The Future of Health Care: Regenerative Medicine and Stem Cells

When an octopus is injured and loses one of its limbs, it will grow back after several months. When a starfish loses an appendage, not only will the starfish grow a new arm, but the severed arm will grow a new starfish! Even among vertebrates, regeneration is not unknown – salamanders can regrow lost body parts. Yet when a human loses an appendage, it is forever lost. What do these animals do that we don’t? Many scientists believe that the capacity for regeneration is lying dormant within our biology, and we may soon be able to activate it.

Most complex organisms including humans contain a huge number of different types of cells that each perform a specific function within the body. For the most part, these cells cannot do anything else; a brain cell can never become a white blood cell, or vice versa. But in addition to these specialized types of cells, we have stem cells – “wild card” cells that have no specific function of their own, but are able to become whatever type of cell the body needs. Stem cells show great promise in treating a wide range of diseases, rejuvenating our organs and tissues, and replacing entire body parts.

For several decades, the organ transplant process has been horrendously inefficient. The standard procedure has been for patients to beg their friends and family to donate an organ…if they can even find a compatible donor. If not, they enter their name onto a hopelessly long organ wait list, where they may die before finding a suitable replacement. If they are lucky enough to receive a transplant, patients will spend the rest of their lives taking a strict regimen of drugs to prevent their body from “rejecting” the organ (i.e. viewing it as a hostile invader to be eliminated).

Regenerative medicine will soon transform this process. People will be able to grow their own replacement organs in a lab, and since the new organ is their own, there will be no worries about their body rejecting it. Substantial progress has already been made in many areas. In 2006, doctors first created a human bladder from scratch. They extracted a few bladder cells from patients, and pasted them onto a three-dimensional mold shaped like a bladder. To their delight, the cells quickly grew into a new, fully-functional bladder, which they then transplanted into the patient. In 2010, doctors first performed a similar procedure using stem cells instead of bladder cells. Regenerative medicine is quickly becoming the standard for treating serious bladder diseases. Clinical trials are underway for similar procedures for other organs including the heart, although these procedures are at least a decade from being used in hospitals. In June 2010, scientists successfully grew a liver in the laboratory for the first time.

But replacing entire organs is not the only promising use for regenerative medicine. There is no fundamental reason why tissues and organs that have been badly damaged – by disease, injury, or natural wear and tear – cannot gradually be rejuvenated by replacing the damaged cells with healthy stem cells, allowing our body parts to remain in excellent condition throughout our lives. This has ramifications for slowing the human aging process, and possibly even reversing it. When people are able to replace their organs with newer versions of themselves, “old age” will need not be regarded as a time of enfeeblement and illness.

Our stem cells are essentially a blank slate, which can become whatever type of cell we want them to become. Their potential applications to regenerative medicine are practically limitless, as practically every major non-infectious, non-genetic disease results in some form of cellular damage. Regenerative medicine treatment will be a relatively slow and non-disruptive transformation – we will gradually see more and more of these therapies over the next few decades – and is not a cure-all by any means. However, it is one of the most promising new treatments (along with genomics) which will eventually radically extend the human lifespan.

The Future of Health Care - The End of Aging

What disease kills 100,000 people every day (usually after a prolonged period of pain and illness), affects nearly everyone, and kills about 90% of people in the industrialized world?

Aubrey de Grey, a renowned gerontologist, is on a quest to eliminate aging. The search for the fountain of youth has confounded humanity for millennia, but de Grey is on more solid scientific ground than most of his predecessors in this field. He has identified what he believes are the seven causes of biological aging – a list which has remained unchanged for the past 30 years – as well as the solutions for dealing with each cause. These solutions are not merely theoretical; they have all been demonstrated in labs, although most of them are many years away from being generally available.

Some casual observers may conclude that it is physically impossible to prevent aging since people have been trying and failing to do so for millennia. But the fact is that there are naturally-occurring examples of cells that do not age. Unfortunately, they’re called cancer cells, and tend to have the nasty side effect of killing people. Nevertheless, they do demonstrate the reality of cells that do not age.

Each cell in our body normally has an hourglass in it; the cell replicates as many times as it can, then commits suicide when the hourglass runs out of sand. But scientists have discovered how to add more sand to the hourglass. It’s an enzyme called telomerase that occurs at the end of DNA strands. Each time our cells divide, the DNA strands become frayed at the end, until eventually they are too unstable and self-destruct. For the discovery of telomerase in 1984 and subsequent analysis of how it relates to aging, three scientists were awarded the 2009 Nobel Prize in Medicine.

There is still a lot of research that needs to be done before it is possible to halt or reverse the aging process in humans. De Grey’s organizations, the SENS Foundation and the Methuselah Foundation, are currently testing life-extension therapies on mice. The Methuselah Foundation offers the MPrize: a reward of up to $4 million to anyone who can extend the lifespan of mice to record-breaking lengths. The goal is to eventually apply this knowledge to increase the human lifespan.

De Grey is not interested in extending the portion of life in which people are old, frail, and sick. His goal is to extend the healthy portion of life, and ultimately to prevent people from ever growing old at all…and reversing the aging process for those who are already elderly. This is not pie-in-the-sky immortality, as it won’t eliminate all causes of death. It would, however, offer the possibility of lifespans of indefinite length. De Grey has explained the concept as the “Longevity Escape Velocity.” Over the past century, medicine has done an excellent job preventing people from dying at young ages, but very little to prevent aging or increase the maximum human lifespan. At the present, medicine is progressing relatively slowly, adding a few weeks to our lifespan every year. When the Genomic Revolution picks up pace within the next few years, it is likely that this will be increased to a few months every year. De Grey hopes that eventually we can attack the root causes of aging itself to add more than one year to the human lifespan every year. He believes that the first person to reach age 1,000 is alive today…and is probably only about ten years younger than the first person to live to age 150.

The concepts of aging and old age are so ingrained in our mindset that we tend to not even think about them. Like anything that is both horrifying and seemingly inevitable, we have a remarkable ability to push aging out of our minds, or even to go through mental contortions to rationalize it as a good thing. Virtually all major life decisions we make – what career to pursue, how much of our money to save, how much risk to take, who to marry, how many children to have, when to retire, what our religious beliefs are, if or when we should go to college – are ultimately premised on the assumption that we will grow old and die, probably between ages 70 and 100. But what if this ceases to be the case? There is almost nothing that would alter our lifestyles, worldviews, beliefs, and culture as profoundly as the end of aging and the mindset that accompanies it.

Modern biology has already discovered theoretical solutions to all of the causes of aging; it is now a matter of applying them and developing solutions that work for human beings.

(The SENS Foundation and the Methuselah Foundation are non-profit organizations under US law. All donations are tax-deductible. If you have some money to donate, these organizations are helping to solve the single worst disease threatening humanity.)

PREDICTIONS:
By 2045 – The aging process has been halted, for all intents and purposes. People no longer grow old beyond their peak healthy age, between 18 and 25.
By 2060 – It is possible to reverse existing damage from the aging process. It is no longer possible to estimate an adult’s chronological age merely by looking at them. Diseases of old age have, for the most part, ceased to be a problem.

50 Years of Questions

This is a video I made a couple months ago, entitled "50 Years of Questions." It's my vision for what the world might look like in the future, as well as a look back at how far we've come in the last decade.

Note that I just think these are QUESTIONS people might be asking themselves around this time. I'm not necessarily suggesting that we'll know the answers to all of them by the dates I listed.