Saturday, 9 September 2017

Tricky transplants: From changing personalities to designer vaginas

Transplants are fantastical but tricky beasts. In the last week alone it was reported that a 13 year old girl who died from a brain aneurysm and donated her organs helped eight different people - a record number for a single donor. However transplants can be challenging. They can be surgically complex, like in 2011 when nine-year-old Alannah Shevenell had six of her organs replaced in one incredible operation. Alannah had a massive tumour taking over her abdomen, which necessitated the removal of her stomach, liver, spleen, small intestine, pancreas and part of her oesophagus, along with the tumour. All of the removed organs were replaced with transplanted organs and Alannah is now back in school and thriving. 

Transplants can also be emotionally complex. This was the case for a 44 year old Chinese man who received the world’s first penis transplant in 2006. He had been left with a 1cm penis stump following an accident, and in an impressive feat of surgery, surgeons gave him the penis from the cadaver of a 20-something year-old. Two weeks later they had to chop it off. Initially it appeared to have gone well, the blood supply was good and he could urinate through it, but the recipient asked for it to be removed. He couldn’t live with the idea of having a dead man’s penis.

This emotional impact of a transplant is not restricted to genitalia. A study in the Journal of Near-Death Studies interviewed 10 heart transplant recipients and their friends and family, and encountered some strange stories. There was the woman who felt her partner was a better lover since receiving a woman’s heart, and the recipient who reported feeling the impact of the car crash that killed her donor. This is a small sample size, and there is no good evidence or reason to believe a transplanted organ would affect people in this way. However this doesn’t detract from how these people feel, and it demonstrates the psychological fallout transplants can have.

Moving back to solid science, one of the major challenges when it comes to transplantation is rejection. This is when the immune system identifies the transplant as foreign tissue and launches an assault on it, causing damage that can end in the death of the organ, and therefore possibly the recipient. Rejection is more likely when the donor and recipient are a poor tissue match. This matching is largely based on a set of proteins called Human Leukocyte Antigens (HLAs) that are found on the surface of every single cell in our bodies. Our HLAs are like a barcode that identify our cells as our own. A transplanted organ is exceptionally unlikely to be a perfect match, so it’s HLAs are different from our own cells. If they are too different, the immune system successfully plays ‘spot-the-difference’ and targets the transplant for destruction. We can try and mitigate this by using drugs that suppress the immune system, but this immunosuppression puts the recipient at higher risk of developing infections.

Rejection is not a one way street - sometimes transplants attack their new bodies. For instance, bone marrow transplants effectively transplant a chunk of immune system into the new body in the form of white blood cells. These white blood cells attack their new body, in a phenomenon known as Graft Versus Host Disease (GVHD). This can result in symptoms as mild as a rash or as severe as intestinal bleeding and coma. Sometimes a touch of GVHD can actually be a good thing, like in leukaemia after chemotherapy, where the aggressive transplanted T cells can kill off some of the recipient’s remaining cancer cells.

As I said at the outset, transplants are fantastical but tricky. We’ve covered tricky, so I’d like to end on something fantastical: ‘thoes’ and designer vaginas. When someone loses their thumb, it has an understandably massive impact on the range of movements their hand can perform. One option to improve this range is to remove their big toe and put that in the place the thumb used to be, creating something called a ‘thoe’. The loss of the big toe generally has less impact on a person’s quality of life than having a missing thumb, and the thoe has the added benefit of avoiding rejection because it isn’t foreign tissue. 

Another transplant type that avoids the issue of rejection is a designer vagina. In 2014, in the Lancet, doctors reported a first - they had created vaginas grown from the vulval cells of four girls born with Mayer-Rokitansky-K├╝ster-Hauser Syndrome (MRKHS). MRKHS affects up to 1 in 1,500 female births, and leaves sufferers with a completely or partially absent vagina. By growing vulval cells on a synthetic scaffold the doctors were able to grow vaginas tailored to their recipients, and they were a remarkable success.  After an average of 6.75 years, all the girls gave their new vaginas ratings well within the normal range for lubrication, arousal and orgasm. Pretty fantastical.

These stories, along with many more, can be found in my book Immune: HowYour Body Defends and Protects You, published by Bloomsbury Sigma on September 21st 2017

Saturday, 18 February 2017

Raising a feminist

Being a new parent is full of trials and tribulations. Some are practical challenges that you never envisaged in your life. Like trying to change a nappy on a vigorously rolling one year old without getting covered in poo. Others are more philosophical, like how do I raise a feminist? For this I turn to Eva and Jude, two children who were on a programme called the Secret Life Of Five-Year-Olds (if you haven’t seen it, find it on Channel 4, it’s immense). Why can’t girls be scientists? Jude, a 5-year-old boy, replies that they’d ‘make silly potions’. His companion, a 5-year-old girl named Eva, promptly volunteers ‘I extracted the DNA from a banana once’. Boom. Drops mic. 

I’m not alone in thinking Eva is a feminist icon. I want to write to Eva’s mum and ask for a guide to raising a little girl who schools boys on karate and is aware of the suffragette movement. I suspect step one is to be a well informed feminist yourself. I asked my husband to name some famous females in science or medicine and he could name more than I could. Ugh. I have therefore been schooling myself on some of the less well celebrated, but seriously fierce, females that have blazed a trail in science or medicine. Let me share:

Image: American Red Cross
Clara Barton founded the American Red Cross in 1881 at the age of 60, and headed it for 23 years. This formidable lady also provided aid to soldiers during the American Civil War, venturing into the heart of the battlefield, where medical units feared to tread. In addition to nursing, caring and cooking for soldiers, one of her most significant contributions came towards the end of the war when families sought information about missing loved ones. Then President Lincoln wrote: “To the Friends of Missing Persons: Miss Clara Barton has kindly offered to search for the missing prisoners of war. Please address her . . . giving her the name, regiment, and company of any missing prisoner.” Over four years she and her team responded to over 63,000 letters and identified over 22,000 missing men. Today the Red Cross still provide this searching service and describe it as one of their most valued activities.

Image: Nobel
Irene Joliot-Curie had rather big scientific shoes to fill, with her parents Marie and Pierre Curie having both earned Nobel Prizes. Yet fill them she did - sharing the 1935 Nobel Prize for Chemistry with her husband Frederic Joliot. Irene worked with her mum to provide mobile X-ray units during World War I, returning to her studies in Paris before going on to work at the Institut de Radium which had been founded by her parents. It was here that she and her husband bombarded a piece of aluminium with alpha particles, artificially creating a radioactive substance for the very first time and earning them a Nobel Prize.

Rebecca Lee Crumpler made history in 1864 when she became the first African American woman to be awarded a medical degree. Little is known about her life, and despite her massive achievement no images of her exist today. What we do know of her comes from her 'Book of Medical Discourses', whose existence is further testimony to her intelligence and fortitude as it was one of the first medical publications by an African American. Reflecting on why she had entered into medicine she said: "It may be well to state here that, having been reared by a kind aunt in Pennsylvania, whose usefulness with the sick was continually sought, I early conceived a liking for, and sought every opportunity to relieve the sufferings of others.” Her desire to alleviate suffering was such that she treated children without concern for their parents ability to pay her.

If you’re interested in more impressive women, there’s a helpful (though woefully short) list of female Nobel Laureates available here. The NIH also has an interesting project called Changing the Face of Medicine which celebrates female physicians. 

In the week of Galentine’s Day, I’d like to say a big thank you to these women and to all the strong women I’m lucky to have in my life. I look forward to raising my little feminist with my staunchly feminist hubbie, and maybe toots will follow in the footsteps of these illustrious women. Or maybe she’ll carve her own unique path. Whatever road she chooses I hope she’ll know that well-behaved women rarely make history.