“The most insane thing I have ever done” is how Dr Michael Wagels described the world-first reconstruction of 36 centimetres of a patient’s tibia.
A PhD graduate and senior lecturer at The University of Queensland, Dr Wagels is continually expanding his horizons, with living joint replacements and regenerated organs firmly in his sights.
“We are looking at what is coming in five, 10, 20 and 50 years so we can be leaders,” Dr Wagels says.
“Personalised medicine and surgery is happening now, but you can see it becoming much more common.
“We want to be ahead of that wave – to the point where we are manufacturing bits and pieces of people and implanting them, instead of a substitute.
“It will be cheaper and allow us to continue to provide high quality health care to our community into the future.”
Clinical Director of the recently opened Herston
Biofabrication Institute, Dr Wagels is a visionary.
Talk to him for half-an-hour and you realise he is the kind of person who turns science fiction into reality.
In 2017, Dr Wagels successfully transplanted a 3D-printed shinbone into the leg of 27-year-old Reuben Lichter, who faced amputation after sustaining a serious bone infection.
Dr Wagels inserted a scaffold into Mr Lichter’s leg, around which the bone successfully regenerated and grew to the point where the patient could walk again.
“The closest anyone had come to reconstructing a bone defect was 15 centimetres, but you can’t get 36 centimetres
of bone from anywhere in the body,” Dr Wagels said.
“I had the idea from a sheep study that we could use the lining of the bone, rather than the bone itself, to wrap around the inside aspect of the scaffold, so the bone grows into the 3D printed scaffold, which supports and directs the growth of new bone.
“Over the course of 18-24 months the patient grew sufficient bone to have an entirely new shinbone. That was pretty spectacular.”
Dr Wagels, a plastic and reconstructive surgeon, has applied the same technique successfully in other patients, including a man who lost one-third of his skull in a motorbike accident.
“The beauty of the scaffold I use is that it is bioresorbable so it gets very quickly integrated with the body’s own tissues and then dissolves,” Dr Wagels says.
“Within eight weeks, this gentleman had evidence of bone regrowth on the inner and outer aspect of the scaffold, which
is quite remarkable.
“Subsequent CAT scans eight months later showed continued bone regrowth.
“A lot of tissue engineering falls down, when you scale up, from a lack of blood supply.”
Regenerating bone is one thing. To replicate the art with something more complex, like a joint, is another thing entirely.
“A living joint replacement has never been done before. You need to be able to manufacture not just bone but also cartilage,” Dr Wagels says.
“There are people looking at engineering cartilage and bonding it to bone, but that has never been done successfully.
“You also need to stabilise the joint with ligamentous structures and lining tissue, which produces the fluid that keeps the joint well lubricated.
“When you get an infection in a joint replacement, the whole thing has to come out. Even if the joint replacement doesn’t get infected, it will wear out. The current life of a joint replacement is about 10 years.
“A living joint replacement would be more resistant to complications: it would be the patient’s own tissue, so would not be rejected and, conceivably, should last longer.”
Dr Wagels said there was “just as compelling an argument” for similar organ procedures.
“At the moment if you need a kidney transplant you need to be on immuno-suppressant drugs so you don’t reject the organ,” he says.
“The thing transplant patients are most likely to die of in Queensland is skin cancer because immuno-suppressant drugs amplify the damage done due to sun exposure.
“What if you could take a circulating stem cell from someone’s blood, process it in a way that you can send those stem cells down a particular path to become kidney cells, and keep them alive while they grow until it becomes a transplantable organ?
“This is why partnering with our core academic partner, UQ, is so important because they possess a wealth of expertise regarding organoid research.”