Book Review

Future Strategies for Tissue and Organ Replacement. J. M. Polak, L. L. Hench, P. Kemp (Eds). London, UK: Imperial College Press, 2002: 419 pp. Once upon a time biologists, engineers and material scientists spoke the same language. But after thinking they could rival the heavens, their language was confounded so that they did not understand one another and they were scattered around the world. Thus in 2002 it was necessary to create books such as ‘Future Strategies for Tissue and Organ Replacement' so that we can understand what each has to offer regarding the problems of tissue engineering and regenerative medicine. Developmental biologists pioneering the use of stem cells, transplant immunologists inducing tolerance and material scientists creating scaffolds, among others, are focusing on addressing the donor organ shortage or making nerves regenerate. They are preparing skin substitutes and new treatments for diabetes or musculoskeletal disorders. There is much excitement and much hype in this area and this book takes a serious and critical look at what is possible and what must be carried out in order to make these possibilities come to fruition. Some chapters are excellent. The chapters ‘Recent Developments in Skin Substitutes’, ‘Tissue Engineering in the Musculoskeletal System’, and ‘Engineering the Liver’ are excellent overviews of the state of the art in these areas. The concept of using developing kidneys to replace kidney function is introduced in another chapter in this section, which focuses on particular organs. A catalogue of what Tony Atala has performed in the genitourinary system is also included in this section. The lead editor has written a brief but very readable introduction to stem cells, making this a good place to start to learn about the variety of cell sources that may become available for tissue and organ replacement. Unfortunately there is only one chapter on materials (by the second listed editor) and it focuses on just one material (bioglass), so is of questionable value in this text (it is the opening chapter). Luckily, there is a good, although somewhat disjointed, overview of the field in the third chapter entitled ‘Tissue Engineering: Clinical Applications and Mechanical Control’; this chapter should have opened the book. Another overview chapter (placed near the end of the book) on the ‘Possible Production of Spare Parts Using Developmental Biology’ was more challenging, at least to this reader. In trying to give a realistic portrayal of what will be possible through exploitation of regenerative medicine, it served more to dampen enthusiasm for regenerative medicine. By explaining all the reasons why regenerative medicine will not work, it acted much like the postdoc who can prove in advance why any idea or experiment you suggest will not work. I try to rid my laboratory of such persons as soon as possible: a similar fate should befall this chapter. An overview of xenotransplantation, ‘Will Pigs Fly’, highlights the issues associated with these aspects of regenerative medicine. This chapter remained positive, albeit realistic throughout. The chapter on ‘Therapeutic Strategies for Xenotransplantation’ with its almost 200 references is an excellent guide to what has been attempted in this area. Combined with chapters on encapsulation and on gene modification, this section of the book, ‘Xenotransplantation’, is one of the strongest. I have no doubt that immunological issues are a serious limitation to regenerative medicine strategies, although I am not sure that the emphasis on xeno- to the complete exclusion of allo- is warranted. There are two chapters on low temperature preservation and on the safety of human tissues, and these are welcome additions because these topics are highly relevant and often overlooked. Not surprisingly, the chapter on safety covers only UK and European regulations but should be of interest to North American readers just the same. Many textbooks on tissue engineering and regenerative medicine will be published in the next few years. But as we rebuild the ancient ability to speak to each other, many small but useful edifices will be encountered along the way. This book is one such attempt.

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