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Artificial Organ Engineering Artificial Organ Engineering Maria Cristina Annesini • Luigi Marrelli Vincenzo Piemonte • Luca Turchetti Artificial Organ Engineering 123 Maria Cristina Annesini Vincenzo Piemonte Department of Chemical Engineering Faculty of Engineering Materials and Environment University “Campus Bio-medico” of Rome University “La Sapienza” of Rome Rome Rome Italy Italy Luca Turchetti Luigi Marrelli ENEA- Italian National Agency for New Faculty of Engineering Technologies, Energy and Sustainable University “Campus Bio-medico” of Rome Economic Development Rome Rome Italy Italy ISBN 978-1-4471-6442-5 ISBN 978-1-4471-6443-2 (eBook) DOI 10.1007/978-1-4471-6443-2 Library of Congress Control Number: 2014936613 © Springer-Verlag London 2017 The author(s) has/have asserted their right(s) to be identified as the author(s) of this work in accordance with the Copyright, Design and Patents Act 1988. This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The information presented in the book is addressed to engineers and is not intended to be directly used to take any medical decision. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer-Verlag London Ltd. Introduction The history of medicine has always been characterized by the attempt to treat a wide range of diseases, some very serious and with high mortality, and others debilitating and detrimental for the quality of life of patients. With the increase of life expectancy, organ failure has become quite common, making the problem of degeneration of some body parts (organs, joints etc) increasingly critical. Therefore, the possibility of replacing these parts, represents an interesting opportunity for increasing life duration and improving its quality. Substitution of a part of the human body can be achieved by transplantation from a human or animal donor. Tissues for transplantation can be obtained from the recipient’s own body (autotransplantation). Tissues or organs can be taken from a different living or dead compatible human donor (allotransplantation) or from an animal (xenotransplantation). Unfortunately, while the population of patients requiring organs continues to increase, the lack of an adequate number of donors, along with biological and ethical problems connected with allotransplantation and xenotransplantation, makes organ transplantation still inadequate and the number of patients on the waiting lists is growing rapidly. A possible alternative to trans- plantation consists in the use of artificial and bio-artificial organs. The availability of devices able to substitute, or at least support, damaged vital functions can allow the patient to be kept alive a long time or, at least, until either a transplantation is possible or the physiological activity of the native organ is restored. Furthermore, artificial organs play a key role in enhancing a patient’s quality of life. However, the current state of development in the fields of biotechnology and bioengineering does not allow all organs and tissues to be available. At present, several extracorporeal artificial assist devices are available and in use, such as the artificial kidney, whereas only few implantable devices are approved for clinical use. In the last decades, biomedical engineering has made great strides in this field with the support of nanotechnology, microelectronics, and biology and with the significant contribution of the fundamentals of chemical engineering such as thermodynamics, kinetics, and transport phenomena; therefore, we can imagine that in the future, the number of miniature artificial organs for permanent implantation will increase. A comprehensive definition considers v vi Introduction artificial organs “any equipment, device, or material, directly or indirectly inter- faced with living tissue and used to substitute, partly or entirely, or to strengthen functions of a natural organ or of any other part of the body badly working or lacking.” This definition, drawn from a conference of the National Institute of Health, considers as artificial organs both devices performing physical–chemical functions (such as artificial kidney, blood oxygenator, and artificial liver.) and electromechanical devices (such as pacemakers, heart valves, artificial hands, and orthopedic prostheses) or aesthetic parts (such as mammary prostheses). A different approach distinguishes between artificial (and bio-artificial) organs and prostheses, defining the former as devices substituting or supporting any physical–chemical function of the body and the latter as devices designed only for mechanical or electromechanical functions. The earliest artificial organs were mostly based on mechanical technologies. The first artificial kidney, which marks the beginning of artificial organ history, was basically a blood filter aimed at removing waste material from the body. Likewise, artificial hearts and ventricular assist devices (VADs) were all based on pump and valve technology. However, biomedical researchers have quickly realized that most human organs cannot be substituted by artificial ones mimicking only their mechanical functions. Endocrine organs, for example, are exceedingly complex in their functions to be artificially reproduced at the present state of scientific and technological knowledge. A typical case is represented by the liver, which carries out many biological functions, among which blood detoxification and synthesis of biomolecules essential in metabolism are only the most well-known. While blood detoxification can be fairly performed by the use of membranes, synthesis mechanisms and other hepatic functions are still far from being repro- duced by an artificial liver. Today, many artificial devices are rough simplifications of the biological original and are able to reproduce only some of the vital functions. For these reasons, biomedical research has concentrated its efforts on the devel- opment of hybrid systems, coupling biological and artificial components. These devices, named bio-artificial organs, usually contain a bioreactor where cells or a tissue of the organ to be substituted carry out the functions of the native organ. Besides artificial and bio-artificial organs, a third approach, named neo-organs, is now emerging. This approach is closely connected with tissue engineering and is based on growing, over suitable biodegradable supports (scaffold), cells of the tissue to be produced or stem cells. Tissues with various three-dimensional struc- tures can be currently produced with this technique. Very good results have been obtained in the production of bone and skin tissue, to be used in case of burns. Research is in progress in the field of nerves, muscles, and blood vessels. As for market scenarios, according to a recent report published by the Transparency Market Research1, the world market of artificial organs, including 1http://www.transparencymarketresearch.com Artificial vital organs and medical bionics market (artificial heart, kidney, liver, pancreas and lungs, ear bionics, vision bionics, exoskeletons, bionic limbs, brain bionics and cardiac bionics)— Global Industry analysis, size, share, growth, trends and forecast, 2012–2018. Introduction vii prostheses, is expected to grow at a compound annual growth rate (CAGR) of 9.2 %. Since in 2011 the artificial vital organs and medical bionics market were evaluated at about US$ 17.5 billion, the above CAGR value gives a forecast of US$ 32.3 billion in 2018. It is a substantial and continuously developing market that has a preeminent importance in technologically advanced countries, especially in the field of new devices. The global market of artificial organs is led by the artificial kidney, which made up 48 % of the global market in 2010. Its use is highly recommended as a short-/medium-term treatment, especially when used as a support while waiting for a kidney transplant. Industrial research is focused on the development of better membranes and on more efficient and cheaper production technology. Recently, promising steps forward have been taken in the field of artificial and bio-artificial livers. Devices such as MARS (Molecular Adsorbent Recirculating System) and ELAD are quite largely used to provide for the detoxifying needs of the organism. A bio-artificial liver could also provide the metabolic functions of natural liver. In coming years, technological advancements are expected in the field of an implan- table bio-artificial pancreas with remarkable lucrative prospects connected with the current spreading of diabetes
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