Nothing funny about science

by Brian Clarey

The stuff coming out of the Wake Forest Institute for Regenerative Medicine is complex, dense and truly amazing.

Do you know what I’m talking about? If you can’t quite put your finger on it, I’ll fill you in. The institute has made national — and local — news by engineering human organs in downtown Winston-Salem laboratories. The first lab-grown organs to be successfully implanted into humans came from here — bladders, grown from cells harvested from the eventual recipients. Kidneys are made there by “printing” them from a machine loaded with living cells. Right now they’re figuring out a way to manufacture human livers from stem cells.

And last week, as reported in the journal Gastroenterology and, subsequently, the Winston-Salem Journal, the amazing doctors of the institute have broken through another barrier.

Dr. Khalil Bitar, who came to the institute from the University of Michigan, has manufactured from human nerve and muscle cells a working human sphincter.

The human body has more than 50 sphincters — strong rings of muscle that contract to block passage between organs and orifices. You have one in your throat so that nothing goes into your lungs when you eat and drink. There’s one in your diaphragm that allows food to pass from your esophagus to your stomach. There’s one in your eye.

But the one they’ve made over in Winston-Salem is a mighty sphincter, the most important one in your body and certainly the biggest: the one in your butt.

Stop laughing. This is science. Certainly there’s nothing funny about this to the millions — millions! — who suffer from fecal incontinence, for whom this breakthrough likely seems as if it dropped straight down from heaven.

And the technology behind it is not easily digestible. The anal sphincter is actually two sphincters, an external and an internal one, which act in tandem to control the release of feces from the body with a pinching action. Interesting fact: The internal sphincter is an involuntary muscle, over which we have as much control as we do our hearts or our intestines. But the external sphincter is voluntary, like a fist, and the sophistication required to engineer one of these babies in the lab is the science of life itself.

You don’t make a discovery like this right out of the chute. The Wake Forest Institute for Regenerative Medicine has been at it since 2006, when Director Dr. Anthony Atala reported that patients implanted with bladders grown in the lab were adapting with some success. This made a big splash in the world of internal medicine. And the research has built up since then — the discovery of pluripotent stem cells in amniotic fluid, able to grow into almost any type of human cell, was the tip of a large body of innovation that burst forth in the coming years.

And now downtown Winston-Salem has become a research center for the regeneration of human spare parts, and a sort of factory for bladders, urethra, valves, blood vessels. Perhaps one day soon we’ll see hearts, livers and lungs coming out of the institute — seems like it’s right up their alley. And discoveries like this can only be held back for so long.

It’s astonishing, really, and the impact is explosive.

Besides lending weight to the facilities at Wake Forest and Baptist, the institute also gives Winston-Salem a leg up in the business world. This is the best facility of its kind — No. 1, not No. 2 — a streak of technology and science in the City of the Arts that has emerged as a leader in the field. We are wiping up the competition, and really putting the squeeze on bioenigneering technology.

As for the sphincters, they’re not ready for people just yet, but they seem to work just fine in mice. Meanwhile there are the millions of broken-hearted folks who wait for innovation in this area.

One can imagine the pressure behind a project like this.

But it was all worth it. Now, thanks to Dr. Bitar and the Wake Forest Institute for Regenerative Medicine, the city of Winston-Salem has risen above the waterline and left its mark on the world of bioengineering. This is more than a bunch of hot air. Whereas the city was once synonymous with the tobacco industry, perhaps in the future it will be more closely associated with that most functional of muscles, the sphincter.