The WHO has released a comprehensive report on the emerging technologies and scientific innovations that will improve global health.

Its “horizon scan” found the five most promising innovations were:

• genomics for early diagnosis and pre-diagnosis of disease
• more effective systems of vaccine production and distribution
• cost–effective point-of-care diagnostics for HIV and hepatitis B virus load testing
• broad-spectrum antimicrobial drugs that do not cause resistance or tolerance, and
• rapid remote diagnostics including smart implants, protheses and wearable sensors.

Stem cell technology also ranked highly across multiple domains such as tissue engineering and regenerative medicine; molecular biology, cell, immune and gene therapy; and organ care technology and bioprinting.

Among the international group of experts contributing to the report was Scientia Associate Professor Kristopher Kilian who holds a joint position across the Schools of Chemistry and Materials Science & Engineering at UNSW Sydney. He is also Co-Director of the Australian Centre for NanoMedicine.

The limbic spoke to Associate Professor Kilian about his research, his contribution to the WHO report [link here], and the value of such an exercise.

Scientia Associate Professor Kristopher Kilian

Tell me about your research and being involved in the WHO report

I’m very interdisciplinary and I think maybe one of the reasons I was approached is that my research really spans the physical and biological sciences. I worked in the DNA microarray business when I first started in the late 90s before going back to get a PhD where I developed a lot of point-of-care sensors and new devices for biotechnology. And then I got totally intrigued by the world with stem cells so I did a bit of a pivot. My research started focusing more on how stem cells choose to differentiate based on what’s in their local environment.. And so, at the heart of my lab, we’re really just absolutely intrigued with how cells make decisions…. what is it about signals that are close by that gets a stem cell to decide to turn into bone versus muscle?

In biology you’re always thinking about proteins, growth factors, metabolites, and those signals, but in reality your cells are influenced by things like the stiffness, the viscous properties of the tissue, the pressure, forces, dynamics and gravity. So the overarching goal of the laboratory is to use the techniques of materials chemistry to build model systems where we can understand how these things influence stem cells. And then we’ll ask how do the mechanical properties of the microenvironment influence their decision making. When we’re exploring these fundamental biological questions, oftentimes new materials or assays emerge that could be quite useful for another field called tissue engineering. I don’t think of myself as a conventional tissue engineer but if we can stumble upon a material that would make stem cells form functional heart tissue, then why not try to use it in a clinical trial to help patients?

Where do you see stem cells having their biggest impact?

I think there’s a few different types of stem cell technology that will be of high impact in the next decade. One of them is capitalising on their native therapeutic property to be able to essentially work as little growth factor delivery vehicles. There’s a number of clinical trials going on exploring how they may be useful for eliciting a favourable healing response in wound healing, as well as modulating the immune system. In general wound healing, treatment of things like diabetic foot ulcers. After COVID there was a number of explorations using stem cell derived products and cells directly for treatment of things like acute respiratory distress syndrome. There’s a whole range of conditions where stem cells may be able to provide a therapeutic impact. Graft versus host disease. Cardiovascular diseases. Peripheral ischaemia.

Some of the other areas where stem cells have roles in the future…are for personalised medicine. We’ve recognised now that taking stem cells from a patient and building an entire organ is very difficult; we are decades away from being able to do that reproducibly in my opinion. But along that journey, what we’ve recognised is that we can make little mini organs quite easily. And so the real promise of this is in the area of precision medicine and personalised therapeutics. So if I could take a skin sample from a patient, and I can take let’s say a tumour biopsy from the same patient, I can regrow their tumour in the laboratory, and then from their blood or skin sample I could form stem cells and make a mini liver and a mini heart. So if you want to test out cancer therapeutics, you can also look at cardiac and liver toxicity in the same experiment. This has become so exciting because it’s just absolutely apparent that the animal models don’t work as well as we’d hoped… their physiology just doesn’t reflect how human physiology is.

The report says stem cell technology can be combined with gene editing. Your thoughts?

This is really the emerging Holy Grail …the idea being that not only can you isolate stem cells from a patient, and perhaps engineer them to replace damaged or diseased tissue, but with the advent of CRISPR/Cas9 gene editing and all these related technologies, we now have the ability to correct a mutation in those cells directly. So if we take out some of these mutations of the genes within the stem cells, and then use them for therapy, then you’re killing two birds with one stone – you’re able to replace the damaged tissue but also correct the genetic mutation that may be causing unwanted problems. I suggested we’ve got a little over a decade before we’re going to be using CRISPR-modified stem cells for replacing tissue.

And then there’s bioprinting…?

I think that 3D printing in the biofabrication space is a new tool that’s here today. I see it more as an enabling complementary tool to go alongside a lot of the stem cell work because with the ability to have high resolution printing of complex matrices and cells in well defined architectures, this is going to allow us to get closer to this vision of rebuilding organs and tissues. Every week we’re seeing high profile papers coming out with these new bioprinting techniques. And we’re only now starting to integrate them with the advanced biological tools. And so I think over the next decade, we’re going to see many examples of the complementarity of these things, both stem cell engineering and 3D biofabrication. Ultimately, I think it’s what’s going to allow us to actually make the full size tissue engineered grafts for regenerative medicine.

In your opinion, how valuable is a report like this? What’s its purpose?

I was actually really excited to be involved, because I think, oftentimes, the pace of innovation and the direction of innovation doesn’t match up with what’s going on in the trenches. From my perspective, having a coherent, cohesive document from an organisation like WHO provides a good template for policy – for governments to really keep an eye on what’s coming, what’s going to have the biggest impact, and how quickly it’s going to have an impact. It also makes sure that we have the ethical and legislative frameworks in place to maximise the potential of these technologies. In addition, I think funding is equally important – ensuring that both the public and the funding bodies are up to speed on where things are going on these important topics. We want to make sure that those are aligned with what is the most promising research avenues that are going to have a real impact on health.