Reversing progressive memory loss, transplantable 3D printed organs, and improvements in resuscitation.

13 November 2014

Possibly the most frightening thing about Alzheimer's Disease is the progressive loss of self; many humans measure their lives by the continuity of their memories, and when that starts to fail, it calls into question all sorts of things about yourself... as long as you're able to think about them. I'm not being cruel, I'm not cracking wise, Alzheimer's is a terrifying disease because it eats everything that makes you, you. Thus, it is with no small feeling of hope that I link to these results at the Buck Institute for Research On Aging - in a small trial at UCLA of patients who were suffering several years of progressive, general memory loss they were able to objectively improve memory functioning and quality of life in 90% of the test subjects between three and six months after beginning the protocol. A late stage Alzheimer's patient in the test group did not improve. The program was carefully tailored to each test subject and makes the assumption that Alzheimer's is not a single disease but a process involving a complex of different phenomena. This is why, it is hypothesized, single-drug treatments have not been successful to date. The treatment protocol tested involved changes of diet, modulation of stress levels, exercise, sleep modulation, a regimen of supplements observed to have some influence over the maintenance and genesis of nerves, and a daily pattern which seemed to serve as a framework to hold everything in balance. The framework is unfortunately fairly complex, and at least at first a caregiver may need to be involved in helping the patient. Looking at how everything fits together it seems to me that there may also be elements of cognitive behaviorial therapy involved, or at least emergent in the process. Interestingly, six of the patients who had to quit their jobs due to encroaching dementia were able to go back to work (it saddens me that there are people who need to work rather than enjoy their lives after a certain age). I don't know if this is going to catch on, protocols like this tend to slip through the cracks of medical science, but it's definitely something worth keeping an eye on.

Longtime readers are no doubt aware that bioprinting, or using 3D printers to fabricate biological structures is an interest of mine. Think of it: Running off replacement organs, specific to the patient with no change of rejection and less possibility of opportunistic infection because immunosuppressants don't have to be used. It's already possible to fab fairly complex biological structures thanks to advances in materials science but now it's time to get ambitious... a company called 3D Bioprinting Solutions just outside of Moscow, Russia announced that by 15 March 2015 they will demonstrate a 3D printed, viable transplantable organ. They claim that they have the ability to fab a functional thyroid gland using cloned stem cells from a laboratory test animal for a proof of concept implementation. The fabbed organ will mature in a bioreactor (which are apparently now advanced enough to be commodity lab equipment) for a certain period of time) before implanting it in the laboratory animal; if all goes according to plan, the lab animal should show no signs of rejection, hormone imbalance or metabolic imbalance. I realize I might be going out on a limb here (I try not to be too optimistic) but, looking at the progression of bioprinting technology since 2006 I think they've got a good chance of success next year. Additionally, I think they might make good on their hopes of fabbing a living, functioning kidney some time next year. And after that? Who knows.

Television to the contrary, resuscitating someone whose heart isn't functional is far from a sure thing. Bodies only have a certain amount of oxygen and glucose dissolved in the bloodstream, and when you factor in the metabolic load of the brain (roughly one-fifth of the body's resting oxygen utilization alone) there isn't much to work with after very long. Additionally... well, I'd be rewriting this excellent article on resuscitation, which pretty clearly explains why the survival rate of cardiac arrest is between 5% and 6% of patients, depending on whom you talk to. Of course, that factors in luck, where and when the patient entered cardiac arrest, how young and healthy they are or are not, and how strong their will to survive is. Due to hypoxia a certain amount of brain damage is almost a certainty; maybe just a few neurons, maybe a couple of neural networks, but sometimes the damage is extreme. About ten years ago the AMA started to look at the data and switched up a few things in the generally accepted resuscitation protocol; the Journal of Emergency Medical Services published an interesting summary recently, of which I'll quote bits and pieces. Assuming a fallen patient in ventricular fibrillation, paramedics gaining access to a long bone in the body for intraosseus infusion because it offers better access to the circulatory system (yeah, I just cringed, too) for drug administration, the induction of medical hypothermia to slow metabolism (which was maintained for a period of time following resuscitation), machine-timed ventilation, and the application of a likely scary number of electrical shocks prior to transportation to the hospital approximately forty minutes later... the survival rate of such situations is now somewhere around 83% (even factoring in a statistical outlier case which lasted 73 minutes). Occurrance of post-cardiac arrest syndrome was minimized by maintenance of medical hypothermia and patients are routinely showing minimal to no measurable neurological impairment.

I'd call that more than a fighting chance.