Embed Size (px)
Citation preview
Kim Solez MD
Last year I described how nearly everyone went sightseeing to avoid regenerative medicine sessions at 2015 AST CEOT
This year CTRMS is a full partner with CST in upcoming Halifax meeting
The Pre-meeting for Banff 2019 in Pittsburgh will be devoted to Regenerative MedicineTissue Engineering Pathology No escape
A Year Makes Big Difference In 2017 Regenerative Medicine in Ascendancy
The Future and All That Jazz music and poetry initiative conveying important messages of science will be the main entertainment at the TERMIS-AM meeting in Charlotte NC with two hours of entertainment at the exhibit area on December 4th and three hours at the NASCAR Hall of Fame on December 5th
A Year Makes Big Difference In 2017 FAATJ is Main Entertainment for TERMIS
Aviv Regevrsquos Human Cell Atlas httpswwwhumancellatlasorg
characterization of all cells in human body by single cell analysis is both promoted and funded via social media (Chan Zuckerberg) If you are not on Facebook you know nothing about it and it will likely be bigger than the human genome project You will be caught napping Nothing about this at 2017 USCAP
In 2017 Human Cell Atlas Poised to Stealth Revolutionize Pathology and Regenerative Medicine via Facebook
Stem Cell Technologies on Google Trends ndash News Headlines and Forecast
Current transplant protocols reach fewer than 10 of those in need
Worldwide 12 million people are in need of transplantation for end stage organ failure Current transplant protocols reach fewer than 10 of this number Regenerative medicine can save the remaining 90 over one million people annually
Tissue engineered bladder
Regenerative Medicine Already Here Working for Tubular Organs Bladder Esophagus Vagina
ViaCyte Announces Highly Anticipated Encapsulation Clinical
Trial Site Expansion into Canada
JDRF-funded researcher Dr James Shapiro will be the lead investigator at the Canadian site TORONTO July 29 2015 -- ViaCyte Inc announced the opening of a second site in its Phase 12 trial for Type I Diabetes which utilizes PEC-01trade pancreatic progenitor cells and the proprietary Encaptrareg drug delivery system which is designed to protect the transplanted cells from a patientrsquos immune system
Regenerative Medicine Already Here Viacyte Trial for Diabetes Therapy
Double Think Stem Cells are Greatest Hope
and Greatest Hype Stem Cell Tourism
Estimated to be $3 Billion a Year Industry and
Growing with More than 700 Clinics Worldwide
Mason C et al Regen Med 2011 May6(3)265-72 doi 102217rme1128 Cell therapy industry billion dollar global business with unlimited potential
Timothy Caulfield - Stem Cell Tourism June 2015
httpswwwyoutubecomwatchv=B0r89nMtg10
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Regenerative Medicine Human Gene Editing Revisiting
Canadian Policy 2017
Science Confronting stem cell hype Professor Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Science Confronting stem cell hype Professor
Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
Stem cell hype Media portrayal of therapy translation MARCH 30 2015
Policy Options Athletes and unproven stem cell therapies JANUARY 01 2015
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Last year I described how nearly everyone went sightseeing to avoid regenerative medicine sessions at 2015 AST CEOT
This year CTRMS is a full partner with CST in upcoming Halifax meeting
The Pre-meeting for Banff 2019 in Pittsburgh will be devoted to Regenerative MedicineTissue Engineering Pathology No escape
A Year Makes Big Difference In 2017 Regenerative Medicine in Ascendancy
The Future and All That Jazz music and poetry initiative conveying important messages of science will be the main entertainment at the TERMIS-AM meeting in Charlotte NC with two hours of entertainment at the exhibit area on December 4th and three hours at the NASCAR Hall of Fame on December 5th
A Year Makes Big Difference In 2017 FAATJ is Main Entertainment for TERMIS
Aviv Regevrsquos Human Cell Atlas httpswwwhumancellatlasorg
characterization of all cells in human body by single cell analysis is both promoted and funded via social media (Chan Zuckerberg) If you are not on Facebook you know nothing about it and it will likely be bigger than the human genome project You will be caught napping Nothing about this at 2017 USCAP
In 2017 Human Cell Atlas Poised to Stealth Revolutionize Pathology and Regenerative Medicine via Facebook
Stem Cell Technologies on Google Trends ndash News Headlines and Forecast
Current transplant protocols reach fewer than 10 of those in need
Worldwide 12 million people are in need of transplantation for end stage organ failure Current transplant protocols reach fewer than 10 of this number Regenerative medicine can save the remaining 90 over one million people annually
Tissue engineered bladder
Regenerative Medicine Already Here Working for Tubular Organs Bladder Esophagus Vagina
ViaCyte Announces Highly Anticipated Encapsulation Clinical
Trial Site Expansion into Canada
JDRF-funded researcher Dr James Shapiro will be the lead investigator at the Canadian site TORONTO July 29 2015 -- ViaCyte Inc announced the opening of a second site in its Phase 12 trial for Type I Diabetes which utilizes PEC-01trade pancreatic progenitor cells and the proprietary Encaptrareg drug delivery system which is designed to protect the transplanted cells from a patientrsquos immune system
Regenerative Medicine Already Here Viacyte Trial for Diabetes Therapy
Double Think Stem Cells are Greatest Hope
and Greatest Hype Stem Cell Tourism
Estimated to be $3 Billion a Year Industry and
Growing with More than 700 Clinics Worldwide
Mason C et al Regen Med 2011 May6(3)265-72 doi 102217rme1128 Cell therapy industry billion dollar global business with unlimited potential
Timothy Caulfield - Stem Cell Tourism June 2015
httpswwwyoutubecomwatchv=B0r89nMtg10
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Regenerative Medicine Human Gene Editing Revisiting
Canadian Policy 2017
Science Confronting stem cell hype Professor Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Science Confronting stem cell hype Professor
Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
Stem cell hype Media portrayal of therapy translation MARCH 30 2015
Policy Options Athletes and unproven stem cell therapies JANUARY 01 2015
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
The Future and All That Jazz music and poetry initiative conveying important messages of science will be the main entertainment at the TERMIS-AM meeting in Charlotte NC with two hours of entertainment at the exhibit area on December 4th and three hours at the NASCAR Hall of Fame on December 5th
A Year Makes Big Difference In 2017 FAATJ is Main Entertainment for TERMIS
Aviv Regevrsquos Human Cell Atlas httpswwwhumancellatlasorg
characterization of all cells in human body by single cell analysis is both promoted and funded via social media (Chan Zuckerberg) If you are not on Facebook you know nothing about it and it will likely be bigger than the human genome project You will be caught napping Nothing about this at 2017 USCAP
In 2017 Human Cell Atlas Poised to Stealth Revolutionize Pathology and Regenerative Medicine via Facebook
Stem Cell Technologies on Google Trends ndash News Headlines and Forecast
Current transplant protocols reach fewer than 10 of those in need
Worldwide 12 million people are in need of transplantation for end stage organ failure Current transplant protocols reach fewer than 10 of this number Regenerative medicine can save the remaining 90 over one million people annually
Tissue engineered bladder
Regenerative Medicine Already Here Working for Tubular Organs Bladder Esophagus Vagina
ViaCyte Announces Highly Anticipated Encapsulation Clinical
Trial Site Expansion into Canada
JDRF-funded researcher Dr James Shapiro will be the lead investigator at the Canadian site TORONTO July 29 2015 -- ViaCyte Inc announced the opening of a second site in its Phase 12 trial for Type I Diabetes which utilizes PEC-01trade pancreatic progenitor cells and the proprietary Encaptrareg drug delivery system which is designed to protect the transplanted cells from a patientrsquos immune system
Regenerative Medicine Already Here Viacyte Trial for Diabetes Therapy
Double Think Stem Cells are Greatest Hope
and Greatest Hype Stem Cell Tourism
Estimated to be $3 Billion a Year Industry and
Growing with More than 700 Clinics Worldwide
Mason C et al Regen Med 2011 May6(3)265-72 doi 102217rme1128 Cell therapy industry billion dollar global business with unlimited potential
Timothy Caulfield - Stem Cell Tourism June 2015
httpswwwyoutubecomwatchv=B0r89nMtg10
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Regenerative Medicine Human Gene Editing Revisiting
Canadian Policy 2017
Science Confronting stem cell hype Professor Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Science Confronting stem cell hype Professor
Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
Stem cell hype Media portrayal of therapy translation MARCH 30 2015
Policy Options Athletes and unproven stem cell therapies JANUARY 01 2015
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Aviv Regevrsquos Human Cell Atlas httpswwwhumancellatlasorg
characterization of all cells in human body by single cell analysis is both promoted and funded via social media (Chan Zuckerberg) If you are not on Facebook you know nothing about it and it will likely be bigger than the human genome project You will be caught napping Nothing about this at 2017 USCAP
In 2017 Human Cell Atlas Poised to Stealth Revolutionize Pathology and Regenerative Medicine via Facebook
Stem Cell Technologies on Google Trends ndash News Headlines and Forecast
Current transplant protocols reach fewer than 10 of those in need
Worldwide 12 million people are in need of transplantation for end stage organ failure Current transplant protocols reach fewer than 10 of this number Regenerative medicine can save the remaining 90 over one million people annually
Tissue engineered bladder
Regenerative Medicine Already Here Working for Tubular Organs Bladder Esophagus Vagina
ViaCyte Announces Highly Anticipated Encapsulation Clinical
Trial Site Expansion into Canada
JDRF-funded researcher Dr James Shapiro will be the lead investigator at the Canadian site TORONTO July 29 2015 -- ViaCyte Inc announced the opening of a second site in its Phase 12 trial for Type I Diabetes which utilizes PEC-01trade pancreatic progenitor cells and the proprietary Encaptrareg drug delivery system which is designed to protect the transplanted cells from a patientrsquos immune system
Regenerative Medicine Already Here Viacyte Trial for Diabetes Therapy
Double Think Stem Cells are Greatest Hope
and Greatest Hype Stem Cell Tourism
Estimated to be $3 Billion a Year Industry and
Growing with More than 700 Clinics Worldwide
Mason C et al Regen Med 2011 May6(3)265-72 doi 102217rme1128 Cell therapy industry billion dollar global business with unlimited potential
Timothy Caulfield - Stem Cell Tourism June 2015
httpswwwyoutubecomwatchv=B0r89nMtg10
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Regenerative Medicine Human Gene Editing Revisiting
Canadian Policy 2017
Science Confronting stem cell hype Professor Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Science Confronting stem cell hype Professor
Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
Stem cell hype Media portrayal of therapy translation MARCH 30 2015
Policy Options Athletes and unproven stem cell therapies JANUARY 01 2015
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Stem Cell Technologies on Google Trends ndash News Headlines and Forecast
Current transplant protocols reach fewer than 10 of those in need
Worldwide 12 million people are in need of transplantation for end stage organ failure Current transplant protocols reach fewer than 10 of this number Regenerative medicine can save the remaining 90 over one million people annually
Tissue engineered bladder
Regenerative Medicine Already Here Working for Tubular Organs Bladder Esophagus Vagina
ViaCyte Announces Highly Anticipated Encapsulation Clinical
Trial Site Expansion into Canada
JDRF-funded researcher Dr James Shapiro will be the lead investigator at the Canadian site TORONTO July 29 2015 -- ViaCyte Inc announced the opening of a second site in its Phase 12 trial for Type I Diabetes which utilizes PEC-01trade pancreatic progenitor cells and the proprietary Encaptrareg drug delivery system which is designed to protect the transplanted cells from a patientrsquos immune system
Regenerative Medicine Already Here Viacyte Trial for Diabetes Therapy
Double Think Stem Cells are Greatest Hope
and Greatest Hype Stem Cell Tourism
Estimated to be $3 Billion a Year Industry and
Growing with More than 700 Clinics Worldwide
Mason C et al Regen Med 2011 May6(3)265-72 doi 102217rme1128 Cell therapy industry billion dollar global business with unlimited potential
Timothy Caulfield - Stem Cell Tourism June 2015
httpswwwyoutubecomwatchv=B0r89nMtg10
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Regenerative Medicine Human Gene Editing Revisiting
Canadian Policy 2017
Science Confronting stem cell hype Professor Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Science Confronting stem cell hype Professor
Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
Stem cell hype Media portrayal of therapy translation MARCH 30 2015
Policy Options Athletes and unproven stem cell therapies JANUARY 01 2015
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Current transplant protocols reach fewer than 10 of those in need
Worldwide 12 million people are in need of transplantation for end stage organ failure Current transplant protocols reach fewer than 10 of this number Regenerative medicine can save the remaining 90 over one million people annually
Tissue engineered bladder
Regenerative Medicine Already Here Working for Tubular Organs Bladder Esophagus Vagina
ViaCyte Announces Highly Anticipated Encapsulation Clinical
Trial Site Expansion into Canada
JDRF-funded researcher Dr James Shapiro will be the lead investigator at the Canadian site TORONTO July 29 2015 -- ViaCyte Inc announced the opening of a second site in its Phase 12 trial for Type I Diabetes which utilizes PEC-01trade pancreatic progenitor cells and the proprietary Encaptrareg drug delivery system which is designed to protect the transplanted cells from a patientrsquos immune system
Regenerative Medicine Already Here Viacyte Trial for Diabetes Therapy
Double Think Stem Cells are Greatest Hope
and Greatest Hype Stem Cell Tourism
Estimated to be $3 Billion a Year Industry and
Growing with More than 700 Clinics Worldwide
Mason C et al Regen Med 2011 May6(3)265-72 doi 102217rme1128 Cell therapy industry billion dollar global business with unlimited potential
Timothy Caulfield - Stem Cell Tourism June 2015
httpswwwyoutubecomwatchv=B0r89nMtg10
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Regenerative Medicine Human Gene Editing Revisiting
Canadian Policy 2017
Science Confronting stem cell hype Professor Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Science Confronting stem cell hype Professor
Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
Stem cell hype Media portrayal of therapy translation MARCH 30 2015
Policy Options Athletes and unproven stem cell therapies JANUARY 01 2015
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Worldwide 12 million people are in need of transplantation for end stage organ failure Current transplant protocols reach fewer than 10 of this number Regenerative medicine can save the remaining 90 over one million people annually
Tissue engineered bladder
Regenerative Medicine Already Here Working for Tubular Organs Bladder Esophagus Vagina
ViaCyte Announces Highly Anticipated Encapsulation Clinical
Trial Site Expansion into Canada
JDRF-funded researcher Dr James Shapiro will be the lead investigator at the Canadian site TORONTO July 29 2015 -- ViaCyte Inc announced the opening of a second site in its Phase 12 trial for Type I Diabetes which utilizes PEC-01trade pancreatic progenitor cells and the proprietary Encaptrareg drug delivery system which is designed to protect the transplanted cells from a patientrsquos immune system
Regenerative Medicine Already Here Viacyte Trial for Diabetes Therapy
Double Think Stem Cells are Greatest Hope
and Greatest Hype Stem Cell Tourism
Estimated to be $3 Billion a Year Industry and
Growing with More than 700 Clinics Worldwide
Mason C et al Regen Med 2011 May6(3)265-72 doi 102217rme1128 Cell therapy industry billion dollar global business with unlimited potential
Timothy Caulfield - Stem Cell Tourism June 2015
httpswwwyoutubecomwatchv=B0r89nMtg10
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Regenerative Medicine Human Gene Editing Revisiting
Canadian Policy 2017
Science Confronting stem cell hype Professor Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Science Confronting stem cell hype Professor
Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
Stem cell hype Media portrayal of therapy translation MARCH 30 2015
Policy Options Athletes and unproven stem cell therapies JANUARY 01 2015
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Tissue engineered bladder
Regenerative Medicine Already Here Working for Tubular Organs Bladder Esophagus Vagina
ViaCyte Announces Highly Anticipated Encapsulation Clinical
Trial Site Expansion into Canada
JDRF-funded researcher Dr James Shapiro will be the lead investigator at the Canadian site TORONTO July 29 2015 -- ViaCyte Inc announced the opening of a second site in its Phase 12 trial for Type I Diabetes which utilizes PEC-01trade pancreatic progenitor cells and the proprietary Encaptrareg drug delivery system which is designed to protect the transplanted cells from a patientrsquos immune system
Regenerative Medicine Already Here Viacyte Trial for Diabetes Therapy
Double Think Stem Cells are Greatest Hope
and Greatest Hype Stem Cell Tourism
Estimated to be $3 Billion a Year Industry and
Growing with More than 700 Clinics Worldwide
Mason C et al Regen Med 2011 May6(3)265-72 doi 102217rme1128 Cell therapy industry billion dollar global business with unlimited potential
Timothy Caulfield - Stem Cell Tourism June 2015
httpswwwyoutubecomwatchv=B0r89nMtg10
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Regenerative Medicine Human Gene Editing Revisiting
Canadian Policy 2017
Science Confronting stem cell hype Professor Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Science Confronting stem cell hype Professor
Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
Stem cell hype Media portrayal of therapy translation MARCH 30 2015
Policy Options Athletes and unproven stem cell therapies JANUARY 01 2015
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
ViaCyte Announces Highly Anticipated Encapsulation Clinical
Trial Site Expansion into Canada
JDRF-funded researcher Dr James Shapiro will be the lead investigator at the Canadian site TORONTO July 29 2015 -- ViaCyte Inc announced the opening of a second site in its Phase 12 trial for Type I Diabetes which utilizes PEC-01trade pancreatic progenitor cells and the proprietary Encaptrareg drug delivery system which is designed to protect the transplanted cells from a patientrsquos immune system
Regenerative Medicine Already Here Viacyte Trial for Diabetes Therapy
Double Think Stem Cells are Greatest Hope
and Greatest Hype Stem Cell Tourism
Estimated to be $3 Billion a Year Industry and
Growing with More than 700 Clinics Worldwide
Mason C et al Regen Med 2011 May6(3)265-72 doi 102217rme1128 Cell therapy industry billion dollar global business with unlimited potential
Timothy Caulfield - Stem Cell Tourism June 2015
httpswwwyoutubecomwatchv=B0r89nMtg10
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Regenerative Medicine Human Gene Editing Revisiting
Canadian Policy 2017
Science Confronting stem cell hype Professor Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Science Confronting stem cell hype Professor
Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
Stem cell hype Media portrayal of therapy translation MARCH 30 2015
Policy Options Athletes and unproven stem cell therapies JANUARY 01 2015
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Double Think Stem Cells are Greatest Hope
and Greatest Hype Stem Cell Tourism
Estimated to be $3 Billion a Year Industry and
Growing with More than 700 Clinics Worldwide
Mason C et al Regen Med 2011 May6(3)265-72 doi 102217rme1128 Cell therapy industry billion dollar global business with unlimited potential
Timothy Caulfield - Stem Cell Tourism June 2015
httpswwwyoutubecomwatchv=B0r89nMtg10
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Regenerative Medicine Human Gene Editing Revisiting
Canadian Policy 2017
Science Confronting stem cell hype Professor Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Science Confronting stem cell hype Professor
Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
Stem cell hype Media portrayal of therapy translation MARCH 30 2015
Policy Options Athletes and unproven stem cell therapies JANUARY 01 2015
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Regenerative Medicine Human Gene Editing Revisiting
Canadian Policy 2017
Science Confronting stem cell hype Professor Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Science Confronting stem cell hype Professor
Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
Stem cell hype Media portrayal of therapy translation MARCH 30 2015
Policy Options Athletes and unproven stem cell therapies JANUARY 01 2015
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsas
px Stem cell Publications Science Confronting stem cell hype Professor
Timothy Caulfield co-authors new stem cell policy guidelines MAY 13 2016
Stem cell hype Media portrayal of therapy translation MARCH 30 2015
Policy Options Athletes and unproven stem cell therapies JANUARY 01 2015
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continued
Research ethics and stem cells Is it time to re‐thinkcurrent approaches to oversight DECEMBER 04 2014
Representations of Stem Cell Clinics on Twitter DECEMBER 01 2014
Unproven stem cell-based interventions amp physicians professional obligations a qualitative study with medical regulatory authorities in Canada OCTOBER 14 2014 Professional Regulation A Potentially Valuable Tool in Responding to Stem Cell Tourism SEPTEMBER 09 2014
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
University of Alberta Health Law Institute
httpwwwhliualbertacaenPublicationsaspx
Stem cell publications continuedStem Cell Tourism and Public Education The Missing Elements SEPTEMBER 04 2014
Policy recommendations for addressing privacy challenges associated with cell-based research and interventions FEBRUARY 03 2014 Commercialization and Stem Cell Research A Review of Emerging Issues
DECEMBER 20 2013 A Role for Patient Advocacy Groups in Countering the Premature Commercialization of Stem Cell Interventions
OCTOBER 01 2013
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
The Positive Aspects of Stem Cell Therapies
The True Hope Has Potential to Reverse Three
Looming Problems in Medicine
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
ldquoThey will never be able to reverse those
trendsrdquo Together we can do those things
reverse those trends make life good again
1 The loss of ldquolusterrdquo in transplantation
2 Workforce problems in nephrology due to lack of appeal to young peoplepotential trainees worldwide
3 Technological unemployment in medicine due to
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Nephrologists amp Renal Pathologists May Be Only People Still Employed in 2045
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and
other conditions in the transplanted kidney began
1991 updated and expanded every two years in
consensus meeting
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Banff Lesion Scoring Sign of Educated Tx Pathologist
imprimatur 1 The formula (=lsquolet it be printedrsquo) signed by an official authorizing printing of a bookhence as sb an official license to print
The Oxford English Dictionary (2nd ed)
Banff lesion scoring g cg i ci t ct v cv ah mm ptc C4d
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
1991 First Conference
1993 First Kidney International publication
1995 Integration with CADI
1997 Integration with CCTT classification
1999 Second KI paper Clinical practice guidelines Implantation biopsies
2001 Classification of antibody-mediated rejection Regulatory agencies participating
2003 Genomics focus ptc cell accumulation scoring
2005 Gene chip analysis Elimination of CAN identification of chronic antibody-mediated rejection
2007 First meeting far from a town called ldquoBanffrdquo ndash La Coruna Spain
2009 Working groups Meeting in Banff Alberta Canada
2013 Establishment of Banff Foundation for Allograft Pathology
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Significance of lsquoBanff papersrsquo
bull More than 5000 citations of the 14 Banff meeting reports
bull 977 Banff Transplantation papers in PubMed
bull Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper
bull 3 Banff meeting reports are among the top 4 cited AJT articles
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Tissue Engineering Pathology Added Soon
bull
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g i t v - score
The Banff communityPathologists
Nephrologists
Tx-Surgeons
Lab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderated
Banff meetingsthesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working
Groups
Feedback concerning weaknesses and strengths by results
from independent research
New membersBiostaticians
Molecular Biologists
ldquoOmicsrdquo-specialists
Off-springsLiver
Pancreas
Lung Heart
CTA
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees K Solez (Chair) L Racusen D Glotz J Demetris M Mengel M Mihatsch D Seron
2015 Local Conference chair Michael Mengel
Organ Steering committee ChairsComposite tissues Linda CendalesHeart Patrick BrunevalKidney Mark HaasLiver Jake DemetrisLung William Wallace and Carol FarverPancreas Cinthia Drachenberg
Banff Working Group (BWG) LeadsMolecular transplantation pathology Michael Mengel Banu SisIsolated v-lesions Banu Sis Ed KrausQuality assurance in transplantation diagnostics Michael Mengel and Parmjeet RandhawaC4d-negative ABMR Mark Haas Banu Sis Alexandre LoupyFibrosis scoring Robert Colvin Brad Farris Michael MengelDigital Pathology in Transplantation Jake Demetris
2015 Scientific program committeeAlex Loupy (Chair)Mark Haas Banu Sis Kathryn Tinkham Candice Rofousse Chris Bellamy Lynn Cornell Carmen LeFaucheurComposite tissues Linda CendalesHeart Patrick BrunevalLiver Jake DemetrisLung William Wallace and Carol FarverPancreasIslets Cinthia Drachenberg and John Papadimitriou
SecretaryTreasurer Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaboration
progress
reports to Budged
proposal and
accountability
for meeting
costs
support
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
The World is Changing Rapidly
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
The World is Changing Rapidly
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
The World is Changing Rapidly
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Perfused 7 days without oxygen or nutrients Of course no nuclei seen
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Canadian Data on Public Interest in Regenerative Medicine
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
The Technological
Singularity
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Podocytes go wandering into the interstitium Song et al
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Many problems with stem cell generate
organs not being discussed Do not exclude
yourself from the action in this area
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Many problems with stem cell generate
organs not being discussed Need to get
those conversations to happenThe recellularized organ clots like crazy impossible to
regenerate more than 80 of endothelial surface Artificial heparized surface not fenestrated Cell traffic abnormal
Hard to get right types of cells to right places
Podocytes seems to be terminally differentiated cells when attempt to culture them they turn into different type of cell
Kidney progenitor stem cell difficult to identify kidney work has lagged behind
Easy to make stem cell generated kidneys that lack loop of Henle Could produce lethal polyuria What is ldquofunctionrdquo
Many old fashioned questions of physiology about how the stem cell generated organ works not just true for kidney true for every organ
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Transplant pathologists will also become tissue engineering pathologists pathologists who analyse organs grown from stem cells This is not something beyond us we can adapt to a work life that includes stem cells Someone needs to cross the disciplines
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions intact nephron hypothesis cell regeneration stunned myocardium contraction band necrosis etc Use your nostalgia Stimulate conversations between stem cell researchers and transplant physicians
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Beginning at the Very Beginning
ldquoWe are at the very beginning of time for the human race It is not unreasonable that we grapple with problems But there are tens of thousands of years in the future Our responsibility is to do what we can learn what we can improve the solutions and pass them onrdquo - Richard P Feynman (1918-1988) Physicist Nobel Prize Winner
The sense of the future is behind all good policies Unless we have it we can give nothing either wise or decent to the world - Snow CP (1905-1980) Novelist and Philosopher
To a large extent the future lies before us like a vast wilderness of unexplored reality The God who created and sustained the evolving universe through eons of progress and development has not placed our generation at the tag end of the creative process God has placed us at a new beginning We are here for the future - Sir John Templeton (1912-2008 ) Financial Analyst
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Beginning at the Very Beginning
Like 1851 when the first International Classification of Diseases was presented in the Grand Exhibition of Technology at Londonrsquos Crystal Palace
Emphasis was on cause of death
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Classification focus is on sustaining life
Native and transplanted organ diseases can also occur in tissue engineered organs
The classification focus of the new pathology discipline of Regenerative MedicineTissue Engineering Pathology is exactly the opposite of traditional classification of disease which starts with causes of death In Regenerative MedicineTissue Engineering Pathology the emphasis is on the degree of normality necessary to sustain life
Normal
Abnormalities of unknown functional significance
Abnormalities which will impair the main functions of the organ
Abnormalities leading to severe organ dysfunction where function may not be great enough to sustain life
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Song et al Interstitium vessels and glomeruli with missing cells
Disordered tubule formation with multiple interconnecting
lumina of differing sizes ldquoCan you really call this a kidneyrdquo (Yes)
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Song et al In addition to missing cells and disordered structures
you have cells in the wrong places Podocytes in the interstitium
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
1 Are there too many missing cells distorted structures for the organ to function adequately
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Focus of Tissue Engineering Pathology The focus of tissue engineering pathology will shift to
the question ldquoIs this organ structurally intact enough to function safely and adequately in the recipientrdquo Using the kidney as an example the specific questions become (Images by Korey Fung)
2 Are there too many cells in the wrong places (eg podocytes in the interstitium)
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Focus of Tissue Engineering Pathology (Images by Korey Fung)
3 Are there missingdistorted structural elements that represent a risk to the patient (missing loops of Henlecausing lethal polyuria)
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Focus of Tissue Engineering Pathology Using the kidney as an example the specific questions
become
4 Is there too much endothelial disruption
for the organ to be properly perfused
5 What are the risks of neoplastic transformation
Classification categories should be not one-off but reproducible generalizable
Tissue engineering pathology has been up to now really dull since most reports were of scaffolds with no inflammatory reaction Move along nothing to see here pathology but from today becomes really exciting with novel morphological changes and lives hanging in the balance
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Khouloud Saliba and I Presented These Ideas
at TERMIS (Regenerative Medicine) Meeting
in San Diego Dec 11-14 2016
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Met Astgik Petrosyan Who Has Written About the Many Additional Variables Which Will Add Complexity to New Banff Classification
Decellularized Renal Matrix and Regenerative Medicine of the Kidney A Different Point of View Petrosyan Astgik hellip and Perin Laura Tissue Engineering Part B Reviews May 2016 22(3) 183-192
A Step Towards Clinical Application of Acellular Matrix A Clue from Macrophage Polarization Petrosyan A hellipPerin L Matrix Biol 2016 Aug 26 pii S0945-053X(16)30133-0
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
Astgik Petrosyan Variables Will Necessitate AI Approaches to New Banff Classification
