Early in 2020, Australia Post issued a set of four postage stamps on Medical Innovations. These stamps are bright and attractive, and each of these innovations were disruptive for the existing practices. Lets explore these, from the most recent to the more established.
Spray on Skin Cells
Fiona Wood is the first woman plastic surgeon of Australia. Born in England in 1958, she completed her MBBS in 1981, and moved to Australia with her husband in 1987. She specialized in Plastic Surgery, and in 1993 began a collaboration with Marie Stoner, a specialist in tissue engineering. Together they have developed a new method to treat burn wounds. Currently, Fiona Woods is the director of Burns Unit, at Royal Perth Hospital.
The usual method of treating burns, is to graft sheets of skin from other healthier parts of the body. Wood and Stoner harvested smaller patches of skin, extracted epithelial cells, and sprayed these over on the wound as an aerosol. This method is now commercial, and available as ReCell System. The advantages of this technique is faster healing and no scarring as the wound heals. Further, this covers an area 80 times that of the size of the biopsy. In 2018, the method was approved by FDA. A further innovation in the technique is to deliver the cell-suspension aerosol with fibrin, so that the cells stick well on the wound.
Human Papilloma Virus Vaccine
Cancer of the uterine cervix, is a common malignancy in women. It is caused by human papillomavirus (HPV) infection. This link between the virus and cervical cancer was first suggested by a German scientist Harald zur Hausen In 1976. He confirmed his suspicion in 1983, and was awarded Nobel Prize for his discovery in 2008.
Meanwhile, in 1991, Brisbane-based immunologist Professor Ian Frazer and Chinese virologist Dr Jian Zhou combined their expertise to develop HPV Virus like proteins (HPV-VLP). Such proteins however did not elicit an immune response. Between 1992 and 1997, scientists Richard Shelegal, Dough Lowy and John Schiller refined the technique further, to develop HPV vaccine from the L1 protein of HPV. The safety and efficacy of HPV vaccine was proven in clinical trials published in 2002, and the first version of the vaccine, approved for clinical use in 2006. This vaccine protects against 90 per cent of HPV-related cancers in women and 95 per cent in men.
Cardiac Pacemaker
Pacemaker is a device, that delivers electrical signals to the conduction system of the heart, to generate cardiac rhythm. This artificial pacemaker becomes important, when our natural pacemaker fails. Role of electric impulses in functioning of the heart was well established by the 19th century, and we were able to record such electric signals on the surface of our body by the beginning of the 20th century. (See a previous blog on electrocardiography)
Dr Mark Lidwill MD (1878–1968) a Sydney based anesthetist, worked with a physicist Edgar H. Booth (1893–1963). In 1928, they inserted an electric current carrying needle, through the skin and into the left ventricle in a child whose heart had stopped. The child gained rhythm and recovered. Meanwhile, Dr Albert Hyman built and patented his cardiac pacemaker in New York in 1932. He recognized Lidwill’s work from a few years earlier. Unfortunately, there were no takers for Hyman’s device.
As cardiac surgery advanced in the early 1950s, so did an interest in reviving the heart through electrical stimulation. Initially John Hopps in Canada, and later Paul Zoll in US developed external cardiac pacemakers. In 1956, we used externally delivered electric current to revive stunned hearts – a process we know today as defibrillation. A few years earlier, an electrical engineer Earl Bakken had founded a company in Minneapolis – and named it Medtronics. Bakken, along with a cardiac surgeon C. Walton Lillehei developed a cardiac wire, that could enter from a vein and reach the heart. Thus, in 1957 we had our first temporary pacemaker with an external device. Next year in 1958, Ake Senning and the physician inventor Rune Elmqvist, in Sweden developed first implantable internal pacemaker.
Medical Penicillin
While Alexander Fleming discovered the anti-bacterial properties of penicillin in 1928, but the yield of the active substance was quite low. Later between 1936-42, Australian-born pathologist Howard Florey and German-born biochemist Ernst Chain developed methods to mass produce penicillin. Successful use of Penicillin in 1943, changed the way we manage infections. (See previous blog on Penicillin)
Australia was also soon at the forefront of producing this life-saving medical penicillin at scale, initially for use in the treatment of soldiers towards the end of WWII. It was also the first country to make it available for civilian use.
The story of these four medical innovations is recent history. While cardiac pacing and medical use of antibiotics are well ingrained, global coverage of HPV vaccine was only 27% in the year 2023. Its cost, non-inclusion in the national programs, and attitudes towards prevention of a sexually transmitted infection, hinder its wider use. Spray on skin cells is an upcoming technology, poised to change the way we treat burns.
