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"  Published in the April 2013 issue One day, when you are ill, when your heart finally beats a thousand times too many, when your liver is sclerotic beyond use, when your pancreas stops producing insulin, when your kidneys no longer protect you from toxins, Dr. Anthony Atala wants to heal you. In his vision, you will visit a hospital in Omaha or San Francisco or Buffalo, and a specialist will diagnose you. Then you&amp;#039;ll have blood taken to determine your genetic makeup, and then those results will be transmitted to an office manager in charge of a sterile white room in North Carolina that Atala has built. In a few days a small vial of stem cells that match your immunological profile perfectly will be extracted from a cryogenic tank in that room and shipped to your surgeon, who will use them to build you a new organ from scratch. It will take four to eight weeks to build and grow and implant the organ, and then you will be whole once again. This is not a new dream. Ever since human embryonic stem cells were first harvested and maintained outside the body in 1998, scientists and surgeons and politicians and patients have conjured up different versions of this dream. But in fifteen years, embryonic stem cells have yielded no major clinical advancements or treatments, let alone made-to-order organs. You can blame scientists for overpromising or fervent ideologues for halting research or private companies for strangling research with patents or the FDA for building clinical barriers too high. Or you can ask Anthony Atala what he plans to do about it. Nearly every scientist who talks about Anthony Atala describes him the same way. Visionary. Created a field. Architect of tissue engineering. This morning, the visionary accelerates his gold Honda Pilot in fits, misses turns, then accelerates again. The car has a huge crack down the windshield, which he hasn&amp;#039;t yet had a moment to fix, and there are Taco Bell crumbs in the backseat left over from his two sons. He&amp;#039;s up by 4:30 a.m. or earlier seven days a week, sending e-mails about grants and research. Then he mashes the pedal in morning darkness to the Wake Forest University Baptist Medical Center, where he is the chair of the urology department. He still operates one day a week, six pediatric patients in a row, their parents waiting anxiously in the waiting room as he cuts into their tiny torsos and repairs hernias and torsions and worse. The three hundred biologists and physiologists and engineers and chemists he oversees at the Wake Forest Institute for Regenerative Medicine watch as he torpedoes through the hallways from meeting to phone call to meeting, his high-pitched cackling laugh the only indication of where he is or in which direction he&amp;#039;s moving. He is fifty-four and has a slightly shaggy head of wavy black hair that makes his perpetual grin and full cheeks even more boyish. &amp;quot;We should start,&amp;quot; Atala says. &amp;quot;I have a call. Not sure with who, but we should start. Let&amp;#039;s go, let&amp;#039;s go.&amp;quot; He doesn&amp;#039;t say this in a gruff way, but with a disarming laugh. As in, Can you believe how crazy this is? And it is crazy. He&amp;#039;s crazy. By their oath, doctors fix and they heal, but they have up to now not created. What Atala and his tissue regenerators do and seek to do is, quite simply, in another realm of science and understanding altogether, born of the genius decoded from our own cells. &amp;quot;I use this term with the greatest respect \u2014 [he&amp;#039;s] kind of a modern Dr. Frankenstein,&amp;quot; says Edward Tenthoff, a biotech analyst at Piper Jaffray who&amp;#039;s closely followed Atala&amp;#039;s career. &amp;quot;He is truly a visionary in his view of where he&amp;#039;s taking the science.&amp;quot; In 1997, when he was thirty-eight and working at Harvard, Atala created the world&amp;#039;s first tissue-engineered organ. He built it by hand. He took a stamp-sized biopsy of healthy cells from a little boy&amp;#039;s broken bladder. He put them into a petri dish and fed the cells with proteins and nutrients until they mistook the petri dish for the human body and began multiplying and dividing as if still in the womb. He painted the new cells onto a biodegradable collagen balloon. A few weeks later, he sewed that cell-coated balloon \u2014 which had grown to become a new bladder \u2014 into the boy. Today that boy and many others who received the same operation are healthy college kids. A couple years later, working with scientists at Advanced Cell Technology, he created the world&amp;#039;s first cloned organs, mini bovine kidneys that pulled toxins from the bloodstream of the cows in which they were implanted. In 2007, when he realized that what was truly holding tissue engineering back were better, more reliable cellular building materials that could be sewn into patients without the problem of immunological rejection, he discovered an entirely new class of stem cells in amniotic fluid. The discovery made the front pages of newspapers across the country. That child in London who received an artificial windpipe last year that will grow with him? A prot\u00E9g\u00E9 of Atala&amp;#039;s helped build it. The urologist in Los Angeles who is injecting stem cells directly into kidneys to keep people off dialysis? He trained in Atala&amp;#039;s lab. Atala has built blood vessels. These are tubular and involve two types of cells, those on the interior that control fluid and those on the exterior that contract. But he figured out a way to build both using a machine that sprays collagen over a spinning rod to form a tubular scaffold. Then the cells are dripped on with a pipette, by hand. The vessels contract, blood and oxygen are ferried through the body. He&amp;#039;s built skin. Soon men and women with horrible burns will be laid upon a table. A laser will scan their wounds and transmit their location and depth to a nozzle that will spray new skin cells right onto their damaged bodies. The work is backed by the U. S. Army, which hopes to treat its more gravely burned soldiers this way. He&amp;#039;s built livers, which are constructed cellular layer by cellular layer with a 3-D printer, until they literally come to life. He&amp;#039;s built sphincters and urethras and heart valves. They beat, beat, beat. Atala wants nothing less than to eradicate all chronic disease. Heart disease, kidney disease, short-bowel syndrome, testicular cancer. Done. Fixed. Gone. In Atala&amp;#039;s future, we will no longer be burdened by our broken body parts. We&amp;#039;ll just replace them with new ones. But after two decades slogging through the stem-cell war, Atala&amp;#039;s learned that science is science, and then it gets released into the world and becomes something else entirely \u2014 a political cudgel, ideological ammunition. When he advocated for embryonic-stem-cell research, he became a villain to the Right. When his lab discovered a source of stem cells that wouldn&amp;#039;t necessitate the destruction of embryos, he became a figure of suspicion on the Left. In 2007, his work \u2014 his name \u2014 was used to argue both for and against embryonic-stem-cell research on Capitol Hill. The same research! He knows that in 2013, every scientific discovery is fuel for or against a point of view. And so he will protect his project, what he calls &amp;quot;my life&amp;#039;s work,&amp;quot; at all costs. And what is his life&amp;#039;s work? It&amp;#039;s a public stem-cell bank he is establishing so that any and every person has the material needed to build nearly any organ. &amp;quot;I don&amp;#039;t worry about politics. It&amp;#039;s not my concern,&amp;quot; he says. His voice is soft, but there is finality to its tone. No, he won&amp;#039;t depend upon ideologues or politicians for permission to pursue his life&amp;#039;s work. They&amp;#039;re mere distractions. Deep in his laboratory right now, twenty-four pig kidneys are suspended in whirling water mixed with soap and solvents. Over one day, the bright-red organs turn pink, then white, then nearly translucent as their cells and DNA are washed away. The remaining jellylike infrastructure is then reseeded with human cells from the inside out. Twenty-two different types of cells in all. Because all of these organs are built using adult stem cells from the patients who would receive them, there&amp;#039;s no risk of tissue rejection. He&amp;#039;s building all of these things. Some, like the bladders and urethras, are in patients today. Others, the kidneys and hearts, are still being perfected in animals. But there are things he can&amp;#039;t build, at least not yet.  You have to understand how he got here.  You have to understand how we got here. A tiny room on the sixth floor of the University of Wisconsin hospital, 1998. The equipment is dated and scuffed, scavenged from other labs. The scientist inside can&amp;#039;t use federal funding for his work on embryos, so he&amp;#039;s relying on a private biotech company called Geron that will hold exclusive rights to his findings. He&amp;#039;s trained in veterinary medicine but has become obsessed with understanding the earliest origins of human biology. He washes away the outer layers from a human blastocyst \u2014 a three- to five-day-old embryo left over from a fertility clinic \u2014 and then tends to the cells left behind as if they were infants. Every day he feeds them with nutrients and carefully picks out any rogue cells that have begun maturing. He wants the cells to multiply perpetually but never age. Here&amp;#039;s what he grows: embryonic stem cells that are capable of becoming any cell in the human body. Heart cells and nerve cells and kidney cells and insulin-making pancreatic cells. This scientist took an embryo that a couple seeking fertility treatments no longer wanted, and he destroyed it to get the cells inside. And then he went before the Senate and told them that because of what he had found, in five to ten years Parkinson&amp;#039;s disease could be cured. That if the government were to begin funding research into embryonic stem cells, many, many diseases could be cured. Here&amp;#039;s what he grows: a rabid pro-life movement that took its fervent opposition to abortion and redirected it toward embryonic-stem-cell research. They will not live in a country that destroys one life \u2014 a four-day-old blastocyst \u2014 to save another. They lost Roe v. Wade; they will not lose this battle. Here&amp;#039;s what he grows: a rabid, pro\u2013stem cell movement, backed in full force by the Democratic party, that accuses opponents of embryonic stem cells of putting ideology above public health and science. They will not allow the right wing to stand in the way of modernity itself. Because of this pitiless trench warfare, for more than a decade there will be no federal funding for finding new embryonic-stem-cell lines or even studying new lines made privately or abroad. Instead, private biotech companies and individual states will attempt to fill the vacuum, the results of their work often patented and privately held. Meanwhile, the political parties will fight ad nauseam, staking their political identities on the issues. National addresses will be given, laws passed to fund research, and those laws vetoed. His second month in office, Barack Obama rescinded restrictions on using federal funds to study new embryonic-stem-cell lines (although funding restrictions on creating new lines remained), and the NIH was immediately sued by pro-life groups. And the science, those cells in the scientist&amp;#039;s petri dish, what did they grow while the ideologues were debating? The greatest strength of embryonic stem cells, their ability to become any tissue in the human body, is also their greatest liability. Like infants, they have the potential to grow up to be anything. But they have deep-seated proclivities. Push them too far in one direction in life, like, say, demand they train to be a liver when all they really want to do is become a gland, and they revolt. A rogue child pushed by his parents to attend law school might drop out and move home; a rogue stem cell becomes a teratoma, a ball of mismatched cells, fat, teeth, muscle, liver... a grotesquerie. Many of the early embryonic-stem-cell experiments done in animals ended this way. A rat may be able to walk better after stem-cell injections into his spine. But then those cells change their mind and become tumors. In recent years, researchers have made inroads in differentiating stem cells to high levels of purity \u2014 in essence getting rid of the tumorous rogues. Antibodies and molecules have recently been developed that zap them dead. But the FDA remains wary and cautious about their clinical safety. But can you imagine what could have been achieved if fifteen years ago the federal government had made unleashing the power of stem cells a matter of our national will? We would have hit the same barriers, for sure. But we also likely would have conquered and bypassed them sooner. President Kennedy made a national commitment to space travel, and eight years later we put a man on the moon. It took a good decade of work, but the country demanded that we figure out a way to treat AIDS, and what was once a death sentence is now a chronic condition. Obama put billions of dollars toward clean energy, and now we are on the cusp of a burgeoning electric car and battery industry. In pledging billions of dollars to create a Brain Activity Map, the president also cited how every dollar invested in the federal-sponsored Human Genome Project returned $140 to our economy. But stem cells \u2014 the potential to make broken men walk again and take half a million Americans off dialysis and revolutionize our treatments for cancer? To potentially unlock the secrets to all disease? To unleash a wholly new medical field and economic engine? That was put on ice for a decade because the politics were too hard. &amp;quot;It&amp;#039;s almost impossible to do [stem cells] in the United States,&amp;quot; says Dr. Richard Fessler, who led what was supposed to be the first-ever human trial using embryonic stem cells for Geron before it was abruptly canceled in late 2011. &amp;quot;The paperwork you have to go through, the years of preparation, the politics that go on with it... So that the scientists who are interested in doing this and who have their careers staked on stem-cell research are leaving the United States.&amp;quot; Dr. Ed Wirth, former medical director at Geron, recently told a conference of stem-cell doctors that what doomed the $145 million study was the burden of paying for basic research. It was the equivalent of asking a private space company to build a new rocket without any of the institutional know-how developed over decades by NASA. Early last year, Advanced Cell Technology announced that it had completed the first clinical trial using highly purified embryonic stem cells to treat two women with advanced macular degeneration, both of whom achieved some improvements in vision. And, perhaps more important, no signs of tumor growth. (The eye was an ideal first indication, because only a limited number of cells were needed.) But this advance, too, is colored with a sense of what could have been. &amp;quot;I had those stem cells a decade ago,&amp;quot; says Dr. Robert Lanza, chief scientific officer for ACT, and an early stem-cell pioneer. Years ago a policeman confronted Lanza at his Worcester, Massachusetts, office. The policeman&amp;#039;s son could barely see. He asked if Lanza could help. &amp;quot;And it&amp;#039;s just heart-wrenching,&amp;quot; Lanza says. &amp;quot;We&amp;#039;ve had these cells in the freezer and I couldn&amp;#039;t do anything, there was no money. And I&amp;#039;m just thinking every year that went by how many thousands of people were going blind. It wasn&amp;#039;t until very recently that we were able to get them into the clinic, because of all the politics.&amp;quot; And Atala, what does he say? Nothing. Over the years, his work has been buffeted mercilessly by the politics surrounding embryonic stem cells, and though he is naturally a man of soft voice and few words, he has learned to say nothing at all. The irony is that he doesn&amp;#039;t even use embryonic stem cells. The rock is smooth and oval, except for one side that has been sanded down with time, so that when you pick it up, as Atala did fourteen years ago on a beach near Boston, it looks as if you&amp;#039;re holding a tiny stone kidney in your hand. At the time, Atala had already had success building the earliest versions of his artificial bladder and was focusing on other organs. He wanted to build a kidney that would instantly pull a half million Americans off dialysis, but it was far more complicated than constructing a thin, hollow bladder. A kidney would have to be hooked up to the ureter. It&amp;#039;s solid, so it would need a complicated circulatory system. And it would need a fabulously complex internal scaffold to keep all twenty-two cell types in the right place so that the kidney would function. Building an organ is a lot like building a house. Even if you get all the materials, you have to put them together in a very specific order or the lights won&amp;#039;t turn on, the boiler won&amp;#039;t work, the toilets won&amp;#039;t flush. All the parts need to communicate with one another and work together, or you&amp;#039;ll end up with just a clump of mismatched cells rather than a functioning organ. Atala turned the stone kidney around in his hand and rubbed his thumb over the outer edge. What he saw was uncanny. Not only did this rock look like a replica of a kidney, it had a slightly upraised seam that bisected the rock into two mirrored halves. The human kidney has this same bisection, called the Brodel&amp;#039;s line. It&amp;#039;s the place with the least circulation and functionality. In moments, the rock triggered a cascade of thoughts, solutions slamming together with the speed and intensity of a twenty-car pileup. Atala didn&amp;#039;t actually have to build a whole new kidney and circulatory system from scratch. If he were to cut a diseased kidney open at the Brodel&amp;#039;s line, then he could simply insert a silver-dollar-sized sliver of new, healthy kidney tissue. Just a simple addition of 10 percent of functioning tissue would be enough to get most patients off donor lists and dialysis. Rather than building an entire new house from scratch, Atala could just add a new boiler. &amp;quot;It&amp;#039;s at the craziest times! These things really come up at the craziest times,&amp;quot; he says. &amp;quot;I looked at the rock. I picked it up. It had a seam on it.&amp;quot; He believes in serendipity. It&amp;#039;s what he named his small fishing boat, which is docked on a North Carolina lake. He believes that if he struggles with problems long enough, lets them simmer at low heat in the back of his mind, and leaves his thoughts open to ideas or perspectives he might never have considered, then the solution will eventually reveal itself through chance. It&amp;#039;s why when he was training he spent so many hours at the library flipping through academic journals from every realm late into the night. Engineering. Art. Dentistry. Many of the solutions to his challenges were out there, discovered by other people in other fields for other purposes; he just had to find them. One evening he Xeroxed an abstract about a group of researchers who were taking bones from morgues, freeze-drying them, then using them as replacement segments during orthopedic surgery. Wild, weird stuff. Great, mind-rocking stuff. If they can do this, freeze-dry bone, he thought, &amp;quot;Why not do many different things? You could pulverize the bone, you could take the cells out of the bone, you could wash the cells away... Why not do that with living tissue?&amp;quot; A year after Atala created his first bladder, the entire field was shaken by the discovery of embryonic stem cells, which could be made into anything. It had a similarly mind-blowing effect. Atala wondered what other kinds of stem cells might be out there. Was there a better material than the curmudgeonly old adult stem cells he&amp;#039;d been using to build organs? Those had to be painstakingly coaxed to grow, like pulling an old professional out of retirement. This made them incredibly stable, but also very slow in dividing and replicating. It would take months or years to build some organs. Some cells seemed nearly impossible to grow outside the body, and others were simply too dangerous to find and extract from a living patient. Atala knew embryonic stem cells were too unstable to introduce into a child&amp;#039;s body. And even if he could build an infant a stable new liver or heart valve out of embryonic stem cells, if it didn&amp;#039;t match the newborn&amp;#039;s genetic makeup, Atala would be sentencing the child to a lifetime of harsh immunosuppressants. That might be a fair trade-off for a sixty-year-old getting a lifesaving lung transplant, but not for a newborn. He wondered if there might be another source of stem cells that were more stable than embryonic, but also more personal to each patient, so there would be no rejection issues. Atala believes that good ideas come only from insurmountable challenges. He buries them in the back of his head like memories he can&amp;#039;t forget. Every few days or weeks he pulls them to the front of his mind, rotates them, then shoves them back. &amp;quot;You revisit that challenge over and over again to see how to get around it. You revisit it and finally things happen where you actually see something or you hear something that triggers a thought.&amp;quot; He and his team started with skin, which is full of fibroblast cells, some of the most primitive in the body. But the stem cells they derived weren&amp;#039;t flexible enough. They dug further. Atala was working at a maternity clinic. They tried discarded foreskin. Still not right. Back in his office, Atala picked up the smooth kidney-shaped rock, which he had kept with him since that day on the beach. He rolled it in his hand, felt the raised seam, and considered for the thousandth time an alternative source of stem cells.  In Paolo de Coppi&amp;#039;s dreams, all the children are born with missing aortas and tracheas and lungs, and he saves them. He builds these babies new organs while they&amp;#039;re still slumbering away safely in their mothers&amp;#039; wombs, and then once they are born, when their broken hearts and lungs are about to give way to the burden of life on the outside, De Coppi opens up their tiny chests and sews in the new organs he&amp;#039;s built, and saves them. He wants to learn how to do this, and so he leaves Padua, Italy, in 2000 and goes to work for Atala. In Atala&amp;#039;s lab at Harvard, animals are impregnated and De Coppi treats them as he would a human carrying a malformed child. The fetus grows, De Coppi waits, and about two thirds of the way through gestation he performs an amniocentesis, as he would on a human patient to test for an abnormality. A few weeks later De Coppi returns. A needle is inserted into the womb once again. But this time the tip ventures all the way through the amniotic fluid to the growing fetus itself, where it removes a small biopsy of healthy stem cells from which De Coppi hopes to build a new organ. The needle comes back out of the womb, De Coppi gets his cell sample, but many of the animals die. They cannot survive the miracle procedure. Non potevo mai fare questo su un umano, he says to himself. I could never do this on a human. It is a failure. Without the cells, De Coppi cannot build his miniature organs and save the malformed children. And he has an aversion to embryonic stem cells. There is the clinical issue. Embryonic stem cells, still unproven, are far from safe enough to implant into babies that are just days old. But he also has moral objections. De Coppi, a Roman Catholic, cannot get past the idea that to harness the life an embryonic stem cell might provide, another potential life must be sacrificed. He believes in the promise and scientific good that embryonic stem cells could bring, but no, he won&amp;#039;t use them. He stops performing his animal experiments, he starts probing for another way to build his organs. One afternoon, De Coppi vents to Atala about the experiments and the dead animals. It becomes a brainstorming session that becomes an idea. De Coppi&amp;#039;s not sure if it would work, probably wouldn&amp;#039;t. But maybe... He asks Atala if they could try a new method for finding stem cells in amniotic fluid. Atala&amp;#039;s answer is emphatic. He tells De Coppi to get into the lab immediately. It takes nearly ten years.  Can you imagine what it feels like to present your work during that time at stem-cell conferences and over and over again elicit the same response from colleagues: dour faces and shakes of the head? This can&amp;#039;t work, yes. But the more cynical see something else in the headshakes. This will get in the way of other work. Can you imagine what it feels like to get your paper sent back four times from the world&amp;#039;s most prestigious journal in the field, Nature Biotechnology, members of your team suspicious that it&amp;#039;s not the science holding the paper back but ideology? You&amp;#039;ve been through this before, papers and projects rejected or pushed aside for various reasons you can&amp;#039;t control. Don&amp;#039;t worry about the politics, you tell your team. Let the science speak for you. Because you know the science does work. You know that the stem cells you learned to retrieve and sort from the amniotic fluid that cushions a baby during pregnancy have many of the properties of embryonic stem cells. They can form all three major germ layers, which is the test for stem cells. They can become blood or muscle or liver cells. They can&amp;#039;t be used to create nerve cells, but they can be used to build organs, for babies still in the womb and for grown men alike. And here&amp;#039;s something else they don&amp;#039;t do: They don&amp;#039;t form tumors. If embryonic stem cells are infants, these new amniotic stem cells are kindergartners. They&amp;#039;ve had a few months to develop in the womb before being sloughed off by the fetus, so their personalities are starting to come out, whether they want to be pancreas cells or liver cells. While it might only take a week to coax embryonic stem cells into becoming liver cells, the process takes amniotic cells a month. But that&amp;#039;s because they&amp;#039;re stable. Rather than trying to force a stem cell to become a specific tissue type, you can now find one that is already leaning in that direction. And so can you imagine the feeling of satisfaction when that acceptance from the prestigious journal finally comes, and your team wakes up on January 8, 2007, to see the work on the front pages of newspapers across America? There&amp;#039;s vindication and pride and joy. But vindication and pride don&amp;#039;t fund science. In fact, they might actually kill it. In Washington, D. C., where a bill to overturn President Bush&amp;#039;s six-year-old ban on funding embryonic-stem-cell research is set for a vote in three days, there are heated and hurried meetings, because Democrats in the House and Senate finally have the votes to pass this law, but now this... the Republicans see a way to kill it. And Atala has unwittingly provided it. Here&amp;#039;s Representative Joe Pitts, at a Republican press conference: &amp;quot;All of you from Newsweek,The Washington Post, all across the board made it very clear that [Atala&amp;#039;s findings] could change the entire debate because amniotic stem cells are pluripotent....&amp;quot; Here&amp;#039;s John Boehner, then the Republican House minority leader: &amp;quot;The breakthrough... appears to confirm that the full potential of stem-cell research can be realized without the destruction of living human embryos.&amp;quot; A letter must be drafted, Atala was told by the Juvenile Diabetes Research Foundation, which for years had funded various projects at his lab. The embryonic-stem-cell community had come too far in the fight to have it all derailed now. And so they wanted a letter from Atala stating that he still saw the need for embryonic-stem-cell research. And because he is a scientist, he believed this to be true. So he drafted the letter. But can you imagine what it feels like when your letter is read before the cameras and reporters, when the Democratic senators and congressmen wield your words just like the Republicans? &amp;quot;Even Dr. Atala, the author of the study, says it is essential that the National Institutes of Health\u2013funded researchers are able to fully pursue embryonic-stem-cell research....&amp;quot; &amp;quot;I do want to reiterate the importance of the letter from Dr. Atala....&amp;quot; &amp;quot;As Dr. Atala himself has said, this is no substitute for embryonic-stem-cell research....&amp;quot; Nobody told him the letter would be made public. Nobody said it would be purposefully leaked, drawing his work from the comfortable sidelines to the eye of the political storm. &amp;quot;I was shocked,&amp;quot; he says now. Then he corrects himself: I was surprised. &amp;quot;I was disappointed that this work was going to be embroiled in a political debate. This was a scientific piece of work. Not a political piece of work. &amp;quot;I realized at that moment, it was unfortunate that the political climate was such that science couldn&amp;#039;t just go forward for what it was.&amp;quot; Three months later \u2014 three months after the Democratic-led Congress passed a bill overturning the federal restrictions on embryonic-stem-cell research, which President Bush will once again veto \u2014 another bill began working through both houses of Congress. And it&amp;#039;s a law based upon his work. Since publishing his paper, Atala had been telling scientists and reporters and congressmen alike about his dream of a public amniotic-stem-cell bank. If the bank had just a hundred thousand distinct specimens, it would have all the material needed to build organs that were perfect genetic matches for 90 percent of the population. Atala did not believe that an amniotic-stem-cell bank would eliminate the need for embryonic stem cells, or a future embryonic-stem-cell bank. But the technology was ready and safe, and he believed it was time to start treating patients. The bill, which was sponsored by an alliance of pro-life Democrats and Republicans, would lay the groundwork for an amniotic-stem-cell bank. It passed the Senate in April with seventy votes. But a House version of the bill, the National Amniotic and Placental Stem Cell Bank of 2007, stalled and stalled and stalled, and would never come up for a vote. Months later Atala was called to the Hill to testify on some other, unrelated issue. He&amp;#039;s asked to do this from time to time. He ran into the chief of staff for one of the bill&amp;#039;s cosponsors, who told him what had happened: Nancy Pelosi wouldn&amp;#039;t let it come to the floor for a vote because it would get in the way of the Democrats&amp;#039; own push for embryonic-stem-cell funding. The Democratic leadership&amp;#039;s view of stem cells was zero sum: Until embryonic stem cells are funded, no other stem cells would be funded. The bill, the public bank, was dead.  Describing his arrogant former student Robert Oppenheimer, who went on to create the atomic bomb, Max Born wrote, &amp;quot;I have never suffered as much with anybody as with him.&amp;quot; Steve Jobs, bless his asshole soul, built that shiny piece of glass and metal in your pocket by making his employees cry. It&amp;#039;s unclear which of James Watson&amp;#039;s crimes is worse: believing the Anglo-Saxon mind is superior to the African mind or proudly telling people that. The New Yorker said it in the very first line of its profile on Craig Venter: &amp;quot;Craig Venter is an asshole.&amp;quot; And they were right. The road to the twenty-first century was bulldozed by assholes. Anthony Atala is a nice man. He is preternaturally patient. He rushes himself, but not others. Every phone conversation begins the same way, whether he&amp;#039;s talking to someone from DARPA or an NIH official or an old acquaintance. How are you doing? He says it in a way that makes it seem like he truly wants to know. Really. That&amp;#039;s great, that&amp;#039;s just great. When a friend is underdressed for dinner \u2014 wearing sneakers rather than dress shoes \u2014 Atala changes into sneakers, too. Visitors from out of town get tours of Old Salem and the historic Moravian bakery. &amp;quot;You have to try the sugar bread,&amp;quot; says Atala. &amp;quot;It&amp;#039;s a real local specialty.&amp;quot; Then, if time allows, Wake Forest. Eleven P.M. and he&amp;#039;s walking the grass quad, pointing out his favorite architectural features, half-moon windows floating in the night. Or look at him on a January evening in Winston-Salem. Atala operated early this morning on a little boy suffering from a torsion who came to the hospital dressed as Woody from Toy Story, miniature cowboy boots, miniature cowboy hat. Then a full day at the lab, a rushed lunch meeting, an interview with a potential new hire, a call about a research grant from the Navy, another meeting, another phone call, another meeting... then he gunned it home to pick up his son around 7:00 P.M., and now he stands in a tan Boy Scout leader shirt and green hiking pants in the rec room of a Catholic church. His BlackBerry and beeper are looped through his belt, accessories of a different life, a little stiff in the room full of teenaged boys and after-work fathers. A few weeks earlier the scout leader of his son&amp;#039;s troop asked Atala if he would teach the merit badge for citizenship. He&amp;#039;d be responsible for four sessions, an introductory class, a visit to the state legislature, a volunteer project, and last, a visit by a local official or two to answer questions about citizenship and laws. Of course Atala would do it! But not just anyone can teach a merit badge. He had to be certified first. He spent last week reading the Boy Scout manual cover to cover, then got up at 8:00 A.M. on Saturday to take a six-hour scouting class. Sunday was spent putting together the fifteen or so slides of his citizenship PowerPoint presentation. He stands tall and beanlike in front of three dozen teenagers. &amp;quot;What are your obligations to the community?&amp;quot; he asks in the same calm, kind tone he used this morning when explaining to Woody&amp;#039;s parents how to treat the stitches on his abdomen. Silence in return. He answers the questions himself and pushes along. There&amp;#039;s a flowchart of the city government. A detailed map of Winston-Salem. &amp;quot;Where is the hospital?&amp;quot; asks Atala. &amp;quot;Where is city hall?&amp;quot; More silence and grumbles. The boys are staring away or playing with phones or writing notes. &amp;quot;What are the rights of citizenship?&amp;quot; &amp;quot;The right to bear arms!&amp;quot; yells one of the teens. And that&amp;#039;s it \u2014 the room erupts in cackles, shouts, and laughter. Atala continues, but it&amp;#039;s not going so well. With each question, the boys only grow louder, more obnoxious, and the room is slipping out of control. Now a firm clap of his hands. &amp;quot;Everyone quiet down and listen,&amp;quot; he says, but even Atala&amp;#039;s raised voice just doesn&amp;#039;t resonate much. He&amp;#039;s moving through the slides faster now, stops with the jokes, racing the clock to get done. He assumes they will eventually realize that the laughing and shouting will only slow the talk down. But he&amp;#039;s no match for teenage testosterone. And just when it&amp;#039;s become pretty clear that one&amp;#039;s civic duty is to savage the nice guy in the scout uniform trying in vain to conduct a seminar on civic duty, the booming voice of a thousand grounded weekends explodes from another father in back. &amp;quot;Everyone shut up. Listen to Dr. Atala!!!&amp;quot; And the boys quiet down immediately. Atala says there are two ways of doing science today. There are the brash, aggressive scientists who rush to press conferences and rush to publication. And then there&amp;#039;s the other way. &amp;quot;Everything we&amp;#039;ve done, if you look at patients that had bladders put in... we had up to an eight-year follow-up before anyone ever heard anything about it. And we certainly did the same thing with the amniotic cells. We worked on them for ten years before we published the work.&amp;quot; Later this year he&amp;#039;ll publish a paper on a new organ that has succeeded through years of clinical trials. It will likely make news around the world when it comes out. But for now, he&amp;#039;s silent. &amp;quot;It&amp;#039;s not about, you know, all the other stuff,&amp;quot; he says. That&amp;#039;s how he describes politics and hype \u2014 all that other stuff. &amp;quot;We want to get these into patients. The best way to get these into patients is to do it carefully, judiciously, and responsibly. And to be able to make sure that long term we can get there.&amp;quot; Anthony Atala is not an asshole. But you can&amp;#039;t help but wonder what might have happened during the past fifteen years on Capitol Hill if he were. It&amp;#039;s been six years since the bill to fund Atala&amp;#039;s bank was killed on Capitol Hill. In that time many believed Atala&amp;#039;s amniotic stem cells would be proven outdated relics from an earlier scientific age. First because by unlocking federal coffers, the true power of embryonic stem cells would finally be realized and eclipse what Atala&amp;#039;s stem cells were capable of. And later by the promise of new, even more sophisticated iterations of embryonic stem cells. Soon after Atala&amp;#039;s paper was published in 2007, the scientific world was upended by the discovery in Japan of &amp;quot;induced pluripotent&amp;quot; stem cells, or iPS cells. By adding four genes to an adult skin cell, a scientist managed to trick them into turning back into embryonic stem cells, Benjamin Buttoning them in an instant. In theory, iPS cells could be derived from patients, so there would be no issues with rejection. And because they appeared to be identical to embryonic stem cells, they could potentially be used in more applications than could amniotic stem cells. But time passes. Excitement must be tempered, tested, challenged. Like embryonic stem cells, iPS cells are inclined to form tumors, raising similar barriers to clinical applications. And while they appear to be genetic copies of the cells from which they&amp;#039;re derived, they may not always be treated that way by the body. In 2011, a scientist at the University of California, San Diego, injected both embryonic and iPS cells into mice. Both sets of stem cells were genetically identical to the mice, and yet inexplicably only the iPS cells were rejected. Recent research has somewhat tempered these immunological concerns. But it remains far from certain whether the roguish tendencies of iPS cells can in fact be tamed for clinical use. Many scientists still believe that iPS cells are the future, especially when it comes to treating disease. For instance, Dr. George Daley, at Boston Children&amp;#039;s Hospital, created iPS-cell lines from people suffering from Parkinson&amp;#039;s, Huntington&amp;#039;s, and other genetic ailments. He watches these &amp;quot;diseases in a dish&amp;quot; develop and tests the effectiveness and toxicity of different drugs and antibodies against them, a method some big-pharma companies are now trying. So you can blame the federal government for never putting financial support behind embryonic-stem-cell research. Or private industry for stifling progress by locking up advances and stem-cell lines with patents. Or the FDA for making the rules for bringing a stem-cell treatment to market too prohibitive. Or maybe you can simply concede that mastering the biology of getting embryonic stem cells to do what you want without forming tumors was much harder than expected. Regardless, one thing is becoming clear a decade and a half after their discovery: The miraculous promise of stem cells may come true yet.  He&amp;#039;s looking for lab space. Through the secured door, through the &amp;quot;dirty&amp;quot; room in which you must take off your shoes and cover your clothes in a gown, through the next doorway, through which clean, pressurized air pushes out to ensure that dirty, outside air doesn&amp;#039;t push in, will sit a cluster of chest-high nitrogen tanks. One day they will be full. In the years after his stem-cell bill was killed, Atala occasionally asked his local congressman if it might be time to reintroduce an amniotic-stem-cell-bank bill, but it was never a good time. The Democrats had other, bigger priorities, he was told. Wait until we finally overturn the federal restrictions on embryonic-research funding. Wait until we pass health care. Wait. If the government wouldn&amp;#039;t help, then his next option was private funders. He&amp;#039;s had dozens of inquiries through the years from companies looking to corner the market on amniotic stem cells with a private bank. Can you imagine how much a private bank might charge for the stem cells you need for a new kidney? Atala could, so he refused. In 2008 Atala gave a talk to the Juvenile Diabetes Research Foundation gala in Boston. He talked about his work building organs. He had recently refined a method for extracting stem cells from placentas rather than amniotic fluid. Using placentas, which are typically discarded at birth, is far safer and cheaper than performing an amniocentesis on a mother. At the end of his talk, an older man approached him. The man said, &amp;quot;I&amp;#039;d like to see what I can do to help you.&amp;quot; One afternoon during his fellowship at Harvard, the nurses in his department offered him an old laser they were going to throw away. He didn&amp;#039;t have any real use for it but figured he would take it anyway and see what he could do with it. He took it up to his office and spent an entire night zapping mouse bladders with the laser to see how they would scar. He&amp;#039;d zap one for five seconds. Then he&amp;#039;d do the next one for ten seconds, and so forth. He worked well into the early-morning hours, went home for a rest, then went back to his lab the next day to see how the bladders had scarred. They hadn&amp;#039;t. They were all completely healed. Atala was shocked. This made no sense. Months later he was back in the lab, but this time he was working with human bladder cells. It was widely accepted that bladder stem cells couldn&amp;#039;t multiply outside the body, but Atala had read about a scientist who had had success doing it. And so he followed the scientist&amp;#039;s protocol exactly. He gently cut up the bladder with a scalpel and soaked the cells in solvents, hoping that the right combination of nutrients and prodding might coax them to grow. And they did multiply and grow for a couple days outside the body, but then they would always die. Atala called the scientist. He told him that he was doing everything exactly as his journal article instructed, but the cells always died. &amp;quot;Well, of course,&amp;quot; replied the scientist. &amp;quot;Mine die after a couple days, too. Bladder cells can&amp;#039;t survive outside of the body.&amp;quot; A few months later, he would test out a new hypothesis: Perhaps the reason the zapped mouse bladders healed is that the laser had reached stem cells that were burrowed deep inside the tissue, farther than anyone had thought to look. Bingo. The bladder stem cells became the basis for Atala&amp;#039;s first engineered organ. Atala likes to tell the story because it shows the power of serendipity in his work. He would never have known where to look for the adult stem cells if he hadn&amp;#039;t been messing around with that discarded laser. But the story also illustrates something else about Atala: He believes in his own intuition and abilities far more than he believes in established dogma. And so when his Amnion Stem Cell Foundation launches next year, it will not be government-run or taxpayer-supported. It will not be beholden to a university or a corporation. It will be a nonprofit. Dr. Mahendra Rao, director of the NIH Center for Regenerative Medicine, says that what sets Atala apart is his industriousness. &amp;quot;He&amp;#039;s said, Well, if I can&amp;#039;t find a company partner, then I need to be able to do it in-house. If I can&amp;#039;t get somebody to manufacture it, then I&amp;#039;m going to figure out how to get that manufactured. And then I&amp;#039;m going to make sure that if I need to license it, then I&amp;#039;ll find a way to commercialize it. That takes a lot of expertise in a lot of different disciplines.... Nobody has tried to put it all together from start to finish like Dr. Atala has.&amp;quot; This is Atala&amp;#039;s solution for building his bank: He is going straight to the people. The gift from the gentleman who approached him, an anonymous donor, is enough to keep the fund running for the next five years, and the rest of the money he will raise. Once the nonprofit bank officially launches, he&amp;#039;ll take whatever donations he can, one dollar, ten dollars, $10 million. It costs $5,000 to process each placenta into a stem-cell line, so he needs at least $500 million to process the one hundred thousand it will take to provide perfect matches of each organ-tissue type for 90 percent of the population. Then another estimated $500 million to keep the bank running in perpetuity. One billion dollars. An impossible number. But it could mean an end to dialysis for 400,000 Americans every year, a savings of $20 billion annually. It could mean that the list of 115,000 Americans waiting for organ donations would slowly shrink away to zero. It could mean a wholesale change in how we treat disease in America. It could mean that a major part of the promise of stem cells would finally be realized. Atala does not believe the amniotic-stem-cell bank will eliminate our need for embryonic stem cells or bring an end to the greater stem-cell debate. He&amp;#039;s stem-cell agnostic. He doesn&amp;#039;t care what kind of stem cells he uses to build his organs, as long as they&amp;#039;re safe. That itself is a new development in the stem-cell battle. There&amp;#039;s no longer a zero-sum game, embryonic stem cells versus amniotic stem cells versus iPS cells. Scientists have realized that, as Rao says, there&amp;#039;s no perfect stem cell. &amp;quot;Really the right cell for the right job.&amp;quot; So we need to develop them all. Dr. Tom Okarma, the former CEO of Geron, now CEO of a biotech company called BioTime Acquisition, is purchasing back all of Geron&amp;#039;s stem-cell assets \u2014 the embryonic-stem-cell lines, the equipment, the research. He&amp;#039;s getting his old team back together. He believes that with a better economy and advances in deriving highly purified stem cells, he can finish the work he started at Geron a decade ago. They haven&amp;#039;t published anything yet, but he says the results from that first canceled trial are in. It was safe. No tumors. Slowly, incrementally, cautiously, more trials are being outlined and planned, and everyone in the field is holding his breath that one wrong move \u2014 one patient who gets a tumor \u2014 won&amp;#039;t doom the whole endeavor. Meanwhile, last December, ACT announced that it was filing paperwork with the FDA in hopes of conducting the first American clinical trial using iPS cells. Two months later, in February, Masayo Takahashi, at the Center for Developmental Biology in Kobe, sought approval for the first iPS trial in Japan, which should begin this year and conclude by 2014 if approved. Shinya Yamanaka, the Japanese scientist who won the 2012 Nobel Prize for discovering iPS cells, has laid the groundwork for a Japanese-government-sponsored iPS-cell bank that could be used for therapy. Atala will wait for the science to come in. He&amp;#039;ll wait for the proof and data. The stem-cell field is one that has always been powered by bold words and impossible expectations. And just as often, a promising discovery one year is irrefutably undermined the next. Or, as Okarma says, &amp;quot;the jury on iPS stem cells is still way out.&amp;quot; If embryonic or iPS cells can pass all the safety tests and prove themselves better and more dependable for building organs, Atala will use them. &amp;quot;But these things take decades to sort out,&amp;quot; he says. &amp;quot;And in the meantime you have decades of patients that you can benefit.&amp;quot; He is a builder, an engineer. And in essence, the amniotic stem cells themselves are just a side project, a means to an end. He couldn&amp;#039;t get the reliable building materials he needed, so, like a dedicated contractor, he found a new source. He&amp;#039;s published papers showing the therapeutic value of amniotic stem cells in treating kidney, lung, and intestinal damage. And so Atala will begin building his bank today. He knows the number he needs to fundraise is impossible. But he also knew it was impossible to grow human bladder cells out of the body. And he knew it was impossible to build a bladder. And it was impossible to make a heart, and a urethra, and a liver. It was impossible to find a new source of stem cells. Anthony Atala knows everything was impossible, until it wasn&amp;#039;t. "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.esquire.com/news-politics/a20599/stem-cells-research-politics-0413/>