인공장기와조직공학 서울대학교의과대학 의공학교실 김희찬
Specific Behavioral Objectives (SBO) 1. 장기대체의목적을그필요성으로설명할수있다. 2. 장기대체의접근방법으로 인공장기 와 장기이식 을구별하여설명할수있다. 3. 조직공학 (Tissue Engineering) 을정의하고생물학적인공장기의의미를설명할수있다. 4. 간세포 (Stem Cell) 의의미와중요성을설명할수있다. 5. 현재임상에사용되고있는인공장기 3 가지를설명할수있다.
인공장기 -I
인공장기 -II *bionic - using electronic or mechanical parts in place of real body parts.
인공장기 III
대체장기의필요성 Diseased( 疾病 ) (diseases, ageing) Disabled( 不具 ) (overuse, misuse, accident) Dysfunctional parts of human body Repair/Replacement ( 기능 / 미용 ) Normal life
장기대체의접근방법 Organ Transplantation ( 장기이식 ) Artificial Organs ( 인공장기 ) Homotransplantation( 동종이식 ) better performance limited supply Xenotransplantation( 이종이식 ) unlimited supply unknown infection ethical problem Autotransplantation( 자가이식 ) ideal solution ethical problem Mechanoelectric( 전자기계식 ) mechanical organ sensory organ size, biocompatibility power requirement Biomaterial( 생체재료 ) tissue biocompatibility longevity Biological( 생물학적 ) secretory organ biochemical organ longevity
장기대체의현재와미래 약 신약유전자치료 장기이식 - 동종이식 자가이식 - 간세포 인공장기 - 전자기계식 - 생체재료 인공장기 - 생물학적 현재 (2001) 가까운장래 (2050) 먼장래 (????)
장기이식
장기 ( 동종 ) 이식 -transplantation- 간 (liver) 신장 (kidney) 심장 (heart)
장기 ( 이종 ) 이식 Xenotransplant - transplant between species - 1. Are xenotransplants safe? 2. Do xenotransplants work? 3. Are xenotransplants ethically acceptable?
Growing New Organs 복제양복제송아지한국호랑이복제복제인간 (?) Human body may be more than a sum of parts, but replacing failing parts should extend and improve life.
What is a Stem Cell? Stem cell : having the ability to divide for indefinite periods in culture & to give rise to specialized cells. Pluripotent -capable of giving rise to most tissues of an organism. Totipotent - having unlimited capability. Totipotent cells have the capacity to specialize into extraembryonic membranes and tissues, the embryo, and all postembryonic tissues and organs. Multipotent More specialized with having a particular function.
How to get Stem Cells 1. Human embryos in excess from IVF(In Vitro Fertilization) clinics 2. Fetal tissue from terminated pregnancies 3. Through the use of SCNT(somatic cell nuclear transfer) 4. Multipotent stem cells are found in children & adults
The Promise of Stem Cell Research
Technological Challenges Knowledge about cell specialization in the human: to direct pluripotent cells to become the type of tissue needed for transplantation Overcome immune rejection problem: to minimize tissue incompatibility Adult stem cell has potential as pluripotent stem cells? : in animal studies, neuronal stem cells produce blood cell types Use of adult stem cell : No immune rejection problem No ethical problem adult stem cells for all cell and tissue types have not yet been found in the adult human adult stem cells are often present in only minute quantities, are difficult to isolate and purify, and their numbers may decrease with age
생물학적인공장기
생물학적인공장기 bioreactor used to engineer functional tissues Scaffold & functional tissues for cartilage & skin engineered cartilage grown in bioreactor for use in scientific studies and joint repair Bio-artificial Pancreas and Liver
조직공학 (Tissue Engineering) Cellular Therapies represent clinical applications of rapidly advancing knowledge in cell and molecular biology Bioengineering for the production of therapeutic doses of primary cells Tissue Engineering is the development and manipulation of laboratory-grown molecules, cells, tissues, or organs to replace or support the function of defective or injured body parts.
인공장기
인공장기부품목록 Artificial brain Artificial eye Artificial ear Artificial tooth Artificial larynx Artificial breast Artificial heart Artificial heart valve Artificial blood vessel Artificial liver Artificial pancreas Artificial kidney Artificial bladder Artificial penis Artificial arm Artificial leg Artificial joints
Artificial Brain Kismet is an autonomous robot developed by Cynthia Breazeal at MIT's AI Lab. Kismet is designed to have meaningful social exchanges with humans. A wide variety of facial expressions allow Kismet to mimic or display emotions "AIBO" is an autonomous robot that acts in response to external stimulation and its own judgment. It displays various emotional expressions and learns by communicating and interacting with human beings.
FIRST SILICON CHIP ARTIFICIAL RETINAS IMPLANTED IN BLIND PATIENTS on June 28, 2000 Artificial Silicon Retina (ASR ) for retinitis pigmentosa The ASR is a silicon chip 2 mm in diameter and 1/1000 inch in thickness. It contains approximately 3,500 microscopic solar cells called "microphotodiodes," each having its own stimulating electrode.
Cochlear Implant
Artificial Heart Robert Tools, world's first recipient of the AbioCor Implantable Replacement Heart on July 2, 2001. Robert L. Tools with the Oak Ridge Boys at an August 21 news conference
Types of MCSS - mechanical circulatory support system - Total Artificial Heart (TAH) Ventricular Assist Device (VAD) Left Ventricular Assist Device (LVAD) Right Ventricular Assist Device (RVAD) Bi-ventricular Assist Device (BVAD)
Application Strategies for MCSS Temporary VAD Recovery VAD Heart Failure Bridge TAH Transplant Permanent VAD TAH Replacement
Statistics 60,340,000 Americans have cardiovascular disease (1) >2,000,000 Congestive heart failures Over 500,000 new cases diagnosed each year Only 2,359 Heart transplants in 1995 (2) 770 patients died on the waiting list (2) Post-Cardiotomy Up to 2% of 450,000 patients/year require support Effective cost of $400,000 per survivor (3) (1) American Heart Association,(2) UNOS Scientific Registry,(3) Minneapolis Heart Institute
Pumps KORTAH Baylor/NASA TCI CCCF/Nimbus Abiomed Biopump Jarvik-2000
Artificial Heart Valves
Artificial Blood Vessels
Artificial Pancreas
Willem J. Kolff, M.D. Artificial Kidney - hemodialysis -
Artificial Bladder Artificial bladder being developed by James J. Yoo M.D., Ph.D.at the Department of Urology at Harvard Medical School.
Artificial Hip Joint
Artificial Knee Joint Cemented Prosthesis Uncemented Prosthesis
Artificial Skin Apligraf, a product of Organogenesis courtesy of Discovery 5 sheets/box, Dow Hickam Inc. Advanced Tissue Sciences
Myoelectric Artificial Arm
Artificial Leg
Artificial Opening(STOMA)
Penile Prosthesis
Artificial Breast
결 론 "I am looking forward to returning to a normal life" Robert Tools, world's first recipient of the AbioCor Implantable Replacement Heart.