
that the main pumping chamber - the left ventricle
- could no longer pump blood around his body. Installing
the Heartmate begins with cutting a hole in the left
ventricle and sewing in a short tube. Then the electric
pump itself is implanted in the upper abdomen. Blood
flows from the heart, through the pump, then back
to the patient's aorta. By February 1993, Mike Dorsey's
heart was near total failure. His doctors estimated
he had just hours to live. Only weeks before, the
Heartmate had been approved by the Food and Drug Administration
for use at Fairfax Hospital in Virginia to keep a
dying patient alive until a heart transplant could
be found. The operation began with sewing into Mike's
left ventricle the tube that connected with the pump.
Then the Heartmate itself was slid into place. The
connection was made between the pump and the heart
it would assist. Finally, the pump's outflow tube
was plumbed into Mike's aorta. The pump was switched
on. At this point, no one knew for how long it would
need to keep pumping. The Heartmate needed an awkward
external, battery-powered air pump, with an air tube
penetrating the skin. It was only intended to be a
temporary bridge, to keep a patient alive until a
transplant heart became available. After seven months
Mike was still waiting, confined to the hospital.
MIKE DORSEY It's not really me, I'd rather be moving
where I have a destination to go to, instead of standing
in one spot, looking at the same old scenery. This
is the battery charger here, in order to be more mobile,
take two batteries, these, just connect the power
source from here.
ALAN ALDA (NARRATION) That's the alarm that went
off if there was ever a problem.
MIKE DORSEY If you don't have it right they do not
go. You just drop them into the pouch like this, fold
the flap down. Now I'm ready for traveling.
ALAN ALDA (NARRATION) Mike got his transplant a few
weeks after this, and today he's still going strong.
NURSE Hi, Michael.
ALAN ALDA (NARRATION) But now we're much closer to
being able to offer patients like Mike a permanently
implanted artificial heart. About 125,000 of the 700,000
Americans who die from heart failure each year could
benefit from an artificial implant. The Abiomed artificial
heart is modeled on the human, with two main pumping
chambers and valves to control blood flow.
ALAN ALDA As the blood goes through there it pushes
its way through but it can't come back the other way,
right?
DAVID LEDERMAN Right.
ALAN ALDA Can that be relied on, after it pumps thousands
of times after you pass through, after it flexes thousands
of times, to maintain that same resiliency?
DAVID LEDERMAN The answer is yes, and it's not thousands
of times. It's approximately one hundred thousand
times per day.
ALAN ALDA Oh boy.
DAVID LEDERMAN Which is close to forty million times
per year.
ALAN ALDA Forty million times. You can flex this
material forty million times…
DAVID LEDERMAN Without it breaking.
ALAN ALDA Not only breaking, but just weakening and
softening and fluttering and that kind of thing.
DAVID LEDERMAN Correct.
ALAN ALDA So this is where you test the valves.
DAVID LEDERMAN Yes. This is where we test… We have
many valves under test. And we test them under very
severe conditions and at an accelerated rate so we
can demonstrate twenty years equivalency in one year.
ALAN ALDA (NARRATION) Just like the Heartmate, the
Abiomed heart is designed to avoid the danger of blood
clots forming inside. But while the Heartmate has
a deliberately roughened interior surface, the Abiomed
heart aims to be completely smooth and seamless. It
also keeps the blood constantly swirling -- made visible
here with fish scales in water -- to minimize stagnant
areas where clots might form.
DAVID LEDERMAN That's the outflow.
ALAN ALDA (NARRATION) It's not until I get to hold
the heart while it's pumping that I really appreciate
how powerful it has to be to substitute for a human
heart.
ALAN ALDA I can really feel the beating. Now interestingly,
when you see a heart pumping, the outside of the heart
is going like that, you see the motion on the outside.
Here all the motion is inside this device. I've held
onto this heart long enough. Would you mind holding
that for a day or two?
ALAN ALDA (NARRATION) The Abiomed heart is run by
rechargeable batteries that receive their power through
the skin. Both Mike Dorsey's Heartmate, and Barney
Clark's Jarvick 7, had unhygienic and vulnerable tubes
penetrating the skin. Over about three years, the
entire Abiomed system -- surgical procedures, implanted
heart and power supply -- was tested about a hundred
times in calves, animals about the same size as human
patients would be. By the middle of 2001, five surgical
teams around the country were ready to conduct the
first human trials. Bob Tools, a 59-year-old with
severe heart failure, was the pioneer. His doctors
estimated he had about 30 days to live. The FDA had
approved five implants, but only for patients as sick
as Bob Tools. He had already been judged to be too
sick to receive a heart transplant. In a seven-hour
operation, Bob Tools' failing natural heart was removed,
and replaced by the artificial system. This is the
computer control, with the battery that will be recharged
through the skin. The control and battery will rest
directly below the heart, in the abdomen. Now the
heart itself. It's attached using cloth collars, sewn
to the arteries. After the implant, Bob Tools began
to make a remarkable recovery. He'd been bedridden
before, barely able to raise his head, and here he
was on his feet. He was even beginning to gain a little
weight. The equipment cart here is just to monitor
the heart's operation. It doesn't have to be attached.
Bob Tools made steady progress, mostly confined to
the hospital, but with the occasional excursion for
the benefit of the press. Bob told reporters he liked
to hear the implant pumping away in his chest. "As
long as I can hear the sounds," he said, "I know I'm
here." Over the next four months, four more equally
sick patients received implants. Then, four and a
half months after his surgery, Bob Tools suffered
a major stroke. He died three weeks later, but he'd
lived five times longer than was expected before the
implant. To date, two patients are still alive, but
there's been one other fatal stroke. Abiomed believes
blood clots may have formed around these plastic struts
on the heart's attachment collars. They're removing
the struts, and ten more implants have been approved.
So we'll soon see if this system has the potential
for the widespread impact that it's inventor thinks
it can achieve.
ALAN ALDA Are you going to be extending a lot of
people's lives because now they'll be able to have
an artificial heart?
DAVID LEDERMAN We hope yes. The fact is that two
thousand years ago the average life span was 30 years,
and a hundred years ago the average life span was
47 years and today the average life time is 75 years.
And there are a large number of people who reach 75
and beyond who are neurologically intact, who are
very productive, and the only thing that is wrong
is a hip, which we replace today, or a muscle like
the heart, which we should be able to replace. And
there is no reason why the end of life should come
prematurely.
NERVES OF STEEL
ALAN ALDA (NARRATION) Don Crago is paralyzed from
the waist down. But using artificial electrical muscle
stimulation, he can walk. Dr. Byron Marsolais started
this project.
DR. BYRON MARSOLAIS He has absolutely no control
of his legs at all. He is totally and completely paralyzed,
and every bit of motion that happens is coming through
the electrical stim.
ALAN ALDA Don, do you get all your balance from holding
on to this walker? DON CRAGO Yes, I do. Yes, I do.
And…
ALAN ALDA Does that put a lot of pressure on your
arms? DON CRAGO No, not really. Most of the pressure's
on my legs. Actually, I prefer to let my legs do the
work, 'cause if I did it with my arms, I would be
tired out.
ALAN ALDA Yeah. How tiring is it to take it every
step? DON CRAGO Not too bad. It's comfortable, you
know? But after the end of the walk, I will breathe
heavy.
ALAN ALDA Standing takes a lot of energy because
you have to stimulate the muscles for a prolonged
period?
DR. BYRON MARSOLAIS Right. He is standing by stimulating
the flexors and the extensors --the antagonistic muscles
-- all at the same time. So he's stiff as a board.
ALAN ALDA And that charge just has to be constant...
DR. BYRON MARSOLAIS It's constant...
ALAN ALDA If you let up on it, he's liable to tip
one way or another.
DR. BYRON MARSOLAIS Oh, he would, for sure. And so
he looks good standing tall and stiff...
ALAN ALDA But you feel the strain?
DR. BYRON MARSOLAIS But he's got strain. DON CRAGO
Yeah, I feel a strain.
ALAN ALDA (NARRATION) My introduction to the Functional
Electrical Stimulation, or FES, program, was 10 years
ago.
DR. BYRON MARSOLAIS Now what I'm trying to get to
is his gluteus maximus muscle, the big seat muscle.
ALAN ALDA (NARRATION) Dr. Marsolais showed me how
he implants wire electrodes.
ALAN ALDA What you're inserting into the muscle,
that's not the electrode itself.
DR. BYRON MARSOLAIS No, no, this is just a little
probe, a very tiny probe.
ALAN ALDA And the reason you're doing this is to
see if you can get the muscle to react, to give its
greatest response?
DR. BYRON MARSOLAIS Exactly. And I want just the
right muscle. That's the muscle that we want, it goes
right down here into the femur, which is the big leg
bone. And you see how it's beginning to jump there?
It's starting to do what we want. I think I can do
better. And in order to do better I have to get it
right beside the nerve.
ALAN ALDA (NARRATION) Dan Kemp, paralyzed in a car
accident is on the table.
ALAN ALDA Now I think Dr. Marsolais looks like he's
found the spot here.
DR. BYRON MARSOLAIS That looks pretty good here,
yup. That's getting a pretty good, tight...
ALAN ALDA I can see it.
DR. BYRON MARSOLAIS See how that jerks thing together
there.
ALAN ALDA It looks like about an inch-and-a-half
from where you were first searching for it.
DR. BYRON MARSOLAIS Yes, that's right, although we're
angled a bit down. We started about here and now we're
about here, so we were a good inch away.
ALAN ALDA (NARRATION) Once he's found the best stimulation
point for the muscle, a hair-thin permanent wire implant
is slid into place. Dan was one of many experimental
subjects who volunteered for the program. In his case
he received 8 electrodes in each leg.
DR. BYRON MARSOLAIS Now we just bring this down to
exactly the position that we were before.
ALAN ALDA (NARRATION) The patients, and Dr. Marsolais,
were literally stepping into the unknown.
ALAN ALDA How do you feel when you are going through
this? Do you feel a little like a guinea pig? DAN
KEMP Yeah I do, but it's well worth it. You know,
down the road, people will be able to look back and
say if it wasn't for people like me that they wouldn't
have gotten as far as they've got in the new procedures.
So you know it goes down the line. Everybody helps
everybody else, whether they realize it or not.
ALAN ALDA (NARRATION) Eric Bellamy, paralyzed in
a motorbike accident, agreed with Dan that it was
worth being a guinea pig. He saw simple, basic ambitions
for himself, and for the program.
ERIC BELLAMY I see being in a chair always, but I
see being able to go up steps and knock on a friend's
door and say, Hey, I'm down here. Instead of running
around the house and screaming, Hey I'm here, I'm
here. I see being in a convenience store -- one step,
you know. Being able to get up and go through a narrow
door to go get into the bathroom -- just for them
answers. And if they can come up with that right there.
Your life's in a chair, but being able to overcome
difficulties would be a tremendous step. And that's
what we're working on right now.
ALAN ALDA (NARRATION) Eric was one of 5 volunteers
who received the most complex of the experimental
systems, with a total of 40 implanted, and 8 external
electrodes. The computerized control box could handle
48 electrodes simultaneously, with connections made
through the skin on his thigh. One big goal was to
establish how many muscles need to be stimulated for
effective standing and walking. Working out how to
sequence the firing of the electrodes was another
challenge.
PAUL MILLER OK, go ahead and stand up.
ALAN ALDA (NARRATION) In this trial, 20 muscles per
leg were being stimulated, compared to the 50 per
side that are involved in natural walking. Eric was
able to walk relatively smoothly, although he still
needed to use his arms to balance. Developing an artificial
balance mechanism is still one of the goals, but they
have been able to reduce the number of muscles needed
for walking to only 8 per side - as in the latest
system we saw Don Crago using earlier. But Eric's
muscles also had to work constantly at full blast.
PAUL MILLER They're using tremendous amounts of muscle
mass. Their quadriceps are on 100%. Their gluteus
muscles are on 100%; their hamstring muscles are on
100%. Their back muscles, everything's just blasted.
ERIC BELLAMY Whenever they do something, their using
100% of all their strength. Whether it's one step,
two steps, they're using everything they got. Letting
me stand, everything goes right into it. 100%, bam!
PAUL MILLER OK?
ALAN ALDA (NARRATION) With tough, motivated subjects
like Eric, they were eventually able to work out how
to reduce the high levels of muscle stimulation, and
they also figured out the best design philosophy.
It's that simpler is better -- they realized that
even the most complex systems were going to get tripped
up by the real world sometimes. Better instead to
go for simpler, standard systems that can bring basic
benefits to the largest number of people, quickly.
Many of the pioneers in FES research have now dropped
out. Eric got a bad infection. Dan couldn't keep up
the long commutes to the hospital. But today, many
people with spinal cord injuries have good reason
to be thankful for the pioneers' efforts.
JEN PENKO This is an easy introduction to the real
world, I guess you could say.
ALAN ALDA (NARRATION) Jen Penko, who was made paraplegic
in a snowboarding accident, is one of the beneficiaries.
She's showing me a rehab area at Cleveland Metro Medical
Center - the first of 3 centers around the country
to be working with the simplified, standard systems.
JEN PENKO For instance there's curb cuts and those
types of things.
ALAN ALDA It takes a little extra energy to get up
that, doesn't it?
JEN PENKO A little bit, but you'll get curbs in the
real world that are a lot more difficult than that.
ALAN ALDA Yeah.
JEN PENKO You can just set it right there, because
I'll get myself set up.
ALAN ALDA (NARRATION) Jen has a simplified system
that just does one thing - allows her to stand.
JEN PENKO So the light by the "stand" means that
it's ready to stand and all I need to do is press
this button to go, and it'll stand. Ready?
ALAN ALDA Yeah.
JEN PENKO Are you sure you're ready?
ALAN ALDA Yeah, yeah. I'm ready, I'm ready.
ALAN ALDA (NARRATION) Jen's system has only 4 implanted
electrodes per side, but that allows her to stand
and get around just enough to really make a difference.
JEN PENKO So here I can reach up, grab window cleaner
and hand it over to you.
ALAN ALDA How long can you stand before you start
to feel stressed out or you're breathing heavily?
JEN PENKO We did a test on that. 33 minutes and 8
seconds was my time figure right now. And that was
a few weeks ago, so. Usually when you're in a grocery
store, one of the tough things, when you're in a wheelchair,
is you can't really see within these big bins. So
that way you can reach over, pick up some Weight Watchers,
good lord knows I need it. And you can start to see
things from a standing level that you really can't
see from a sitting level. Whereas if I was at a sitting
level I'd be lucky if I'd be able to see what was
actually in there.
ALAN ALDA Do you want to go to walking? Is that something
you have in mind?
JEN PENKO Absolutely. Absolutely. To be able to ambulate
is fantastic. I mean, just to be able to stand. We're
focusing on the functional things, but there's a lot
of health benefits to standing as well. I mean, people
that are in wheelchairs that don't stand, you have
problems with the shortening of muscles, with osteoporosis,
with circulation,
ALAN ALDA So you have to be able to get into pretty
much any kind of a seat…
ALAN ALDA (NARRATION) Simply transferring from one
seat to another is a big benefit.
ALAN ALDA ...automobile seat, and a booth like this
which is different from a chair. One, two three. Those
are three slow seconds.
JEN PENKO They are. And considering I'm from the
Boston area, I've had to learn how to count a lot
slower than out here. So it took me a long time to
learn how to count.
ALAN ALDA They count slower in Cleveland?
JEN PENKO I guess they do.
ALAN ALDA (NARRATION) Another part of the design
philosophy is modularity. If Jen and her doctors decide
everything is working well, she can get another 8
electrode implants, which will allow her to walk.
JEN Now I'll sit.
ALAN ALDA So you have the same three seconds before
it puts you in the seated position?
JEN PENKO Uhuh. Same audio that it goes through as
well. Same beeping cycle.
ALAN ALDA Yeah.
JEN PENKO So it's just like a habit. Training me
like a mouse. There you go -- beep. Three seconds
later -- beep. And I'm standing up.
ALAN ALDA What do you call the thing that's implanted?
What is that? JEN It's my receiver.
ALAN ALDA How big is it?
JEN PENKO Um, it's about that big. It's not very
big at all. In fact...
ALAN ALDA (NARRATION) A big change with the standard
systems is that, like with the Abiomed artificial
heart, no wires pass through the skin.
JEN PENKO So this is the box that hold the batteries,
that holds the software and circuit boards.
ALAN ALDA (NARRATION) Instead there's a transmitting
coil with an implanted receiver.
JEN PENKO I have it taped onto the skin so it won't
move. So I have this coil that sends the radio waves
to the receiver that's right here, and you see the
little bump in the skin right there? That's the receiver.
ALAN ALDA (NARRATION) There are now nearly 200 standard
systems in use, but research is continuing. Jim Jatich
received the very first implanted electrodes, in 1986,
to allow his left hand to grip.
JIM JATICH Since I had this implant, once it's put
on me in the morning, I'm on my own and I can write
for myself, feed myself, answer the phone, take messages,
work on a computer. I do engineering drawings on the
computer; I'm trying to start my own business doing
that.
ALAN ALDA That would have been out of the question,
I mean without a tremendous amount of help.
ALAN ALDA (NARRATION) When we met Jim in 1993, he'd
already been an FES research subject for fifteen years,
helping to try out new systems. Back then, for example,
they were perfecting a joy stick controller for the
8 electrodes that give him his handgrip. The joystick
was attached to his right shoulder. So a quick shrug
of the shoulder activates the grip. And then a double
shrug relaxes it. Jim was also one of the first to
try an implanted receiver, so no wires penetrate the
skin. Today Jim is trying another experimental control
system.
JIM JATICH What we have is like a joystick implanted
in the bones of my wrist. There's a magnet and a sensor,
and as the wrist bones pass each other that sends
a signal to the implant, and depending at what angle
I'm at, whatever is programmed into the computer on
the back of my wheel chair, that's how much strength
and how fast my hand closes.
ALAN ALDA So the magnet and the sensor, depending
on how far apart they are, as you move your hand back,
that regulates everything that's gonna happen.
JIM JATICH Right
ALAN ALDA (NARRATION) Jim and the researchers have
been working with the implanted magnet control for
a couple of years.
ALAN ALDA Now if that were full of coffee and heavy…
JIM JATICH You can see how strong I'm holding it.
ALAN ALDA Yeah, you have a really good grip on that.
JIM JATICH Yeah.
ALAN ALDA Yeah. You're a good actor, too. Looked
like you had something in there.
JIM JATICH Oh, it's hot!
ALAN ALDA (NARRATION) With the magnets controlling
his left hand, Jim's joystick can now control a new
implant system in his right hand, so he'll be working
with the researchers on tasks that need two hands
simultaneously. Jim's essentially a member of the
research team, but one perhaps with a special perspective
on the benefits the FES program.
JIM JATICH You know I've talked to friends of mine
that are paralyzed. They won't go into restaurants
when we have meetings, you know like a support group
meeting, because they can't feed themselves. They
don't want to see anyone feeding them so whenever
we have meetings in a hospital or something they show
up, but when we have it in a restaurant they won't
go, because someone has to feed them, you know.
ALAN ALDA So there's a series of things that don't
get done, because of a simple thing like not being
able to pick up a fork. I mean, you get less social.
JIM JATICH That's right. An example is a girl that
came into this project to get an implant. When she
first came in, her face was down, she wouldn't talk
to anyone, no eye contact. After she got the implant
she's feeding herself, going out to restaurants, she
enrolled back in school. Now she's an advocate, talking
to everyone about it. She started a support group.
And I mean, you know it just changes people's lives.
And that's the kick I get out of it, to see how people
change.
ALAN ALDA (NARRATION) You'll recognize the radiant
young bride walking down the aisle. Well, not quite
walking -- let's say progressing. It's Jen Penko,
and that's her Dad by her side. A year after we filmed
her in Cleveland, Jen married her long time sweetheart,
Tim. Jen made it to the altar standing tall, under
her own steam -- thanks to her basic, standing FES
implant. She doesn't yet have her walking system.
PASTOR We have gathered in the presence of God to
witness the joining together of Jennifer Penco and
Tim French, and in the celebration of God's greatest
gift, the gift of love -- a love that abides and grows
through difficulty and trial. This, you see, has been
Tim and Jennifer's experience over the past three
years, of facing injury, months of painful therapy,
healing, and renewal, and has led to the miracle of
Jennifer walking down the aisle this day.
ALAN ALDA (NARRATION) "For those moments, I totally
forgot that I was wheelchair bound," Jen told us later.
It was "...a moment in our lives that we would never
forget, of accomplishment for achieving something
that we had worked toward for so long. For that time,
I wasn't disabled. All the negative sides of disability
disappeared, to be replaced with the gifts of abilities,"
she said. It would be hard to imagine a more vivid
demonstration of the benefits of another kind of marriage
-- the new marriage of biology and engineering that
this program has been about.
