While I’m on the transplant list, I’ll pass when I’m called. This position never fails to confound and anger friends and family, mostly because they know what a pain in the ass dialysis is. But that’s my story and I’m sticking to it.
The reasons are diverse, but deeply intertwingled. There’s the issue of a transplant being a treatment, not a cure. There’s the cost of anti-rejection drugs—monetary costs alone would be well into unaffordable territory at four figures each month for the rest of my life; and that doesn’t factor the emotional and physical costs. Having failed to wrestle the ethical issues into submission for myself in almost four years, there’s little reason to believe that’s going to happen now. No matter where I am on the list, it’s a kidney that could be used by someone else.
The hope for me has always been regeneration. After all, salamanders can readily grow whole new legs when one is lost or damaged. It’s only logical that an organism higher up the food chain should be able to regrow their own parts. It’s basically a hacking problem.
In a November 2003 Wired magazine article, Jennifer Kahn reports that Harvard cardiologist Mark Keating has become convinced that regeneration is possible and has decided to pursue a solution to the evolutionary mystery of why newts can do it but humans can’t. Or, perhaps more accurately, why we can’t do it any more.
Ten percent kidney function is all I need to live without dialysis, and I already have six percent. I’m convinced that I can recover at least another five percent if I can manage to dodge the bullet of what passes for health care in America. Given where Keating seems to be heading, I should be able to grow two new healthy kidneys with something as simple as a protein shot.
One of the first things Keating found after arriving at his Harvard post from a stint in Utah was that if he “suppressed one gene in a zebrafish, the fish lost its ability to regrow fins and organs and instead scarred, just like people. Maybe the gene was easier to switch on and off than anyone thought.”
“A stray piece of evidence seemed to bolster this theory. Experiments done on sheep in 1991 revealed that fetuses in the first two trimesters will recover from a deep cut seamlessly, but a fetus just a few weeks further along will be scarred for life. ‘The question isn’t whether we still have this program in our genes,’ Keating says. ‘The question is, why has this program been turned off?’”
Five years ago Keating and his researchers added a liquid extract of a newt’s regenerating leg cells to mouse muscle cells. Amazingly, when exposed to the newt’s cells, the mouse muscle cells began to “dedifferentiate” into its base components. In subsequent experiments, the researchers added growth factors to the dedifferentiated cells, “making the stem cells mature again to resemble muscle, bone, or fat cells.”
Keating’s preliminary work turns the whole stem cell argument on its head. Work with embryonic stem cells is controversial and poses the same rejection problems as transplanted organs. A person’s own stem cells bypass both the ethical and rejection problems, but there aren’t many available. Keating’s theory is that mature cells can be used for the same purpose, perhaps as simply as “delivering a key protein to the damaged area of the body” that would initiate some sort of a chain reaction at the genetic level, causing cells to dedifferentiate.
The process Keating envisions is already at least partially realized in the use of Erythropoietin (“EPO”), a hormone that “tricks” the bone marrow into creating more red blood cells in kidney failure, cancer, and AIDS patients. Keating’s goal, in short, “is to create epo for the heart.”
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