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Health

Elazer R. Edelman, cardiovascular engineer at the MIT

"The dumbest cell is cleverer than the cleverest of scientists"

Elazer R. Edelman is a unique case, something similar to a heart electrician and its circulatory network. A physicist, engineer and biologist who also cures cardiovascular patients. Tied to the Massachusetts Institute of Technology (MIT) and Harvard University, he is considered a world authority in bioelectric engineering.

JORDI MONTANER | 2 june 2009

You practice as a cardiovascular “electrician”, but I can’t imagine you whistling in front of a seriously ill patient, dressed in blue overalls, a pencil on the ear and a wrench in the hand.
I visit my patients at the ICU, with a perceptive team of my hospital but with a double formation and a certain capability to pick out the physical, chemical or even mathematical causes of the problem that I have to solve. Under this perspective, the range of answers increases.

"Still many years will pass before prosthesis becomes history"
Elazer R. Edelman

And the patient improves?
Prosthesis [stents] have saved more lives than any other medical invention. The hydraulic reasoning’s gain much more substance when we refer to the cardiovascular system and its anomalies, as blood vessels have a life of their own. The endothelium, in a manner of speaking, acts as the “brain” of a system that reacts in response to different physical and biochemical stimuli.

Is it hard to face an “intelligent” disease?
We have advanced extraordinarily in the last twenty years, but we still have a long stretch to decipher. One professor I had told me on one occasion that the silliest endothelial cell is cleverer than the cleverest of scientists, be it biologists, medics or engineers.

Working as an intensive cardiologist at the ICU, supervising laboratory research, teaching and giving lectures in different scientific meetings in and out of the country, it is hard to believe you have time to invent prosthesis…

Time also has to be administered efficiently. I take time, even to train a local ice hockey team, the Brookline Bantam B Team, and live closely together with my wife and three children. My mind is used to think and act efficiently at the same time; it is an automatic process, similar to when one drives or talks on the phone with a computer screen in front without dropping any tasks. Having done various degrees has reinforced this ability.

How do you do it?

At the same time that I talk to my patients and verify their state of health, my brain is trained to process clinical data and interpret processes of digital signalling, hydrodynamic operations, the chemical behaviour of polymers, cellular and molecular mechanisms, and a whole range of reactions that show the most visible from the invisible: an accelerated atherosclerosis, an unstable coronary arteriopathy or an imminent infarct.

Engineering is the application of science and mathematics to the study of material and nature’s energy sourcesYour latest research focuses on the possibility of implanting modified cells via genetic engineering in the vascular area in order to regulate inflammatory and proliferative responses.

Occasionally, luck (serendipity) helps us. In these transplants of cells to the endothelial we use from experimental models, in our lab, materials from different animals.
The vets that look after these animals warned us one day of the risk of chimerism or rejection that underlies in all xenotransplants [the transplantation of cells between different species]. We had already carried out various experiments and we never had anything similar occurring. Like this, we discovered, by chance, that endothelial cells possibly have the ability to inhibit the immune response of the rejection and hence, we initiated a new research line.

What makes an engineer become interested in peoples’s hearts?

Engineering is just the mere application of science and mathematics in the study of the properties of the materials and nature’s source of energy, with the aim to obtain a benefit for people.

The infusion of genetic engineered products in the bloodstream might allow us one day to dispense of surgery and prosthesis.

One is advancing in this sense, but still many years will pass before prosthesis becomes history. The induction of angiogenesis [spontaneous generation of new blood vessels], for example, promises important advances in the cardiovascular field and oncology, but we should not lose site of the fact that for each finding that we apply we always pay the price for an unexpected surprise, an unforeseen response, and therefore we have to be cautious.

Therefore, long live stents…

Even with stents the dilated vessels close again after reperfusion; it is nothing more than the reaction of the endothelial substrate to a non physiological action, imposed from the outside… We still have to learn the complex relaxing and proliferative mechanisms of the endothelial, its intimate language, to be capable of acting in the same way.

It is also said that the endothelial is intelligent. Do you share that idea?

The endothelia is not only intelligent, it is a very sensible and bioreactive organ; it produces various factors, it liberates constrictive vessel substances or vessel diluters to the blood vessels and it has a control that is very difficult to reproduce artificially.

And then there are also mechanical forces.
Especially the shear stress, above all in the most curvaceous parts of the vascular architecture. Risk factors such as diabetes, smoking, hypercholesterol or arterial hypertension interact in a synergetic way, adding negative efforts, so that the vascular equilibrium is lost and the triggered alterations arrive to checkmate the survival of the individual.

The biomecanical surrounding of proliferation

You say you feel at home in Barcelona…

The Chemical Institute of Sarria has collaborated for more than 10 years with MIT. The chemical engineers of this centre have participated in many research work conclusions about the biosphere and the biochemistry of the vascular cellular tissue.

What is your team working on now?

We are researching the impact of the biomechanics surrounding the cellular proliferation and the metabolic activity; we analyse several regulation patterns of the proliferation of adhesive endothelial molecules.

Have you reached any conclusion?

The main one is that the blood flow determines the expression of a gene, baptized with the initials KLF4, which is present in different vascular paths, orchestrating the behaviour of the flat muscular cells and the endothelial ability to respond to injuries or variations of the flow.

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