Laboratory-grown vaginas implanted in patients | Hacker News Reader

Laboratory-grown vaginas implanted in patients

kurzweilai.net

173 pointsca98am7977 comments

Physician here. I read this paper when it was posted on Reddit a few days ago and it was very impressive.

I'll link to the discussion because the top comment was comprehensive and summarizes the published article:

http://www.reddit.com/r/science/comments/22qhob/laboratorygr...

To address questions of how this can be applied to other organs, growing tissue like a trachea or skin is becoming easier. They grow the cells on a scaffold and then you have a tissue. Organs are much more complex and a penis is an organ. We are not at that level of sophistication to grow an entire, functional organ ex-vivo, at least for human use.

Do you have any insight into what would be the effect of this on Sex Reassignment Surgeries?

I wish I did. It's by no means an area of expertise for me, but I would guess that this technique is extremely expensive and will remain limited--at least for the short term--to use in cases of genetic females that require replacement of their vagina due to its congenital absence of loss from cancer/injury.

The location of blood vessels, nerves, etc. is different in genetic male vs. female and may require a totally different approach.

Unfortunately, limited for now. The implantation was done in patients who have most of the "infrastructure" already in place, rather than the somewhat more dramatic restructuring required for sex reassignment surgery.

But it is a very promising first step.

Sex industry jokes aside it has been amazing to watch this field of research advance. While still limited to relatively simple structures (tracheas, vaginas, cartilage, etc.) this is helping actual patients now, not just lab demos. Imagine when we can grow a new eye, kidney, lung, or heart.

I love what our industry does with technology but to me it still pales in comparison with things like bio-engineering. Perhaps that's just my perspective.

EDIT: Attaching a bit of a personal outlook. I am about a month away from having a tumor removed and the primary surgery doesn't bother me as much as the reconstruction process that will be required after. Having my own tissues grown to fill in the hole would definitely change my perspective.

> Imagine when we can grow a new eye, kidney, lung, or heart.

Imagine that we can grow _better_ eye, kidney, ... extra eye, kidney...

Huge ramifications for religion. Thinking of Mark 8:22. To know God, you must become... We have to be ok with this at some point.

Who's Mark 8? Also, which God? Are you talking about a specific novel or just general gnosticism or mythology?

That's a bible verse describing Jesus making a blind man see. Point is, knowing God better is apparently of value to religious Jews and Christians. Biblical study can serve this effort. If it (knowing God) really is important to believers, then they have to consider how science plays a role in that effort as well, except that what science offers may not be nearly as satisfying in a traditional religious sense.

What beautiful irony, the bible itself extols the value in "knowing god" - for which I will read, knowing the natural world. Yet when anyone tries to do that, they very often end up being persecuted by the very same church.

Not that any of this Mark nonsense makes any difference in the real world. Aside from contributing to huge death tolls across the world in the name of minor semantic difference in reading, religion adds absolutely no value to advances in medicine.

In another lovely irony, the eye is one of the single most convincing pieces of evidence for the non-existence of god! Why, otherwise, would "he" have bothered to create a blind spot.

If we could all just stop with this outdated nonsense and focus on the actual problems the world faces, like climate change and overpopulation instead of worrying about which particular form of doctrine to pick we might as a species stand a chance.

> In another lovely irony, the eye is one of the single most convincing pieces of evidence for the non-existence of god! Why, otherwise, would "he" have bothered to create a blind spot.

So we could learn to trust in Him and stop relying entirely on ourselves.

haha! what does that even mean - that's just typical religious mumbo jumbo. It's by relying in "HIM" that we have the blind spot. If "He" is so capable wouldn't he have thought of a better way to connect the optic nerve, like evolution did in other species? I know I can't win an argument using logic with a zealot, but seriously, let's stop with the "trust in him" claptrap.

>> "religion adds absolutely no value to advances in medicine"

I know what you mean, but the number of hospitals hosting groundbreaking medical research that happen to have "Saint" in their name contradict the way you're trying to say it.

I recommend shying away from superlatives when stating a case.

I'm surprised to see that my questions were down-voted, and that a religious tirade ensued. I was just curious who Mark 8 was. The comment I was replying to mentioned Mark 8 with the assumption that everybody knew who that was... Sometimes religious people are so indoctrinated that they think they live in a [theology book]-centric universe. I'm sorry I crossed you, Mark 8.

How about "an eye for an eye" (Matthew 5:38, apparently)?

- So sorry about your eye! You're half-blind now! I should really stop running with scissors.

- Ah, that old thing? I was going to get a new one anyway.

If we can replace organs at will, its logical to believe that somewhere, inflicting grievous harm as punishment is going to become common.

If someone's lung or heart can be replaced in a day, do your qualms about stabbing someone in the chest go down?

Small wounds often heal within days, yet I don’t go around stabbing people (not even with tiny knives!). Sure, maybe some offences turn from ‘murder’ into ‘grievous bodily harm’, but that shouldn’t be bad in and of itself?

Better recovery would make grievous injury more dangerous for the assailant, not less. Leaving aside murderous intent for a moment, and think about a car accident from reckless driving: the party at fault would be on the hook for the bill, and regrowing complex organs won't be cheap.

I wouldn't think it'd become more common. Personally, I'd say no to the possibility of my qualms going down about it because:

-That is still considered a screwed up thing to do someone,

-It's illegal: you'd be charged(and probably convicted) with attempted murder, or at the very least, assault and battery, which carries significant fines and jail time,

-the person could still die as a result of it

I have, from time to time, played the "I can't get behind that" game.

It goes like this: 1) Observe that a lot of older people in my life---and throughout history---are / have been intolerant of something that you find benign (myriad things have taken this role in history: bare ankles, women voting, rock music). 2) Infer by the law of averages that I am probably not very different from most people. 3) Assume I will therefore have a 'thing'that a younger generation will be fine with that I am utterly intolerant of. 4) Try to guess that 'thing.'

It's a hard game. My best guess at this time is "In a world where medical science and services have evolved to the point where life-saving procedures are routine, automated, and five-nines successful, a younger generation will find ever more violent and dangerous versions of (http://en.wikipedia.org/wiki/Choking_game) to be fun to play, and I can't get behind that!"

A bit flipped, but I expect younger generations to be intolerant of the way animals are treated in our society; e.g. mousetraps, factory farming, animal experimentation. I'm not sure how to factor that into your game; "can I get behind future intolerance of behaviours that I consider ordinary" I guess.

I was totally serious. Totally.

The journal The Lancet, which published the peer-reviewed case report[1] on the latest news commented on in the submission here, makes available the full text of a commentary article from 2011[2] about the work of the same doctor, who has worked on several kinds of replacement human organs.

My alma mater university is one of several centers around the world of research on growing human tissues on spatial matrices of various kinds to grow replacement organ parts (e.g., heart valves) or organs (e.g., tracheae).[3] I had the pleasure of touring one of the labs here with one of my children, and the researchers in the lab said the research involves experimenting with different materials to form the matrix on which the human cells grow, and of course learning what three-dimensional form of the matrix will produce the best replacement part, with plenty of other issues to research besides. This path of research is one of the reasons why I think it is quite plausible that incremental improvements in life expectancy at middle age and old age, which have been steady throughout my lifetime,[4] will continue as each reader of Hacker News reaches middle age and old age.

[1] Abstract of "Tissue-engineered autologous vaginal organs in patients: a pilot cohort study"

http://www.thelancet.com/journals/lancet/article/PIIS0140-67...

[2] http://www.thelancet.com/journals/lancet/article/PIIS0140-67...

[3] http://www1.umn.edu/news/news-releases/2010/UR_CONTENT_17680...

[4] http://www.prb.org/Journalists/Webcasts/2010/humanlongevity....

http://www.nature.com/scientificamerican/journal/v307/n3/box...

The work behind this is the result of a huge effort, starting 20-30 years ago. Some people had given up on the promise of tissue engineering - one of my mentors suggested just over a year ago to me that the field was a poor choice to start a career in due to too many researchers and not enough progress. Its a very active field of research, and practically every university with a life sciences or bioengineering department will be doing some sort of work on it.

Thanks for posting the journal links.

We're not done yet. Most of the currently feasible organs are relatively simple in geometry and homogenety. More complex organs like the kidneys, liver, and espessially brain are probably exponentially harder to make. I personally think we'll have nanotechnologies and regenerative techniques that will leap-frog lab-grown organs before we are making more complex organs (which will be the desired approach unless, as in these cases, the organ is absent). A major disadvantage of lab-grown organs is they still need major surgery to implant.

I also think we will soon find (if we haven't already) that the limit on human lifetime and quality is from diet and excercise, and that these approaches get much more gains per dollar. We will soon find (if we haven't already) that health is limited by resources, not science. Prevention before intervention.

(PhD student in Bioengineering. I don't work in tissue engineering but most of the people in my office do.)

But prevention is impossible, metabolic damage would at best be slowed down with the right diet and exercise, and not all that much it seems. At least some of the damage is also quite independent of those factors as well. Repairing our bodies seems like the clearest approach to real longevity, regardless of the specific technique.

(No bioengineering background here though, so what do I know.)

Depends on the goal. If maximizing quality and length of life under constrained resources, prevention is more effective. But, as you mention, prevention does have inherent limits on life span. Biotechnology could allow further, perhaps infinite extension to lifespan.

I'm not sure this is a good goal to have. To paraphrase Jobs in his Stanford Convocation speech, death allows the clearing of old ideas and provides urgency to motivate the living. Further, the infinite-living "you" would no longer really be "you", since all the matter and its organisation would be replaced several times over. (Biologically, this also happens but at a different scale so the organisation is more preserved). Arguably, your own ideas, thoughts, and concept of self remain.

It's perfectly possible to learn to change your ideas and continue to learn and adapt over time well into adulthood. Not everyone does it, but I pursue personal growth and learning, and consequentially change quite a lot from year to year. I would happily commit to change and adaptation in order to live for thousands of years. I don't think I need death to give me urgency. If anything, thinking about my mortality tends to reduce my motivation.

I find the idea that an infinite living "me" would not be "me" very strange. It's like saying that if you keep adding fuel to a fire, once the original fuel has burned away it's no longer the same fire. My mind is a dynamic process, even if it changes state, it's still a continuation of the same process.

Ultimately, the ideas and urgency of ordinary human beings probably won't determine what happens to humanity in the long run. We're on course to develop powerful AI even with the technology and ideas we already have. Who knows what will happen then, but I think a stagnated immortal human race is a very unlikely outcome.

More complex organs like the kidneys, liver, [...]

Interesting. I was under the impression that the liver was going to be one of the easier ones, due to its own ability to regenerate. That's not to say that it's going to just automatically hook up the bile duct and such...

do even need to create artificial livers? i thought liver transplant was easy thanks to its regeneration. Of course you can't simply do the same thing with vaginas... hence the need for engineered ones

do even need to create artificial livers?

There's still the issue of having to take immune system suppressing drugs, and rejection in general. Its less of an issue for the donor (though it is still major surgery) because the donor's liver will regrow and be back to full function.

There is a fair bit of focus on it. I'm not sure if that is because of the ease of building them or the need for it - it is a fairly critical organ and there is a shortage of donors. I believe the challenge is the vascular (blood vessel) network, which is quite developed and important to the liver's function.

A lab-grown liver could be quite advantageous to a donated liver - the lab would use the person's own cells to make the tissue. Rejection becomes less of an issue. Today, liver recipients need to go on immuno-suppressants. It is inconvenient to take dozens of pills a day and these people are more prone to illness.

I'm curious to know whether this could be offered to M->F transsexuals.

I think this technology might be even more useful for trans men, where unlike trans women there's less flesh available to sculpt the structures you want.

Why would a trans man want a laboratory grown vagina?

They wouldn't but they might want a laboratory grown penis.

There's a lot less skin down their for them to create a penis with currently, so this technology could give surgeons a lot more to work with.

Using skin grafts and prosthetics they can already create the structures they want, so this would merely make a slightly more realistic looking structure, but probably not make it 'functional'. There's a number of active processes that would have to be reproduced, and I doubt there's sufficient existing wiring/processes in place to create the same effects. If you just don't have the wiring, it's difficult to make it work organically. But I can completely believe it will be possible in the future to create synthetic pumps to induce erection, and redirecting female ejaculation through the phallus should be simple enough.

I don't feel like finding the source, but iirc one of the articles covering this mentioned that they actually managed to grow a penis before they did vaginas, so that is indeed very good news for transmen. Whether it's been actually attached to someone successfully is a different question of course..

Indeed. The current state of the art in vaginoplasty is nearly indistinguishable from the real thing; I think elasticity could be improved, but transwomen who can afford it are pretty well-served already. (Although affording it is kind of a huge deal; if this tech could be made significantly cheaper than standard vaginoplasty, it would be an enormous benefit to a lot of women.)

Phalloplasty, on the other hand, is somewhat disappointing right now--mainly because we can't yet create erectile tissue, so they have to resort to thing like pumps to get an erection. If we could create fully-functional penises, a lot of FTMs would be very happy.

I would imagine they would need to replace a lot more tissue in the pelvic region compared to implanting a new vagina in a genetic woman who already has all the required surrounding tissue.

While an artifical ear or eye has practical benefits, genitials might mean more to the recipients. Hard to tell: which would you rather go without?

It mentions that nerves grew into the structure, but doesn't explicitly state how well feeling was restored.

Restoring the related organs, uterus, fallopian tubes and especially the eggs themselves, still seems like science-fiction - at least, for now.

Considering that the 4 patients were teenage girls born without vaginas, it seems unlikely that they'd be able to tell how it compares to non-artificial one. Maybe that would be included in another study, on using it as a replacement (after injury/cancer).

Yes, but at least now it's two-weeks-into-the-future science fiction, not Star Wars science fiction.

There's a cultural bias against medical treatment for stuff that is less visible or critical. There's a general consensus that things like eyes or legs are useful, even though surveys of paraplegic patients report that partial restoration of genital sensation is more meaningful to them than walking.

Fewer people think about less obvious senses like _tasting_ and _smelling_, to the point that it can be difficult to get the condition taken seriously, even though complete loss of smell can be highly traumatic.

There is a class of people who regard humans (including themselves) as highly advanced and complex robots which slot neatly into worker roles in society, defined by their objective utility. Such a view basically means things that you don't need to function are frivolties and spending resources towards guaranteeing the personal joy of people is an anathema. It kind of seriously makes me consider the "philosophical zombie" hypothesis.

It's interesting that you should mention smell, since I was born without a sense of smell - the term is anosmia. It is very poorly studied, and most studies deal with people who lose their sense of smell due to neurological diseases or head trauma.

In my case it's clearly genetic (my mom and her dad both can't smell), and almost no one studies it. From what I've read I'd much rather be born without a sense of smell than lose it, since that can be very traumatic.

I was specifically thinking of anosmia and ageusia. There are many invisible disabilities that most people aren't aware of; anosmia is one of the ones where most people who don't have the issue don't even see why it might be a problem until they've really thought about it.

Couple of articles about or by people who have experienced the loss:

http://www.slate.com/articles/health_and_science/medical_exa...

http://www.smh.com.au/lifestyle/diet-and-fitness/life-withou...

Anosmia is much more serious when it's the result of trauma or some other disease - it makes food taste radically different, and is likely to cause depression. That said, I've never had a sense of smell, so I don't know what I'm missing. And the world is much less smell-focused than vision or hearing, so if you have to lose a sense, smell is near the top of the list.

Sounds like for you it's a drawback but not a trauma. It's also not a problem I have personal experience with, though I have with others.

I guess my point was a lot of people hearing about traumatic loss think its no big deal because you can still work without it and don't immediately make the connection between "losing your sense of smell" and "losing the ability to taste chocolate like you're used to".

Do you think we'll start seeing people with bad livers/kidneys/organs pre-ordering new ones and having them frozen/stored? if i'm some rich 80 year old tycoon with a bum heart, i could see myself having new versions of all my parts stored for me at a lab for when i need them.

Then other parts of your body would start failing in interesting ways. Interesting from a scientific perspective, but I'd imagine pretty horrible from a human one. Your heart and kidneys don't fail by themselves, your entire body suffers cumulative damage from mistreatment and it's just those parts that fail in a terminal way first.

Well, once we can solve the problem of the first things to fail, we can work on solving the problem of the next set of things that fail, etc.

I wonder how far you need to go before a brain transplant is cheaper / safer than replacing it. I can see replacing major veins as being doable but capillary's are far less so.

Or perhaps, when our time comes, we can simply die, leaving the world to the next generation as it has been for billions of years.

Sure, we can; but if we'd thought that way before we would never have developed medicine. For some reason in every generation there are people who seem to think that using the medical science they are familiar with (or just slightly less) is okay and normal, but using anything more is somehow contrary to nature. But using our mind to develop new ways to overcome the limitations of our bodies is our nature just as much as the failures of our bodies are.

I don't want to and you can't make me.

For farther comments on the issue, read up on the element of hubris in Greek mythology.

Right, but oftentimes (but not always) the "cumulative damage" is causally linked to a single source. For example, when your kidneys fail, the rest of your body suffers crazy loads, since the kidneys are tasked with maintaining electrolytic balances in your blood, which other organs depend on. For example, failing kidneys don't clean out potassium from your bloodstream, which causes your heart to come under increased load and usually results in sudden cardiac death.

So replacing a failing kidney early on will keep your heart in a much better shape. Of course, in the long run, you'd need to replace everything, and in the very long run there's always cancer...

That is not necessarily true. There are lots of instances where a specific organ is experiencing failure and could be replaced and the rest of you is pretty normal functioning. Especially in kidney failures or injuries, liver failures or injuries, and hearts as well. Think about all the people on dialysis. Lots of them are awaiting a new kidney from a donor. What if, instead of waiting 2 years for a match they grow you a new one in a few months? Same thing with the incredibly regenerative liver. Hearts might be another story, not sure there. We'd probably need to be able to grow those completely outside the body first.

Have you seen "The Island"? If not, I think you'll really enjoy that film. It's a great look into the ethics of that idea and one possible scenario that could play out in a utopian/dystopian future. Don't read any more about it unless you don't want to watch it. It's better with "fresh eyes".

"If only you could see the things I've seen with your eyes"

I have seen it. There was also a movie with arnold schwartzenneger in it the 6th day where they clone people to replace them when they die, or before they die. http://www.imdb.com/title/tt0216216/?ref_=nm_flmg_act_19

I haven't seen The Island, but another really good book that I remember from my teens which featured this concept was "The House of the Scropion". Instead of using laboratory organs as replacements though, they use real people.

I'm counting on it:) I think we can see something like this in our life time the way that information is moving.

Fun Fact: Laboratory-grown babies implanted in patients happened decades ago.

As a trans woman, I'm very happy about this sort of advance, but I question why I'm seeing it at the top of my HN feed.

A lot of people here seem to REALLY LIKE vaginas.

Just saying.

Is it that unexpected that hackers enjoy reading stories about breakthrough medical hacks? This is pretty amazing.

No. It is not amazing. This is a natural and expected progression of bioengineering technology, and rather easily understood.

More complex organs will require either decellularized donor organs or volume-printed extracellular matrix scaffolds, combined with induced pluripotence in autologous donor cells. It will be a while before it becomes cheap enough for hobbyist hacking, but have no doubt that someone visiting this site right now will be biohacking on himself or herself in the future. I'm guessing magnetite organelles injected by syringe into the palms and fingertips would be a popular first mod.

> No. It is not amazing. This is a natural and expected progression of bioengineering technology, and rather easily understood.

You must be a blast at parties.

That hypothesis is likely untestable. I would either have to be invited to a party, or host a party attended by more than one person.

"Amazing" has become the generic "doubleplusgood" adjective of popular culture. Since I believe that words mean things, when someone uses "amazing" descriptively, I could give them the benefit of the doubt, and assume that they are also saying that they are overwhelmed, and incapable of fully comprehending the complexities in the thing described. I could also pessimistically assume that they are using "amazing" because it has become an increasingly common adjective in all audio and video broadcasts, and they simply don't care to use the vastness of English vocabulary to express themselves with precision or conciseness.

Either way, I feel like I can call people out on using "amazing" with the sort of smugness that can only be found in a random guy on the Internet.

Engineered tissue implants are not amazing. They are marvelous, spectacular, exciting, wondrous, phenomenal, stupendous, unusual, glorious, groundbreaking, and noteworthy, to be certain. But they lack the quality of essential, impenetrable mystery that I feel is necessary to warrant the use of the word "amazing".

Mostly, I'm tired of hearing and seeing the same damned word over and over again, from people who apparently are not aware that it does not convey unconditional positive emotion so much as relative superiority over the one doing the describing. As such, if you think everything is amazing, you are describing yourself as having a severe cognitive defect.

This issue irritates me enough that I am willing to burn karma on it. Don't even get me started on the people who use "journey" to describe something that involved neither literal travel nor a spiritual or ideological transformation.

What kind of person doesn't like vaginas? Except gay men, except those of them that do like vaginas in the aesthetic sense. It would be like not liking breasts or abs or butts or legs or penises. I mean, you don't need to like them sexually, it's just that, well, they're nice to look at.

Quite a few gay-identifying men go out of their way to make sure you know how disgusting female genitalia are to them.

I'm bi, and I think both sets of genitals look pretty ridiculous when not seen through the lens of arousal. The rest of the body I can generally appreciate aesthetically, but genitals are just weird.

They are amazing! The different size ranges they must accommodate, including childbirth, make them an evolutionary "engineering" marvel. If the lab grown ones can do the same, that would make then an actual engineering marvel.

Possibly. On the other hand, the comments on this post seem to mainly show interest in the medical technology. (Just imagine the top-voted comments on a similar post on Reddit...)