The Man Growing Organs On Demand
Justin Rebo, KindBio and their fantastic sacks
The initial heart transplant was not greeted with universal applause. Shortly after Dr. Christiaan Barnard performed the procedure for the first time in 1967, people bombarded his hospital in South Africa with letters that characterized the doctor as a butcher and a ghoul. A fellow cardiologist likened the operation to a form of cannibalism. Many people criticized Barnard for picking one life over another and playing God.
It did not take long for most of this criticism to dissipate. Within a couple of years, the public became accustomed to the idea of heart transplants and then they welcomed them. Last year, about 10,000 people worldwide had heart transplants, while nearly 165,000 people received a kidney, liver, lung or pancreas.
There would be far more organ transplants if there were more viable organs available. Which brings us to the next medical and ethical quandary that society may soon face.
A three-year-old startup named Kind Biotechnology has begun work on what it calls an integrated organ network, or ION. This acronym undersells what Kind is making, which is a collection of organs that can be grown inside of an animal’s womb and then harvested for transplantation. Cue the gasps from some and the cheers from others.
By creating a series of genetic edits, Kind can alter the development of an embryo so that it forms organs without also forming limbs, a central nervous system and brain. The result is a group of organs growing in the womb. It sounds like science fiction, but Kind has already done this hundreds of times in mice and now rats, according to Justin Rebo, the company’s founder and CEO.
In the months ahead, Kind plans to expand its technology to larger mammals like pigs and possibly sheep with the hopes of producing organs good enough to endure the transplantation process. One day, Rebo expects that humans might be able to use these animal-grown organs to deal with medical emergencies and to help people live longer.
“We’re working on a platform to build abundant organ medicine, which we believe is a path not only to treating organ failure, but eventually to being more broadly medically useful and even impacting human lifespan,” Rebo says. “The point of medicine is to make people live longer and healthier lives. That’s what it’s always been. And that’s what we’re working on.”
TENS OF thousands of people languish waiting for viable organs each year. Scientists have been trying to solve this problem for decades by trying to create individual organs in their labs. In some cases, they take the cells of an organ and then try to coax them into developing more fully to make, say, a lab-grown kidney or liver. Companies like United Therapeutics and eGenesis have also been editing the genes of pig organs to make them more suitable for human use.
While there has been some success with these approaches, Rebo considers them too basic and limited to produce the full complement of organs that humans need. He contends that you can’t create the best organs in isolation and that they need to develop alongside each other. “The heart relies on the kidney to modulate the system environment in the right way to allow it to live and grow,” he says. “And both rely on the lungs and the liver and so forth, and both need access to nutrients, which is provided by the intestines.”
Rebo is a doctor and scientist with a long history in the bio-tech and longevity fields. And he’s not alone on this quest to create organs inside of what could be called headless bodies. R3 Bio, co-founded by John Schloendorn and Alice Gilman, is pursuing similar technology, although without much detail as of yet. Gilman has talked about trying to create animal models that could be used for medical testing so that researchers would no longer need to experiment on living, conscious mammals like primates. RenewalBio in Israel is also believed to be working in this area, trying to build organs from a patient’s own cells. (Schloendorn and Rebo were previously collaborators.)
Before even getting to the ethical considerations of Kind’s technology, there are myriad practical, scientific matters to confront.
Rebo’s vision is that you might grow a collection of organs inside of a pig’s or other animal’s womb and then have those organs placed into humans. To do this well, there would need to be genetic edits made to the organs so that the human bodies would accept them. In addition, you would need to mature the organs outside of the womb so that they could grow and be suitable for humans of different ages.
All of these are incredibly difficult technological challenges, and it’s unclear that we can actually pull them off in anything resembling a cost-effective, repeatable fashion in the nearish future. Rebo, though, talks matter of factly about taking today’s lab research and making it more concrete. He thinks all the major problems are solvable via advances with genetic editing technology and hardware systems that can support the development of organs outside of the body by helping regulate hormonal, immune and other functions.
“So initially the transplants would be into neonatal pigs or neonatal whatever larger animal that we use,” he says. “But even beyond that, I think many people don’t know is that there are case reports where kidneys, for example, were transplanted from a seven-month infant into an adult and they were life sustaining. I want to emphasize that we don’t have a plan to do a human system. But we have seen that you don’t have to keep these things going for an extended period of time for their organs to be useful.”
The notion of a body being able to develop in a healthy fashion without a central nervous system and brain to aid in the process seems hard to fathom. This, however, does happen on occasion in nature. There are babies born without brain stems and without their neocortex, which is responsible for cognition, and that survive for years – the most famous example being Baby K.
The ethical questions are equally challenging. There’s something very off-putting about the idea of headless meat sacks being grown for harvest.
That said, organ transplantation is unpleasant as is. There’s a black market for organs that is the stuff of nightmares. And, in general, sick old people are sitting around waiting for young people to have a car crashes or some other horrific accidents so that they might get an organ and live a few more years, which is a grim calculus. Beyond all of that, what we already do in terms of harvesting sentient animals for food is abhorrent, and most of us seem to deal with this just fine. It does not feel like a huge leap, at least to me, to think about taking an organ from a brainless sack to save a child or a loved one.
“I understand that this looks weird,” Rebo says. “But ultimately, it’s a system that prioritizes ethics and prioritizes something that can actually work. We can grow these things with our present technology.”
While Kind must currently grow the organs in the womb of an animal, there are futures where similar functions could take place inside of artificial wombs. We wrote earlier this year about Becoming Bio, which has developed an artificial placenta. Over the last couple of years, scientists have also made huge strides in the perfusion systems that keep organs functioning outside of the body. Bexorg does this with brains. And Science Corp. recently unveiled a whole perfusion product line.
Rebo, 47, grew up in Pennsylvania – one of those kids who built Tesla coils and lasers for fun. After obtaining his medical degree in 2010, Rebo went right into bio-tech working with embryonic stem cells and then on parabiosis, where an old animal and a young animal have their bodies fused together to share a circulatory system.
“Ever since I was very young, I thought that the wisest and best people in the world must be working on the obviously most important problem, which is to make people live longer and healthier lives,” he says.
He started KindBio about three years ago after growing dissatisfied with the rate of progress in the longevity field. Today, the company, located in New Hampshire, has a handful of employees. Rebo declines to say how much money the company has raised or from whom.
Kind has spent much of its time researching and identifying the genes that disrupt the formation of the central nervous system and brainstem and other genes that lower the metabolic demands of the organ systems to make them easier to sustain. “They’re not small, tiny cutouts,” he says. “We’re talking about taking out multiple exons.”
Rebo says that Kind has proven out its technology in mice and will move to larger animals this year – first in pigs and then possibly sheep. The company has yet to try a transplant with the organs it has grown and does not expect to do so until the work on the larger animals begins. “The timeline in the larger systems is longer than in mice because mice grow very fast and the generation time is short,” Rebo says. “I would like to have large animal IONs in less than three years and would consider the goal of that stage of research to be a transplant and demonstrating that the organs are life-sustaining.”
The technology, if it works, will start out expensive. Rebo, though, can see a future where the price comes down enough to perhaps open the organ work up to other uses beyond transplants. It could, for one, help with animal testing of drugs. “From there, you can imagine getting to a level of scale and cost effectiveness where you could even look at ethical animal products more broadly. You could imagine a leather application or even a meat application.”