10 ms·

An extra-uterine system to physiologically support the extreme premature lamb

143 points by artsandsci 10y ago

hprotagonist 10y ago
CHOP regularly does top-notch work. This looks super cool.
- tantalor 10y ago
  In case anybody else is confused: https://en.wikipedia.org/wiki/Children%27s_Hospital_of_Philadelphia https://en.wikipedia.org/wiki/Children%27s_Hospital_of_Phila...
- egocodedinsol 10y ago
  It is an amazing place - it has been consistently ranked as the best children's hospital in the US, though at that level it ends up depending more on specialty and who's doing the rating.
marknadal 10y ago
This is one of the most important and powerful work/research I have seen in over a decade, I'm literally at tears realizing the potential of this technology. Thank you so much for working on this, history will remember it and be thankful.
- BronSteeDiam 10y ago
  What makes you say that? What are some of the potential benefits?
  - egocodedinsol 10y ago
    Extreme premature births are the leading cause of infant mortality in the US. Even if the infant survives, they often have incredibly complex consequences that cause lifelong issues because, e.g. the lungs have not fully developed but are required to be used after birth. It's possible that keeping extremely premature infants in an 'artificial uterus' could decrease some of these complications, especially those related to respiration.
deleted 10y ago
[deleted]
jawns 10y ago
In case you're wondering, the study's authors point out: > Our goal is not to extend the current limits of viability, but rather to offer the potential for improved outcomes for those infants who are already being routinely resuscitated and cared for in neonatal intensive care units. One of the biggest current problems with pre-term babies, the study notes, is a respiratory condition called bronchopulmonary dysplasia: > an arrest in lung development secondary to premature transition from liquid to gas ventilation So having the lambs (and, eventually, the preterm infants) remain in a liquid environment allows their immature lungs to continue developing, so that when they eventually transition to gas ventilation (breathing air), their lungs are able to function correctly.
- omginternets 10y ago
  >Our goal is not to extend the current limits of viability In the interest of looking at thing squarely in the face, this can eventually (and therefore will) be used to extend the "current limits of viability". It's important not to put blinders on because this has a very real impact on medical ethics. Is it ethical, for instance, to develop human embryos outside of the womb for convenience?
  - tormeh 10y ago
    >Is it ethical, for instance, to develop human embryos outside of the womb for convenience? Why not, assuming outcome is identical?
    - omginternets 10y ago
      >assuming outcome is identical Well sure, if we're assuming there's no problem, then there's on problem, but that's a bit ... circular... Moreover, there's a mountain of evidence showing that prenatal environment shapes a large swath of physical and psychological traits.
      - derefr 10y ago
        That mountain of evidence mostly says that the in vivo prenatal environment is kind of... awful, though. As in, mother and foetus competing for nutrients with better maternal genes resulting in better defenses against the placental "parasite", and thus worse developmental outcomes; and better foetal genes resulting in better parasitic strategies to penetrate the uterine wall, and thus worse perinatal health outcomes for the mother. I'd honestly stake >$10k, at this point, on the hypothesis that "growing children from embroyos in vitro, hooked up to an unlimited nutrient drip" will result in children much healthier than "regular" children, along every axis we can think of. (Presuming, of course, that we first figure out every micro-nutrient such a drip would be required to provide.)
isoprophlex 10y ago
What an amazing idea, pushing the boundaries of medicine... In the table with experiment outcomes I see one lamb that survived for a while without mechanical ventilation... Was this the best outcome of the set? I couldn't make out if some of them were actually viable, and survived?
- woliveirajr 10y ago
  Couldn't understand, too, if their lives were terminated on purpose or all couldn't survive outside the environment. I'd appreciate any insight of it.
  - isotropy 10y ago
    Sounds like the lambs were terminated immediately after coming out of the biobag, so the researchers could get a clear picture of how lung development progressed in the biobag without confounding factors coming from spending too much time in the open air.
- apendleton 10y ago
  It seems there was one individual that was kept alive post-"delivery," and it got tests and imaging six months later that confirmed that it was developing normally, but that the others were terminated so they could be autopsied. The assessments of, e.g., brain morphology, require sectioning the brain and examining it under a microscope.
mikeyouse 10y ago
While this is amazing and I'm certain it's going to save a number of lives.. Does anyone else get the sense that we're going to start seeing "farms" full of these bags in an effort to save time / money / stress on cows and sheep?
- jacquesm 10y ago
  Or not to need cows and sheep any more for the reproductive part at all.
  - slobotron 10y ago
    Milk comes from cows that would otherwise nurse their calfs, so you need to get them pregnant anyways. At least that is my understanding...
    - deleted 10y ago
      [deleted]
- jawns 10y ago
  Remember that this technology does not cover the full gestation period. It only works starting at the edge of viability. In order for an extremely premature lamb to end up in one of these bags, either preterm birth must be induced, or surgery must take place. Neither of those options is low-cost or without the potential for significant complications. You would likely end up with high rates of mortality and morbidity, and even if the BioBags were able to successfully sustain the animals, they would probably never be considered suitable for anything other than research. There may come a day when a BioBag is able to cover the full gestation period, but even then, I highly doubt that it would be cheap enough for use with livestock.
  - cr0sh 10y ago
    This kind of research has been going on for quite a while: http://www.nytimes.com/1996/09/29/magazine/the-artificial-womb-is-born.html http://www.nytimes.com/1996/09/29/magazine/the-artificial-wo... http://www.hcs.harvard.edu/~hsr/wp-content/themes/hsr/pdf/fall2008/35-39%20ArtificialWombs.pdf http://www.hcs.harvard.edu/~hsr/wp-content/themes/hsr/pdf/fa... Not discounting what you are saying; just wanted to add some more context...
wesleytodd 10y ago
I have been reading the ["The Vorkosigan Saga"](https://en.wikipedia.org/wiki/Vorkosigan_Saga https://en.wikipedia.org/wiki/Vorkosigan_Saga) and one of the consistent themes is the "Uterine Replicator". Sounds very much like what this could become in the future. Not only is this book series great and very entertaining, I think it tackles some technology and social ideas that others in the genre do not.
- azernik 10y ago
  In part this is the result of being written by a female, strongly feminist author who has the gender implications of sci-fi technology in mind. On a separate note, I quite enjoy the way that she also explores the relationship of a "backwards" polity with a more advanced international community.
DigitalJack 10y ago
Brings Axlotl tanks to mind.
surgeryres 10y ago
To clear some confusion - they did not grow this lamb in the bag starting from conception. The major limiting factor as to when it can be transferred to the bag is when the umbilical vessels are large enough to safely and efficiently cannulate. Oxygenation, nutrient delivery and waste removal are all done via the umbilical vessels through external devices. The biggest road block in growing a baby in a bag fully ex utero would be the period before when the umbilical vessels are accessible. Before this time in utero, local mommy angiogenesis in the wall of the placenta serves the role of the umbilical vessels. Replicating this ex utero is a completely different problem.
- nojvek 10y ago
  I imagine they will figure out ex-utero in a couple of decades. Our understanding of genetics will improve too. I imagine an underground bunker somewhere growing babies in tiny pods in 1000's. Those babies are in pods until full adult hood and an artificial process is injecting memories and skills into the brains of this pod babies. Bonus brownie points if there is a pod cluster on an alien space. A billion super humans that land on earth who were all manufactured in transport. Do they treat humans like we treat cows pigs and chicken?
  - serf 10y ago
    > A billion super humans that land on earth who were all manufactured in transport. This is a common concept in space-faring science fiction. It's one of the few 'practical' methods of sending a species with a human life span far out into the universe; with an ark filled with genetic material. Although most stories have the humans being manufactured in the good ole' fashioned way during transport, a few franchises (warhammer 40k, mobile suit gundam, certain entities in mass effect I think, halo to a certain extent, etc) speak of body-assembly-lines. (and in the case of Halo or Warhammer40k, yes -- the clones are quite often treated as expendable cattle.)
- killjoywashere 10y ago
  The placenta, however, would be a sweet target for 3D tissue scaffolding: grow the embyro on one plate and maternal on the other.
jlebrech 10y ago
this tech will render invalid the whole pro-life/pro-choice argument.
vitorbaptistaa 10y ago
Super interesting research! I wonder: is there a limit on how long the lamb could be kept in this extra-uterine system? In other words, could the lamb be grown in this system until it's an adult?
skocznymroczny 10y ago
Wake me up when we can make women obsolete

143 points by artsandsci 10y ago

hprotagonist 10y ago

CHOP regularly does top-notch work. This looks super cool.

tantalor 10y ago
In case anybody else is confused: https://en.wikipedia.org/wiki/Children%27s_Hospital_of_Philadelphia https://en.wikipedia.org/wiki/Children%27s_Hospital_of_Phila...
egocodedinsol 10y ago
It is an amazing place - it has been consistently ranked as the best children's hospital in the US, though at that level it ends up depending more on specialty and who's doing the rating.

marknadal 10y ago

This is one of the most important and powerful work/research I have seen in over a decade, I'm literally at tears realizing the potential of this technology. Thank you so much for working on this, history will remember it and be thankful.

BronSteeDiam 10y ago
What makes you say that? What are some of the potential benefits?
- egocodedinsol 10y ago
  Extreme premature births are the leading cause of infant mortality in the US. Even if the infant survives, they often have incredibly complex consequences that cause lifelong issues because, e.g. the lungs have not fully developed but are required to be used after birth. It's possible that keeping extremely premature infants in an 'artificial uterus' could decrease some of these complications, especially those related to respiration.

deleted 10y ago

[deleted]

jawns 10y ago

In case you're wondering, the study's authors point out: > Our goal is not to extend the current limits of viability, but rather to offer the potential for improved outcomes for those infants who are already being routinely resuscitated and cared for in neonatal intensive care units. One of the biggest current problems with pre-term babies, the study notes, is a respiratory condition called bronchopulmonary dysplasia: > an arrest in lung development secondary to premature transition from liquid to gas ventilation So having the lambs (and, eventually, the preterm infants) remain in a liquid environment allows their immature lungs to continue developing, so that when they eventually transition to gas ventilation (breathing air), their lungs are able to function correctly.

omginternets 10y ago
>Our goal is not to extend the current limits of viability In the interest of looking at thing squarely in the face, this can eventually (and therefore will) be used to extend the "current limits of viability". It's important not to put blinders on because this has a very real impact on medical ethics. Is it ethical, for instance, to develop human embryos outside of the womb for convenience?
- tormeh 10y ago
  >Is it ethical, for instance, to develop human embryos outside of the womb for convenience? Why not, assuming outcome is identical?
  - omginternets 10y ago
    >assuming outcome is identical Well sure, if we're assuming there's no problem, then there's on problem, but that's a bit ... circular... Moreover, there's a mountain of evidence showing that prenatal environment shapes a large swath of physical and psychological traits.
    - derefr 10y ago
      That mountain of evidence mostly says that the in vivo prenatal environment is kind of... awful, though. As in, mother and foetus competing for nutrients with better maternal genes resulting in better defenses against the placental "parasite", and thus worse developmental outcomes; and better foetal genes resulting in better parasitic strategies to penetrate the uterine wall, and thus worse perinatal health outcomes for the mother. I'd honestly stake >$10k, at this point, on the hypothesis that "growing children from embroyos in vitro, hooked up to an unlimited nutrient drip" will result in children much healthier than "regular" children, along every axis we can think of. (Presuming, of course, that we first figure out every micro-nutrient such a drip would be required to provide.)

isoprophlex 10y ago

What an amazing idea, pushing the boundaries of medicine... In the table with experiment outcomes I see one lamb that survived for a while without mechanical ventilation... Was this the best outcome of the set? I couldn't make out if some of them were actually viable, and survived?

woliveirajr 10y ago
Couldn't understand, too, if their lives were terminated on purpose or all couldn't survive outside the environment. I'd appreciate any insight of it.
- isotropy 10y ago
  Sounds like the lambs were terminated immediately after coming out of the biobag, so the researchers could get a clear picture of how lung development progressed in the biobag without confounding factors coming from spending too much time in the open air.
apendleton 10y ago
It seems there was one individual that was kept alive post-"delivery," and it got tests and imaging six months later that confirmed that it was developing normally, but that the others were terminated so they could be autopsied. The assessments of, e.g., brain morphology, require sectioning the brain and examining it under a microscope.

mikeyouse 10y ago

While this is amazing and I'm certain it's going to save a number of lives.. Does anyone else get the sense that we're going to start seeing "farms" full of these bags in an effort to save time / money / stress on cows and sheep?

jacquesm 10y ago
Or not to need cows and sheep any more for the reproductive part at all.
- slobotron 10y ago
  Milk comes from cows that would otherwise nurse their calfs, so you need to get them pregnant anyways. At least that is my understanding...
  - deleted 10y ago
    [deleted]
jawns 10y ago
Remember that this technology does not cover the full gestation period. It only works starting at the edge of viability. In order for an extremely premature lamb to end up in one of these bags, either preterm birth must be induced, or surgery must take place. Neither of those options is low-cost or without the potential for significant complications. You would likely end up with high rates of mortality and morbidity, and even if the BioBags were able to successfully sustain the animals, they would probably never be considered suitable for anything other than research. There may come a day when a BioBag is able to cover the full gestation period, but even then, I highly doubt that it would be cheap enough for use with livestock.
- cr0sh 10y ago
  This kind of research has been going on for quite a while: http://www.nytimes.com/1996/09/29/magazine/the-artificial-womb-is-born.html http://www.nytimes.com/1996/09/29/magazine/the-artificial-wo... http://www.hcs.harvard.edu/~hsr/wp-content/themes/hsr/pdf/fall2008/35-39%20ArtificialWombs.pdf http://www.hcs.harvard.edu/~hsr/wp-content/themes/hsr/pdf/fa... Not discounting what you are saying; just wanted to add some more context...

wesleytodd 10y ago

I have been reading the ["The Vorkosigan Saga"](https://en.wikipedia.org/wiki/Vorkosigan_Saga https://en.wikipedia.org/wiki/Vorkosigan_Saga) and one of the consistent themes is the "Uterine Replicator". Sounds very much like what this could become in the future. Not only is this book series great and very entertaining, I think it tackles some technology and social ideas that others in the genre do not.

azernik 10y ago
In part this is the result of being written by a female, strongly feminist author who has the gender implications of sci-fi technology in mind. On a separate note, I quite enjoy the way that she also explores the relationship of a "backwards" polity with a more advanced international community.

DigitalJack 10y ago

Brings Axlotl tanks to mind.

surgeryres 10y ago

To clear some confusion - they did not grow this lamb in the bag starting from conception. The major limiting factor as to when it can be transferred to the bag is when the umbilical vessels are large enough to safely and efficiently cannulate. Oxygenation, nutrient delivery and waste removal are all done via the umbilical vessels through external devices. The biggest road block in growing a baby in a bag fully ex utero would be the period before when the umbilical vessels are accessible. Before this time in utero, local mommy angiogenesis in the wall of the placenta serves the role of the umbilical vessels. Replicating this ex utero is a completely different problem.

nojvek 10y ago
I imagine they will figure out ex-utero in a couple of decades. Our understanding of genetics will improve too. I imagine an underground bunker somewhere growing babies in tiny pods in 1000's. Those babies are in pods until full adult hood and an artificial process is injecting memories and skills into the brains of this pod babies. Bonus brownie points if there is a pod cluster on an alien space. A billion super humans that land on earth who were all manufactured in transport. Do they treat humans like we treat cows pigs and chicken?
- serf 10y ago
  > A billion super humans that land on earth who were all manufactured in transport. This is a common concept in space-faring science fiction. It's one of the few 'practical' methods of sending a species with a human life span far out into the universe; with an ark filled with genetic material. Although most stories have the humans being manufactured in the good ole' fashioned way during transport, a few franchises (warhammer 40k, mobile suit gundam, certain entities in mass effect I think, halo to a certain extent, etc) speak of body-assembly-lines. (and in the case of Halo or Warhammer40k, yes -- the clones are quite often treated as expendable cattle.)
killjoywashere 10y ago
The placenta, however, would be a sweet target for 3D tissue scaffolding: grow the embyro on one plate and maternal on the other.

jlebrech 10y ago

this tech will render invalid the whole pro-life/pro-choice argument.

vitorbaptistaa 10y ago

Super interesting research! I wonder: is there a limit on how long the lamb could be kept in this extra-uterine system? In other words, could the lamb be grown in this system until it's an adult?

skocznymroczny 10y ago

Wake me up when we can make women obsolete