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Medicine and Science and Research…Oh My.. | Michael Langworthy | TEDxNewBedford


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)

2 Comments

  1. Kathy Beard
    Kathy Beard November 30, 2015

    Nice to see this, Dr. Langworthy! I miss working with you directly but I'm happy to see your research in orthopedics and biologics continues.

  2. Unicorn 7777
    Unicorn 7777 June 19, 2016

    Fascinating -Informative.  Regenerating bone and cartilage. Healing faster and more completely through nature's own matrix. Outstanding Tedtalk !!  Looking forward to more like this.

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