David Warmflash, MD
February 03, 2023
When I was a child, I watched syndicated episodes of the original Star Trek. I was dazzled by the space travel, sure, but also the medical technology.
A handheld “tricorder” detected diseases, while an intramuscular injector (“hypospray”) could treat them. Sickbay “biobeds” came with real-time health monitors that looked futuristic at the time but seem primitive today.
Such visions inspired a lot of us kids to pursue science. Little did we know the real-life advances many of us would see in our lifetimes.
Artificial intelligence helping to spot disease, robots performing surgery, even video calls between doctor and patient — all these once sounded fantastical but now happen in clinical care.
Now, as we move into the 23rd year of the 21st century, you won’t believe what we’ll be capable of next. Three especially wild examples are moving closer to clinical reality.
Human Hibernation
Captain America, Han Solo, Khan — all were preserved at low temperatures and then revived, waking up alive and well months, decades, or centuries later. These are fictional examples, to be sure, but the science they’re rooted in is real.
Rare cases of accidental hypothermia prove that full recovery is possible even after the heart stops beating. The drop in body temperature slows metabolism and reduces the need for oxygen, stalling brain damage for an hour or more. (In one extreme case, a climber survived after almost nine hours of efforts to revive him.)
Useful for a space traveler? Maybe not. But it’s potentially huge for someone with life-threatening injuries from a car accident or a gunshot wound.
That’s the thinking behind a breakthrough procedure culminating decades of research on pigs and dogs, now in a clinical trial. The idea: A person with massive blood loss whose heart has stopped is injected with an ice-cold fluid, cooling them from the inside, down to about 10°C.
Doctors already induce more modest hypothermia to protect the brain and other organs after cardiac arrest and during surgery on the aortic arch.
However, this experimental procedure — called Emergency Preservation and Resuscitation (EPR) — goes far beyond that, dramatically “decreasing the body’s need for oxygen and blood flow,” says Samuel Tisherman, MD, a trauma surgeon at the University of Maryland Medical Center and the trial’s lead researcher. This puts the patient in a state of suspended animation that “could buy time for surgeons to stop the bleeding and save more of these patients.”
The technique has been carried out on at least six patients, though none were reported to survive. The trial is expected to include 20 participants by the time it wraps up in December, according to the listing on the US clinical trials database. Though given the strict requirements for candidates (emergency trauma victims who are not likely to survive), one can’t exactly rely on a set schedule.
Still, the technology is promising. Someday we may even use it to keep patients in suspended animation for months or years, experts predict, helping astronauts through decades-long spaceflights, or stalling death in sick patients awaiting a cure.
Artificial Womb
Another sci-fi classic: growing human babies outside the womb. Think the fetus fields from the Matrix, or the frozen embryos in Alien: Covenant.
In 1923, British biologist J.B.S. Haldane coined a term for that – ectogenesis. He predicted that 70% of pregnancies would take place, from fertilization to birth, in artificial wombs by 2074. That many seems unlikely, but the timeline is on track.
Developing an embryo outside the womb is already routine in vitro fertilization. And technology enables preterm babies to survive through much of the second half of gestation. Normal human pregnancy is 40 weeks, and the youngest preterm baby ever to survive was 21 weeks and 1 day, just a few days younger than a smattering of others who lived.
The biggest obstacle for babies younger than that is lung viability. Mechanical ventilation can damage the lungs and lead to a chronic (sometimes fatal) lung disease known as bronchopulmonary dysplasia. Avoiding this would mean figuring a way to maintain fetal circulation — the intricate system that delivers oxygenated blood from the placenta to the fetus via the umbilical cord. Researchers at Children’s Hospital of Philadelphia (CHOP) have done this using a fetal lamb.
The key to their invention is a substitute placenta: an oxygenator connected to the lamb’s umbilical cord. Tubes inserted through the umbilical vein and arteries carry oxygenated blood from the “placenta” to the fetus, and deoxygenated blood back out. The lamb resides in an artificial, fluid-filled amniotic sac until its lungs and other organs are developed.
Fertility treatment could benefit, too. “An artificial womb may substitute in situations in which a gestational carrier — surrogate — is indicated,” says Paula Amato, MD, a professor of obstetrics and gynecology at Oregon Health Sciences University. (Amato is not involved in the CHOP research.) For example: when the mother is missing a uterus or can’t carry a pregnancy safely.
No date is set for clinical trials yet. But according to the research, the main difference between human and lamb may come down to size. A lamb’s umbilical vessels are larger, so feeding in a tube is easier. With today’s advances in miniaturizing surgical methods, that seems like a challenge scientists can overcome.
Messenger RNA Therapeutics
Back to Star Trek. The hypospray injector’s contents could cure just about any disease, even one newly discovered on a strange planet. That’s not unlike messenger RNA (mRNA), the breakthrough technology that enabled scientists to quickly develop some of the first COVID vaccines.
But vaccines are just the beginning of what this technology can do.
A whole field of immunotherapy is emerging that uses mRNA to deliver instructions to produce chimeric antigen receptor-modified immune cells (CAR modified immune cells).
These cells are engineered to target diseased cells and tissues, like cancer cells and harmful fibroblasts (scar tissue) that promote fibrosis in, for example, the heart and lungs.
The field is bursting with rodent research, and clinical trials have started for treating some advanced stage malignancies.
Actual clinical use may be years away, but if all goes well, these medicines could help treat or even cure the core medical problems facing humanity. We’re talking cancer, heart disease, neurodegenerative disease1 – transforming one therapy into another by simply changing the mRNA’s “nucleotide sequence,” the blueprint containing instructions telling it what to do, and what disease to attack.2
As this technology matures, we may start to feel as if we’re really on Star Trek, where Bones pulls out the same device to treat just about every disease or injury.
Sources:
Samuel Tisherman, MD, trauma surgeon, University of Maryland Medical Center, Baltimore.
Paula Amato, MD, professor of obstetrics and gynecology, Oregon Health and Science University, Portland.
Memory Alpha: “Tricorder,” “Biobed.”
StarTrek.com: “Hypospray.”
Scientific Reports: “Therapeutic hypothermia after cardiac arrest increases the plasma level of B-type natriuretic peptide.”
Annals of Emergency Medicine: “Hypothermic Cardiac Arrest With Full Neurologic Recovery After Approximately Nine Hours of Cardiopulmonary Resuscitation: Management and Possible Complications.”
Defense Technical Information Center: “Safety and Feasibility of Emergency Preservation and resuscitation for CardiacArrest from Trauma (EPR CAT).”
ClinicalTrials.gov: “Emergency Preservation and Resuscitation (EPR) for Cardiac Arrest From Trauma (EPR-CAT).”
University of Alabama at Birmingham: “UAB Hospital delivers record-breaking premature baby.”
Science: “CAR T cells produced in vivo to treat cardiac injury.”
Leave a Reply