Artificial organs: current status and future directions
Int J Artif Organs 2016; 39(12): 587 - 589
Article Type: EDITORIAL
- • Accepted on 31/12/2016
- • Published in print on 10/02/2017
- • Available online on 11/02/2017
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At the end of 2016, the
The evolution of scientific reports on different artificial organs in the literature
In the past 15 years, scientific research and clinical applications relating to the various artificial organs have differed markedly between them. One way to estimate these trends is to use the number of publications on different listed cited in PubMed (
Number of publications reported in PubMed per year per key word
|VAD = ventricular assist device; ECMO = extracorporeal membrane oxygenation.|
Scientific reports related to artificial organs
The numbers reported in
Regardless of the reason for the lower impact of publications in artificial organ journals, the number of articles published in the general area of “artificial organs” in PubMed significantly dropped from 2015 to 2016. Over the last year there were almost half the number of publications from 2015 in this field. This trend will have to be confirmed in the future, but it is a sign that research and innovation in this specific area is diminishing with time, or at least it is not increasing. This trend was expected, but I would like to bring two observations in this regard to the attention of readers. The first is that despite having a lower impact as far as new development is concerned, the field of artificial organs still requires scientific and clinical research that must be pursued in order to continue improving the functions and efficiency of artificial organs. As pointed out recently by several investigators, clinical applications of hemodialysis, VAD, and ECMO only replace in part the native organ functions (1-2-3-4-5). These limitations should be the objective of academic and industrial research.
In addition, there is a continuous need to investigate the comorbidities that develop in patients treated with artificial organs, to be able to mitigate them for clinical and economic reasons. Another important limitation in the clinical use of artificial organs is that they have high costs, which massively increase the costs of medical treatments. In most the countries in the world these even make the use of these systems infeasible. The possibility of investigating how to reduce these costs may expand the use of artificial organs with direct benefit for both patients and industry. Thus, despite the observed trend of the impact of the field in specialized journals, the growth of scientific and clinical research related to artificial organs is a major need for our societies. Unfortunately, the possibility of supporting basic research in this field is scarce and not actively supported by the medical industry.
Another consideration I would like to make is that in the past 2 decades, besides research in traditional artificial organs, a very important increase in the scientific impact of so-called bioartificial organs and tissues has taken place. Specifically, the number of investigations containing the term “tissue engineering” published from 2000 to 2016 increased more than 10-fold. We know that the field was attractive for scientists but also for clinicians as well as for the general public. A lot of expectations derive from the concept that development of biological substitution of diseased tissue and organs can be much more effective in replacing native tissue than artificial devices. However, despite important advancements in some clinical applications, such as skin and cartilage (6-7-8-9), the effective replacement of diseased or damaged tissues by bioartificial tissues or even bioartificial organs is still far from a clinical reality (10, 11).
In this context, even more exciting expectations have been envisioned by the latest developments in cell therapies and, more recently, with stem cells and inducible, pluripotent stem cells. However, once again, the use of these therapies in effective clinical applications remains distant, and a great deal of research need to be performed before cell therapy can be successfully adopted in clinical settings (12, 13). In the meantime, it is important to keep in mind that we still need to work on innovating and refining artificial organs that are already in clinical use, since a large population of patients are already treated today with these devices and their lives depend on artificial devices. We can predict that these therapeutic strategies will continue to be used for a long time before being replaced by bioartificial alternatives or by radically improved pharmacological treatments that are able to not only prevent disease progression but also to induce remission of the disease.
Is it time to widen the field in artificial organ research?
This analysis of the status and trends in artificial organs suggest that the growth of scientific research is rather limited as compared to other areas of medicine. However, in my opinion, we need to realize that some important transformations took place in recent years regarding medicine and engineering. In the 1960s and 1970s, the need for clinicians to use technology for artificial organs was a great opportunity to join these 2 disciplines, allowing engineers to understand the biological functions involved and develop devices able to interface with biological tissues, while clinicians discovered the advantage of using technology to achieve important clinical results. Today, while not growing as fast in artificial organ research, this collaboration is extending in a large number of directions, all characterized by the use of technology in health care. For example, the number of publications in PubMed related to “medical devices” increased 3-fold from 2010 to 2016. Recently, the use of various technologies for the medical treatment of diseases and end-stage organ dysfunctions, but also for disease prevention and rehabilitation, makes the impact of medical technology fast growing and the object of a large number of investigations. This trend is also the result of the increasing need to customize patient treatment using so-called personalized medicine.
In my view, the traditional field of artificial organs should open to the wider area of medical technology, since both fields share a common knowledge in the spheres of engineering and medicine. In addition, the development of new devices and instrumentation to be used in the clinical setting can greatly benefit from the expertise and knowledge developed by experts in artificial organ research. The expectation is that the pioneering work initiated more than 50 years ago with the use of artificial organs will continue in the more generalized application of medical technology to medicine, with the active contribution of biomedical engineers and clinicians to maximizing clinical results and reducing the costs of modern medical treatments.
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- Remuzzi, Andrea [PubMed] [Google Scholar] 1, 2, * Corresponding Author (email@example.com)
IRCCS - Mario Negri Institute of Pharmacological Research, Anna Maria Astori Center, Bergamo - Italy
Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (Bergamo) - Italy