Translator: Robert Tucker Reviewer: Delia Bogdan
So my talk is: "Medicine and Science in Research, Oh My,"
a bit of a tongue in cheek.
And really there's three points I'd like you to take home from this.
The first point is: Nature can actually show us
the way to design very effective and very safe products.
Number two: If you're going to pursue this type of research
you have to take it to the edge of the envelope.
And in this case it's research in austere environments,
where you will go, and you will test the concept,
you will test the product under real-world conditions,
and you're likely to fail.
So, the vast majority of my research, we've had a multitude of failures,
but the third component is: That's the way nature works.
Nature is designed to let things fail,
and finally something will flow to the top
that actually works and is fairly functional.
So, the first slide up here,
this is actually a slide of human osteoarticular cartilage.
You see there's a very ingenious design to it.
This has a horizontal and a vertical orientation
of the bone spicules.
The collagen on top is very, very smooth.
Now, we'll be coming back
to look at some of the substances within this cartilage.
Now, this is the two simple molecules.
There's a a molecule of proteoglycan and one of collagen.
Now the proteoglycan in this case is a sponge,
has a very high avidity for water.
The collagen then wraps that sponge up,
and keeps it from swallowing it, keeps it from exploding.
This is actually a miniature blow-up
of what your articular cartilage looks like.
Very ingeniously designed; very, very strong;
the half-life for articular cartilage is 114 years.
Do you know the oldest person that lives is? It's 114 years.
So collagen is directly dependent upon our health.
We've not been able to replicate this structure in industry.
So nature's come up with this, nature can make this work.
But we certainly have not been able to replicate this.
Now, everyone likes Jell-O, alright?
That construct that you just looked at, bone and cartilage, is essentially Jell-O.
Now, you remember the commercial: "Watch it wiggle, see it jiggle."
Cartilage itself would not be particularly strong,
so it's the fiber orientation of those specific molecules
that make it strong and functional.
So, if nature can do it, and we now have - you know, you got TED talks,
we've got organic chemistry, we have cellular molecular biology -
we may be able to unlock some of those simple secrets,
that nature has out there and improve our form and function.
This was a construct that I started mucking around with
about 12 years ago.
Now, this construct was designed to take into consideration anisotropic properties.
So, anisotropic properties are the ability of a joint
to resist forces from different directions,
at different speeds, at different times.
And so we took the Jello-O construct,
and we strengthened it by orienting the fibers.
- You can see here I was trying to use little squares, rectangles and circles -
And it did,
it markedly strengthened the construct.
And what this construct was supposed to do
was to replace arthritic articular cartilage
within a human being.
We weren't even close.
It did strengthen, don't get me wrong.
But it was a failure.
But it was a good failure
because it pointed us more and more in the direction
of where fiber orientation had to go.
So switching gears a little,
I'm going to talk about research in the austere environment,
and talk a little bit about Afghanistan.
So, 2001 we were attacked,
we are in a protracted war with terrorism elements.
They've a particular construct they use called the improvised explosive device.
This thing is a high energy agent.
When it goes off, it shatters bone, it shatters the joint,
it rips muscle, it rips skin and nerves.
And it also kicks up dirt.
And within that dirt - it carries it into the wound -
and you have bacteria and viruses and funguses
that are now deposited into the wound.
So, in 2012 I went with a team to Afghanistan.
We were going to look at:
Was it feasible to have our biologic technology utilized
in the treatment of injured combatants?
And so we went in, open-minded.
And it makes sense that if you can have something
that you could squirt into a bone,
that would immediately fix it,
it would decrease pain, it would decrease bleeding.
But we had to come back.
And after observing the wounds for three months,
there was so much focal contamination, so much fungal contamination.
They actually had a fungus
that was eluding a heparin that would eat up the arteries.
So this stuff was nothing to play around with,
and we had to make a decision that this was a failure,
that we were not going to be able to utilize biologic fixation
in order to treat the bones of the wounded.
So, I'm over there for nine months.
About three months into it I've determine our mission's a failure
as far as that goes.
But it gave me some time to look at some other things.
And one of the things to look at
was traditional surgical techniques
in dealing with folks that are wounded in combat.
Now this is an external fixator.
And you could see that there's some rods and there's some pins,
and those all had to be flown in.
Those rods are about a thousand bucks a piece,
so there's about five, six thousand dollars worth
of hardware on this individual.
All that had to be flown in, had to be sterilized.
It takes a lot of logistical support to have the stuff in there.
It takes a surgeons and a clinical team with nurses and anesthesiologists
to know how to use his stuff.
So, I was able to look at this,
and, strangely enough, those rods were about the same diameter
of some of the stuff that we were using for another project.
Now this is the back table in a war zone,
and you can see, and if any of you've been in an OR,
you know it's a pretty busy place.
So, there's a tremendous amount of scissors and bowls and retractors,
and all sorts of gowns and dressings and things
that have to be flown in to the austere environment
in order to perform surgery.
And it's not just done to wounded,
there's other folks that would greatly benefit
from the ability to have advanced surgical techniques within their community.
So what if we've come up with an absorbable biologic,
a polyurethane so to speak,
made out of the components of Jell-O?
- Calcium phosphate, hyaluronic acid,
all oriented very, very specifically.
It doesn't polymerize until you mix it.
And then we could actually generate a rod for a bone.
So this thing would still work in a closed fracture.
Well, I'm just saying we're going to not use it in military combat injuries.
So, for the elderly, this would be ideal technology.
Perhaps for a pediatric patient
when you're trying to operate and not involve the physis.
And what if you could build moles
that would further enhance your structural organization.
So, here's a little girl that was burned in an IED attack.
And you can see they're putting a dressing on.
And that dressing has got a very specific configuration.
We can actually pre-administratively print these dressings.
I can three-dimensionally print it,
put a soup in that would have antibiotics that would elute onto the injured site,
but also, from our study of how skin works,
I can put little micropores in it
that would allow epithelium to migrate in.
And this acts as a skin graft.
So, we're able to generate an artificial skin graft
based on nature that helps the patient fight the infection and heal the wound.
Now, this little girls burns are treated -
not only are there terrorism attacks around the world,
but a lot of kids will pull cooking oil over on them in an austere environment.
That's what happened to this little kid did.
At 18 months of age she had pulled some cooking oil on her,
and it contracted the joint.
She's only 7 years old, so she can't ride a bike,
she can barely walk.
And we're able to go back, and I do soft-tissue releases,
but to pin the feet there are actually some biological pins available.
So I don't have to use metal in this child,
I don't have to us plates.
I'm able to use a biologic pin
that would hold the joint stable for a period of three months.
And then it would dissolve.
And the beauty of this: blood makes it dissolve.
Blood interestingly enough is 7% saline, the same as ocean water,
and we'll come back to that in a minute.
So, I'm able to put the pins in,
and the child is able to get her foot flat.
We get her a bicycle, she rides around the camp.
So this is what can happen
if you can bring in technology into an austere environment,
perhaps a village, perhaps someplace around the world,
that doesn't have advanced surgical techniques.
So, a lot of the world,
perhaps more than a billion, two billion people,
do not have access to energy.
So, if we can utilize solar and wind power to power batteries,
and then work with 3D printers based off direct current,
I can actually print, or my team can actually print,
instruments and tools that would be used for this type of surgery.
So, this is the White Sale Project.
And the White Sale Project is actually here in New Bedford.
In 2013 we were able to secure funding.
And this is sort of the third portion of the talk.
Now, you saw when I went to Afghanistan, we were working in an austere environment,
we were testing concepts, and we were testing product,
and we had some failures.
And so with this next portion I need to replicate those conditions.
Now, I don't have a lab here,
so the easiest lab I could get was to bring in a research vessel.
This is a Coast Guard designated research vessel,
has solar power, it's got wind, it's got sails, it's very green,
and my team is able to put 3D printers on board,
and we're able to actually replicate items with this.
This is the Phoenicia, she's 88 tons, 70 feet.
You can see the sails, and it's got a wind turbine on back.
So, she started an expedition from Portland Oregon last year,
came 7,000 miles, down the west coast of California,
off the coast of Mexico, Central America.
At each place my team retrieved samples of seawater.
And at sea water
we're looking at what particular microorganisms
would work best at dissolving a biologic polyurethane.
So there's a method to the madness.
Because what's happened in our oceans
is we have mountains, mountains, of plastic debris.
And that plastic is not going anyplace.
It just circulates there.
I think in the Pacific they've got one like the size of the state of Texas,
just plastic particles.
And the technology that we're now developing,
this is gelatin brand Jell-O.
It goes in the salt water, it gets sunlight on it,
and "poof" it disappears.
It disappears into calcium and phosphate ions
that your shellfish, that your clams, your oysters,
those very things that we started the talk with,
can utilize to make new shells, to make new backbone.
It buffers the water.
And the thing is, the nice thing is, it disappears entirely.
So it doesn't leave trace elements behind.
So it's safe, it's effective, this stuff is actually very, very strong.
This particular fishhook, I stole this from National Geographic,
took a picture of it, and we fed the information into our printer,
and we printed this fishhook.
The fishhook was then tested.
I can hold up a 200-pound person with this fishhook.
We had a number of these,
and we put these into dishes on the way around from Portland,
and we watched the rapidity by which they dissolve.
Now, that would be useful if you're working in maritime industry,
and you're trying to protect your fisheries,
protect your water quality.
Because if a turtle swam into something like this,
it's going to dissolve.
So, to give example, if I've got a fisherman out with a six pack of beer,
and he's got that plastic thing around the top,
he takes it off and throws it into the water,
a fish or a turtle can swim into that.
With this stuff I can make it dissolve in about a week.
So, this is sort of the final slide,
and I've got three components to this slide,
and I want to revisit what we initially started with.
So what I'm holding up there is an absorbable polyurethane.
This is basically gelatin brand Jell-O
that has been structurally characterized to be strong,
effective, beautiful, but also very safe.
And I can make those rods that I used for external fixation.
I can actually put this into somebody's arm,
and it eventually breaks down into calcium and phosphate,
which is what bone cells utilize to make more bone.
So this is the future of medical technology,
at least in the Western Hemisphere,
and probably also in third-world countries.
Because we will be able to use this,
we have to watch for bacterial contamination,
but structurally, this should really be a game changer
as far as rodding of bones and even plating of bones.
I could use this with face fractures
and you would never have to go back in and remove the plate.
Now, that mold, you can see a mold down there
with a bunch of little holes in it.
So, that little girl, little burned girl,
we came back, and I'm like:
"You know, we can do this, we can make a collagen dressing."
And collagen is a potent mediator of platelet activity,
it'll bring in healing cells.
And we can engineer little holes in this,
so that the epithelium will migrate in and heal this.
So, we're already able to manufacture dressing
based on a solar or wind turbine,
and I can go to any place in the world and do this.
And thirdly, I've got a total joint there; I haven't forgotten my original project.
So, my big interest is still in osteoarticular reconstruction,
and, hopefully, we'll get to a point
where we will no longer have to do metal and plastic joints.
What we'll be able to do is:
I'll be able to take a little bit of your cartilage
seed it into one of my matrices,
and then we can take away that diseased portion of your bone.
I hope you take those three messages home with you.
Have a wonderful afternoon.
(Applause)