technology
Healthcare
Natural versus synthetic
from getting enough oxygen, can occur. But Iaizzo believes that preconditioning the heart with these upregulated hibernation factors from bears could limit ischaemic damage. This is particularly crucial for organ recipients who have other medical issues, aside from cardiac problems. “If I can minimise the consequences of ischaemic damage and put that heart – or any organ – in that recipient, it should function better immediately, it might decrease complications and the ICU [intensive care unit] stays, and [lead] to long-term better outcomes,” Iaizzo said. “So this is what we’re pretty interested in.”
Muscle atrophy There’s potential for other areas too, particularly in terms of muscle weakness and patients who have been immobilised during intensive care. As Iaizzo explained, despite various methods to help alleviate this, patients can fall into hypercatabolic states, in which they can lose up to 50 percent of their muscle mass within just a few weeks. “And when that happens, very typically they’ll end up on the ventilator, and if that happens the outcomes are usually not good,” he added. As such, Iaizzo is examining how bears manage to maintain high levels of muscle function and lose minimal skeletal and cardiac muscle masses while immobilised during hibernation, and how this can be applied to such patients. His research starts
6 hours Current window of opportunity for performing a heart transplant
24 hours Potential increase in transplant window using synthetic bear bile
with looking at the cascade of hormones that is released during hibernation – also known as ‘hibernation induction triggers’. “We’ve started out collaborating with Peter Oeltgen at the University of Kentucky… He had been looking at the plasma from hibernators and looking at these molecules, and showed that they had specific properties that could be protective of organs and muscle against ischaemia,” Iaizzo said. “And so we then started looking more into that and [bears] actually have increased levels of these hormones during hibernation, as well as increases in their circulating bile acids and fatty acids. So then we’re trying to tease apart which is most critical – is it the circulating hormones, bile acids or the high levels of fatty acids or a required combination? And so, if we could figure that out, there might [be] greater applications to human medicine relative to patients in the ICU or organ transplantation, or just cardiac surgery in general.”
While synthetic bear bile may well do little to reduce demand for the real thing, it is currently being explored for some potentially phenomenal developments in western medicine
Iaizzo and his team are doing some fascinating work with synthetic bear bile – using lessons learned from nature to improve the survival rates of those awaiting heart transplants is nothing short of extraordinary. It also demonstrates that there is viability to using synthetic bear bile as opposed to the real thing, which, considering the methods employed and the sources themselves, is inarguably cruel. But whether this lesson will translate to those still poaching and farming bears, or those selling and using bile, is unlikely. Traditional Chinese medicine involves a deep-seated belief system for the millions of people who use such treatments. “They really believe in a balance in taking their medicine… and that the bear bile itself, with all of its components… has a more balanced effect on your body than just what is considered to be the ‘active ingredient’ – a compound called ursodeoxycholic acid, which can be created in a lab,” Garshelis explained. The notion of using natural remedies is fundamental in traditional Chinese medicine, and this is where synthetic alternatives fall short. “There is the belief that the bile that comes from a bear, which is composed of many different compounds that have yet to be synthesised, is just inherently better than artificial bile, where these substances are absent,” Garshelis added. While synthetic bear bile may well do little to reduce demand for the real thing, it is currently being explored for some potentially phenomenal developments in western medicine. It also highlights the possibilities available to scientists when they study the countless facets of the natural world. “Maybe we should go back to these more natural remedies and look back to the past,” Iaizzo said. “For example, many have been used in eastern medicine for thousands of years.” Indeed, imagine what treasures of information there are out there to be discovered – or rediscovered, as the case may be. tne 31
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