Philanthropy: How is the coronavirus affecting your work at the Wake Forest Institute for Regenerative Medicine in North Carolina?
Tony Atala: I do both research and clinical medicine. I'm still at the hospital, I'm still practicing. But it's a challenge. Right now we're not doing any elective surgeries. Only emergency cases, surgeries that can't wait.
We put off elective surgeries to stop spread of the virus by patients coming into the hospital, and also because we needed to preserve protective equipment. At a typical surgery you have the anesthesiologist, the nurse, the circulator, the surgeon, the surgeon's assistant—at least five people in the room using up protective equipment. If you're doing five surgeries a day that's 25 sets of masks, gowns, and so forth. So eliminating one active operating room a day saves 25 days of protective gear.
The challenge is that the elective surgery of today could be the emergency surgery of tomorrow. By postponing medical care we’ve created a backlog of cases. We’ll still have to attend to those patients, their diseases didn’t go away. Indeed their conditions may get worse as a result of cancelled appointments.
And by disrupting normal medical services we’ve also decreased payments and reimbursements. Which means financial disruption for hospitals and doctors. So our health-care systems are being drained financially.
Philanthropy: Your research lab is one of the top facilities in the country in areas like lab-grown organs and regenerative medicine. What are you doing on that front now?
Atala: I’m still doing some research, but not nearly as much as normal. We've shut down all lab investigations except essential work. That includes some covid-19 research that is considered essential.
In our regenerative-medicine lab we grow tissues for transplant into patients. And out of that work, over the last few years we’ve created miniature organs the size of a pinhead—tiny livers, hearts, lungs, all grouped together on a nickel-sized plastic base and nourished by fluids—that can be used to test human toxicity, infection rates, drug efficacy, and so forth, instead of needing humans or animals. These “organs on a chip” react to diseases and chemical compounds the same way as a real human body, so they are invaluable in lab experiments. We spent about $20 million on that, and it is a remarkable advance.
For example, there's a drug out there called Hismanal, an antihistamine that was tested in human cell lines, in small animal models, in large animal models—with no toxicity indicated in any of those. It went through Phase 1, 2, and 3 human clinical trials—no toxicity noted. So it was released by the FDA and was on the market for 11 years. Eventually it became clear Hismanal was causing heart blocks in some patients, so the drug was pulled. We took Hismanal and tested it in our organs-on-a-chip system and within two weeks we knew the drug was toxic to the heart. If our tool had existed some years earlier, we would have found the problem right away.
Anyway, as a contribution to covid research we’re now creating these miniature organs and then infecting them with the coronavirus. We put the virus into their cells and then test antidotes, potential therapies. We’re especially looking at the organs that are most affected by covid, like lungs, heart, the GI tract.
To pay for these investigations into covid-19 using our organs-on-a-chip system, we're using our own institutional funding, out of our Wake Forest Institute for Regenerative Medicine budget. Since approximately 10 percent of the funding for our Institute comes from foundations, our donors are thus helping make our covid work possible.
Philanthropy: So you’re contributing toward a vaccine?
Atala: Absolutely. Our organs-on-a-chip system can be used to assess the effectiveness of drugs very early on, and test things before they get to patients.
This will be the fastest that anyone has ever come up with a vaccine in the history of medicine. Never before have we seen so many things developed so quickly. That’s a great, great thing. At the same time, vaccines need to go through clinical trials, be tested, be distributed. And a vaccine will be needed, because this virus is going to stick around just like the polio virus and the measles.
Here and there where we can help we’re also doing some other things. For instance, we have machinery that can test permeability at a particle size. So we ended up testing masks produced in our city. After they passed, 300,000 of these reusable masks were made for the whole community. They are being distributed this week to residents.
Philanthropy: What’s your take on the overall state of the covid pandemic?
Atala: The good news is that most states reached peak infection rates by early May. Peak means the highest number of new cases, and hospital stays, and after that the curve heads downward. It takes about as many weeks for the curve to fall off as it does to rise. So if it took five weeks or two months for a state to reach peak, it’s going to take about that much more time to go down to baseline. Of course when people return to work and normal life there will be some increase of cases, as is typical of epidemics. But the general trend was decreasing as of early May, which is very encouraging.
Reopening things will totally depend on each state, because the numbers are very, very different. Seattle, New York City, parts of Michigan, New Orleans are hot spots. But in places like Iowa or Wisconsin it hasn't been bad. So it has to be a regional decision on when different kinds of places open up. Then the challenge is to avoid unnecessary travel and continue social distancing and careful hygiene. If you do all that you're going to be okay.
Philanthropy: Is there anything unusual about this virus from a medical perspective?
Atala: It’s not an unusual virus at all. It has a very similar envelope to other viruses, similar structure. The only thing that's challenging is that human bodies have never seen it, so we don’t have immune protection. Because our immune systems don’t recognize the virus it takes longer for our bodies to fight back. A delayed response lets a virus spread more quickly. But coronavirus actually transmits less easily than some others. Measles transmits much more readily.
Philanthropy: How is this season affecting medical schools like yours at Wake Forest?
Atala: Medical students have been sent home, like other students, so they aren’t getting the hands-on activities that are needed for medical learning. Medicine is absorbed by seeing and doing, so with medical students unable to be at patient bedsides an important element has disappeared.
Philanthropy: If a donor were to come to you and say, "Tony I would like to give some money to help," what would you suggest?
Atala: There are so many areas. History is replete with donors stepping up to the plate to help, like in the cases of polio and tuberculosis. Philanthropic dollars have gone a long way toward many different causes over time. Federal support can only go so far.
And this is not the last health emergency we’re going to face. There are many more viruses out there. Even patients who recover may need repair of their tissues and organs, using the kind of regenerative medicine I work on. What we need is committed philanthropic support whether or not a pandemic is present.