CELL*WISE

The International Museum of Surgical Science (IMSS) happens to be in Chicago, the great city in which I currently reside. The museum is actually in a historic lakeside mansion that was built in 1917, and in 1950 it was acquired by Dr. Max Thorek and the International College of Surgeons (which was founded in 1935). After renovation and forming the initial Museum collections, it opened to the public as the Museum in 1954. In 1988, it was added to the National and Illinois Registers of Historic Places and became a City of Chicago Landmark.
The Mission of the Museum is to "enrich people's lives by enhancing their appreciation and understanding of the history, development, and advances of surgery and related subjects on health and medicine."

I visited to the IMSS several months ago, and I have to say that it far exceeded my expectations, and overall it was a great experience. The whole place is not that big, but if you go, and especially if you are quite interested in surgical science/medicine, then you should still allow at least 1-2 hours so that you can comfortably stroll through the several exhibits/floors. I think going to this museum would be interesting even for people not in the science/medicine field. I would assume that most all of us humans have been in a hospital before to have some kind of surgical procedure performed or for some medical issue, so there should be something there to which anyone could relate. Or maybe you are not that interested in surgical science, but you are going along with someone else who is, in which case there are still many funny/interesting/historic things to look at in that old mansion. There is also a good amount of fine art (historic and contemporary) including statues and mural paintings. Come to think of it, it may be the best Museum to go to around this time with Halloween and all, because it can be bit creepy with all the surgical tools and paintings of surgical operations (more on that below, with a photo slideshow!).

When I visited the IMSS, there were several different exhibits, some regarding pain relief/anesthesia, milestones in medical imaging, nursing, understanding the spine and spinal surgery, ophthalmology, and history and technology associated with cardiovascular surgery. There was even a room with a turn of the century dentist's office and an apothecary shop, in which a fake pharmacist dude was standing and I think would talk to you, which was fun and slightly creepy.

Of most interest to me was the newest exhibit that is still going on now, Beyond Broken Bones, which was made possible by the generous support of many companies that I have listed in right sidebar. As the description reads, this exhibit "highlights the past, present, and potential of medical innovations for diagnosing and treating injuries and diseases of the musculoskeletal system." It includes discoveries and milestones of orthopedic surgery, and amputation methods and prosthetics of old and new. While reading one of the large-scale text and image displays, I was delighted to see that there was a section on Tissue Engineering, which I really didn't expect to see at all in this Museum.

This fall there is going to be a new exhibit which sounds great, titled "Learning from the Lab: Genetics and Medicine". I guess that will begin very soon, and I think I'll have to go back for this one. Anyone want to go with me?

So, if you are ever on Lake Shore Drive (just south of North Avenue) in Chicago and have an hour or two, check out the International Museum of Surgical Science, even if you are not work in medicine or science. Plus, where else can you get a magic thinking cap, Little Joe Torso, a plush toy of E. coli, anatomical key rings, a lumbar vertebra mug, a glow-in-the-dark finger bone pen, bone or muscle socks, or this awesome Blinded by Science T-shirt!

I have many pictures from my IMSS excursion that I would like to share, so I have put them into a slideshow below. I think the slideshow will play automatically, so you will probably have to replay it by the time you get to the end of this post. There are also options to pause it or speed it up.

I will list here what are in each of the 9 photos, by my own brief titles.
Most of these photos that I show are related to biomedical engineering and biomaterials (past, present, and future). I had other pictures of interesting rooms, statues, and paintings in Museum but they are less relevant to this blog, and you can see some of them by clicking on the different exhibits here.)

1. Outside and entrance of the International Museum of Surgical Science
2. Old Surgical Tools (which looks like it could be a scene from the Saw or Hostel horror movies!)
3. Old Spine Back Pain Treatment
4. Old Limb Prosthetics
5. Modern Joint Replacements
6. Poster of History of Surgical Sutures (absorbable and non-absorbable polymers)
7. Modern Artificial Heart Valve Replacements
8. Room dedicated to history and technology associated with cardiovascular surgery
9. Poster display about biomaterials and tissue engineering for musculoskeletal tissue repair (click link for big view of this)

I hope you enjoy the slideshow!

Personally, I do not actually use the phrase "Regenerative Medicine" that much. As for my background, I would describe myself as a researcher in tissue engineering, and when it comes up, I generally describe my current work as laboratory research with stem cells, biomaterials, biomolecules, and engineering design aspects for the goal of engineering a certain functional tissue in a way that it best mimics that natural tissue. So, it could be that I don't use the term Regenerative Medicine because I work in a lab and I am not (yet?) involved with the actual implantation (patient use) of stem-cell based engineered tissues. Allow me to elaborate.

Many people use terms "Tissue Engineering" and "Regenerative Medicine" interchangeably, which is usually acceptable because they both have the same goal. Technically though, I would say that although the connotations of each terminology are similar, the actual denotations of the terms are not exactly the same (more on that below).
Many people will use both terms together in the same sentence or description. For example, the NIH definition given on the PTEI (Pittsburgh Tissue Engineering Initiative) site reads:
"Regenerative medicine/tissue engineering is a rapidly growing multidisciplinary field
involving the life, physical, and engineering sciences that seeks to develop functional cell,
tissue, and organ substitutes to repair, or enhance biological function that has been lost due to
congenital abnormalities, injury, disease, or aging."
This definition is cited as being from the National Institute of Biomedical Imaging and Bioengineering, June 2004. The statement puts the two terms together along with a broad description, which generally speaking seems okay. But it also makes it look like regenerative medicine and tissue engineering are the same thing. The NIH Definition given on the Tissue Engineering Pages site also begins with:
"Tissue Engineering/regenerative medicine is an emerging multidisciplinary field..."

I think the terms can be used together but should actually be kept separate. A simple example of when the terms are used "together but separate" is with TERMIS - the Tissue Engineering and Regenerative Medicine International Society.

Nowadays, I would say that Tissue Engineering is a significant part of what is referred to as Regenerative Medicine. But I think there a few aspects that make the two terms distinguishable. First, when the term Regenerative Medicine is used, it most usually implies that stem cells are utilized. When the term Tissue Engineering is used, it does not always mean that stem cells are used, because people also use primary/mature/differentiated cells from the human patient (autologous) or from another human patient (allogeneic) or even from another animal (xenogeneic, e.g. from a pig). But the current trend in Tissue Engineering seems to be to use stem cells, adult or embryonic stem cells depending on the tissue application, because of the advantages. Furthermore, Tissue Engineering usually refers to the engineering of tissues first in vitro, meaning in a laboratory setting, and not yet implanted in an animal or human, which would be in vivo. Tissue Engineering will involve the use of a biocompatible material usually referred to as a "scaffold" because most often it will temporarily provide a 3D structure (usually with specific organization and properties) for the cells so that the whole construct can then be implanted and the biomaterial scaffolds will biodegrade with time, while the cells regenerate the certain tissue defect. To me, the term Regenerative Medicine is more general and more focused on the clinical use of engineered tissues or stem-cell based therapies with human patients.

The fields of regenerative medicine and tissue engineering have grown rapidly in the past couple of years, and are now resulting in actual products or services that patients can use. Also, it seems that every other week, I find a new (well, new to me) regenerative medicine-related company that I then add to the "Companies/Industry" section in the right sidebar of this blog, which now has the largest number of links compared to my other categories.

Last week at the 3rd Annual World Congress of Regenerative Medicine, the CEO of Organogenesis, Inc., Geoff McKay, talked about taking the exciting science and research of regenerative medicine and commercializing it into a profitable business. Here is a press release of this news. Interestingly in that news article, when describing "About Regenerative Medicine" it is written that "The related terms 'Tissue Regeneration,' 'Tissue Engineering' and 'Stem Cell Therapies' are often used to refer to some of the activities under the umbrella of Regenerative Medicine." I guess that's a good way of saying it!
Organogenesis was one of the first companies to successfully mass produce tissue-engineered skin containing living cells with their product Apligraf, which received FDA approval in 1998.
Actually, there were several other companies involved with tissue-engineered skin products around that time (although each one has differences, advantages, and disadvantages) including Advanced Tissue Sciences (products Dermagraft and Transcyte), Integra Life Sciences (product Integra), and Genzyme (product Epicell) and LifeCell (product Alloderm). Both Advanced Tissue Sciences and Organogenesis filed for bankruptcy in 2002, but Organogenesis bounced back with big help from Novartis in 1999, and therefore are now the actual first profitable regenerative medicine company. Last year, company Advanced BioHealing, Inc. acquired the former ATS-products Dermagraft and Transcyte, and began sales of Dermagraft earlier this year.
McKay included in his talk the terms "RegenMed 1.0" and "RegenMed 2.0" which were recently coined by Chris Mason in an article in Regenerative Medicine journal. Chris Mason has set up a web page for "RegenMed 2.0" within his website, on which more will be added soon. His excellent editorial article "Regenerative Medicine 2.0" explains that we are now in the era of "Regenerative Medicine 2.0" where there is much focus on the translation of research into commercially successful products. He mentions the Time magazine article from 2000 that named tissue engineering the hottest job for the future. I remember buying this issue off the newsstand when it came out and being excited, although I was still finishing undergrad at the time. However, when I graduated with a B.S. a year later, I realized that there was far more media hype than there was actual tissue engineering jobs/companies existing at that time. Very interestingly, Mason explains that the term "tissue engineering" is being replaced by "regenerative medicine" or "cell therapy". I realized that what he is referring to is that in the healthcare environment for patients, the terms "cell therapy" and "regenerative medicine" sound more friendly and make more sense, as in real healthcare benefits to patients, than does "tissue engineering" which is more the methodology. Ahh, now this makes more sense to me (than when I originally started writing the earlier portion of this post).
In his article "Regenerative Medicine 2.0" (which again you can find HERE), Chris Mason includes a fantastic and detailed table comparing the so-called era of RegenMed 1.0 (1985-2002) to the current period that we are in, coined RegenMed 2.0.

There is a new PBS television series "The Mysterious Human Heart" which started airing tonight. The series consists of three 1-hour episodes. The three episodes will play on PBS TV many different times until the end of this month October. Click on "Check local listings" and enter your zip-code or state for your TV times.
The first episode, "Endlessly Beating", examines the normal anatomy and function of the miraculous heart, as a muscle and a pump. Within that hour, it also tells the story of three patients who have end-stage heart failure, who need either a transplant, an experimental new device, or a heart pump.
The second episode ,"The Spark of Life", focuses on cardiology and the electrical system of the heart. In this episode, there is mention of the very serious and often deadly genetic disease hypertrophic cardiomyopathy, the use of automated external defibrillators (AED), and modern implantable pacemakers.
The third episode ,"The Silent Killer", explores the prevention of risk factors/causes and treatment of the deadly epidemic of coronary artery disease and heart disease.
The website also has some great and easy-to-understand/use features such as an interactive "Tour of the Heart", the "Healthy Heart Guide", and "The History of Cardiology".

Above image reference: Illustrations by Patrick J. Lynch from http://www.med.yale.edu/intmed/cardio/imaging/anatomy/heart_anatomy/index.html

What is that an image of?
It's the inside of your nose. Well, more specifically, it's a CT scan of the sinuses (air-spaces) in a human nose. It was created by Kai-hun Fung, one of the winners of the 2007 Science and Engineering Visualization Challenge (links below).

An important part of any scientific research is imaging. Whereas some results of experiments will be in the form of quantitative data, other results can be shown in the form of images. The best images bring the data to life and create visual excitement for the researcher and an audience. Images can also be so beautiful that they become art. And certainly the phrase, "a picture is worth a thousand words" comes to mind.

For biomedical science and engineering experiments, images are acquired by microscopy or medical imaging.

The three main categories of microscopy are optical/light microscopy (which has many subcategories), electron, and scanning probe. Optical microscopy, which uses visible light, includes such techniques as bright-field, phase contrast, dark-field, polarization, differential interference contrast (DIC), fluorescence (very important for life sciences!), confocal laser scanning (used with fluorescence), and multiphoton fluorescence microscopy. Light microscopes of today are integrated with a CCD camera, computer, and software into electronic imaging systems. Electron microscopy is a separate category microscopy that uses beams of electrons instead of light and includes transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Scanning probe microscopy is another category that includes atomic force microscopy (AFM), scanning tunneling microscopy (STM), and photonic force microscopy (PFM).

Medical Imaging is used to create images of biological tissues for clinical medical purposes as well as in medical science. Different medical imaging technologies include projection radiography (X-ray), fluoroscopy X-ray, MRI, computed tomography (CT or CAT scan), ultrasound, nuclear medicine, and many others.

Visualization (of scientific data) for science and engineering can be in the form of microscopic images and photographs, but it may also include illustrations (usually for medical), computer graphics, or animations, to name a few.

Since 2003, Science magazine and the National Science Foundation (NSF) have co-sponsored an annual visualization challenge. The categories for this challenge are "Photography" (which includes microscopy and medical imaging technologies, as well as photographs from just cameras), "Informational (Computer) Graphics", "Interactive Media" (websites with simulations, computer programs/interfaces), and "Noninteractive Media" (videos). Here is the special feature website of the 2007 Science and Engineering Visualization Challenge, which contains an article summarizing the 2007 Visualization Challenge Winners, and a slideshow of all the winning visualizations (in the "Online Extra" box). You will need a few minutes to watch each of the three videos in the Noninteractive Media category, but if you do, they are very interesting and the topics are nicotine, mobius transformations, and "cloud towers". Also in the "Online Extra" box you can find the previous years competitions.

University of Illinois at Chicago (home to the largest medical school in the U.S.) offers a Master's Program in Biomedical Visualization, which includes concentration areas of medical illustration, computer visualization, and 3-D model/prosthetic design.

I just happened to find the website for Nucleus Medical Art, who specialize in creating medical illustrations and 3D medical animations. Most relevant to this blog, watch the 3D animation they made for Bacterin International Inc. product OsteoSponge™ here.

*Fun Fact: The blue stuff in this blog's main header (with the title CELL*WISE), is actually my image of collagen fibrils within a collagen-based hydrogel that I prepared. I used multiphoton microscopy, which produces second harmonic generation (SHG) signal images of collagen fibrils.