Re-engineering Your Body

Inside and out, we expect perfection. Now, technology is providing the tools.

Repair or Replace

A new era in medicine is dawning. And it's just in time for a culture that worships youth and beauty, that has witnessed a parade of scientific and technological triumphs, and that believes in the American Dream, with its endless opportunities for self-renewal. We don't just hope to stay young and vital, healthy and happy, forever -- we expect it. What is surprising is how far medical science has come toward meeting those expectations. Now there are treatments to repair or replace tissues and organs, therapies that compensate for defective genes, devices that stand in for failing body parts, and treatments to keep us thin and wrinkle-free.

Rebuilding the heart. The motto of this new era might be "Repair it if you can. Replace it if you can't." Ron Trachtenberg, now 59, of Stoneham, Massachusetts, needed some repairs. At 34, he was a self-described Type A person with a young family and a burgeoning accounting practice, when he was diagnosed with severe coronary artery disease. By 46, after a quadruple bypass operation, a heart attack and a second bypass, his poor health had forced him to sell his business. For years afterward, he mostly stayed home, where his wife and two adult children helped care for him. He experienced the severe chest pain of angina as often as three times a day. "It felt like an eight-ton elephant," he says.

Trachtenberg's cardiologist referred him to Douglas Losordo, MD, chief of cardiovascular research at Caritas St. Elizabeth's Medical Center in Boston. Losordo had begun a clinical trial testing an experimental stem-cell therapy on terminal heart disease patients. (Enrollment is now complete.) Although it's a blind, placebo-controlled study and no one can yet confirm that Trachtenberg received the treatment, it's most likely that in February 2004, he was given a drug to spur production of stem cells in his bone marrow. Then those stem cells were harvested from Trachtenberg's blood. Losordo snaked a catheter through an artery into Trach-tenberg's heart, injecting his stem cells into a part of his heart muscle that survived but would not contract. Today, Trachtenberg's heart is pumping better than it has in at least a decade. In the past year, he's had just three severe angina episodes. He walks half a mile a day, and he flew to Florida with his wife on vacation -- his first flight in ten years. "I'm a father and a husband again," he says.

He's also lucky. Heart attacks leave patients with a dead region of heart muscle, and current medications succeed only in keeping neighboring areas of heart muscle alive. The stem-cell treatment Trachtenberg received was designed to get surviving but noncontracting heart muscle back into action. Other patients in Losordo's clinical trial -- a 24-person test to make sure the treatment is safe -- are feeling better too. Clinical trials in Germany showed that stem-cell therapy restores some of the heart's lost pumping capacity in severely ill cardiac patients. But it won't be available in most cardiac units until doctors conduct a large trial that convinces the FDA it's effective.

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