STARSET_MirrorFUTURES: Biofabrication -The Future of Healthcare?
by Karma Lei Angelo
超级战士
Super soldier
德里克在招聘人员对面坐下。他抬头望向BES——生物强化的士兵的全息图像。
Derek sits down across from the recruiter. He stares up at the holographic image of a BES, a bio-enhanced soldier.
“告诉我你的来意。”那个穿制服的人从桌子的另一边说。
“Tell me what brings you here,” the uniformed man says from the other side of the table.
“因为内战，先生。它离我的格子越来越近了。我的小妹妹很害怕。”
“The civil war, sir. It’s getting closer to my grid. My little sister’s scared.”
“她应该害怕。这个派系用肮脏的手段来消灭他们认为是敌人的任何人，包括中立者。” 招聘人员看了看全息图，然后又看向德里克。”你确实知道这与历史上的任何战争都不相似，对吗？你也知道这个现代的敌人需要先进的解决方案来根除？”
“She should be. The Faction uses dirty tactics to eliminate anyone they deem an enemy, including the Neutralists.” The recruiter looks at the hologram, then back to Derek. “You do understand this is not one of history’s wars? That this modern enemy requires advanced solutions to eradicate?”
“是的，先生。”
“Yes, sir.”
“很好。” 招聘人员将一块平板电脑递给了德里克。”一旦你承诺成为BES，就没有回头路走了，孩子。我们不能对你的肌肉进行反向生物工程，也不能移除生物制造的骨头。你的身体将经历永久性的改变。”
“Good.” The recruiter passes a tablet over to Derek. “Once you commit to becoming a BES, there’s no going back, son. We can’t reverse bio-engineer your muscles or remove the bio-fabricated bone. Your body will undergo permanent changes.”
德里克点点头。他开始浏览这份合同。”我需要现在就下定决心吗？”
Derek nods. He starts scrolling through the contract. “Do I have to make up my mind right now?”
“那就看你的了。你要明白，外面的敌人不会停止，不会放慢他们占领下一个地区的步伐。生物工厂的过程只需要几天，然后你将再接受8周的训练。在那之后，你将作为一位正式的BES来到前线。你将变得不可阻挡。”
“That’s up to you. Understand that the enemy out there doesn’t stop, won’t slow down their push to take over the next sector. The bio-fab process only takes a few days, then you’ll be in training for another 8 weeks. After that, you’ll be an official BES on the frontlines. And you will be unstoppable.”
这个年轻人继续阅读法律文件。他又抬头看了看全息图。他的母亲警告过他加入步兵的风险。这是还是那个，在他父亲被诊断出癌症后，拒绝给他一个新的生物打印胰腺的政府。还是这个监管所有医疗保健的政府，现在给他提供了一个几乎好得不能再好的条件。谁不想成为一名在战斗中几乎无敌的超级士兵？
The young man continues to read through the legal paperwork. He looks up at the hologram again. His mother warned him about the risks of joining the Infantry. This is the same government coalition which denied his father a new bioprinted pancreas after the cancer diagnosis. This same government which regulates all health care is now making him an offer almost too good to be true. Who wouldn’t want to be a super soldier, nearly invincible in combat?
德里克靠到椅背上，对整个生物制造过程陷入了深思。他应该听从他母亲的警告，回到家里，远离风险或判断吗？或者他应该在意识到这是一个拒绝为他父亲治疗的政府的情况下，继续选择进行永久性的改变？
Derek sits back, deep in thought over the whole biofabrication process. Should he go back home, safe from risk or judgement, heeding his mother’s warning? Or should he proceed with the permanent changes, knowing this is the same government that denied his father treatment?
什么是生物制造？
What is biofabrication?
根据《物理世界》，生物制造被定义为：”通过生物打印或生物组装以及随后的组织成熟过程，从活细胞、生物活性分子、生物材料、细胞聚集物（如微组织）或细胞-材料混合构建物自动生成具有结构组织的生物功能产品。”
According to Physics World, biofabrication is defined as: “The automated generation of biologically functional products with structural organization from living cells, bioactive molecules, biomaterials, cell aggregates such as micro-tissues, or hybrid cell-material constructs, through bioprinting or bioassembly and subsequent tissue maturation processes.”
换句话说，它是一种培养或复制生物产品的方式。这些也可以使用3D打印机和生物墨水（一种含有活细胞的可打印材料）进行生物打印。这个过程可用于组织工程和再生医学、建筑，甚至是时尚行业。
In other words, it is a way to grow or replicate biological products. These can also be bioprinted using a 3d printer and bioinks, a printable material that contains living cells. The process can be used for tissue engineering and regenerative medicine, architecture, and even the fashion industry.
生物制造的概念开始于2000年代初。被称为 “生物打印之祖 “的德克萨斯大学埃尔帕索分校的生物工程师托马斯·博兰，使用惠普喷墨打印机打印由活牛细胞制成了生物墨水。博兰总结说，如果喷墨打印机可以打印基因，同样的设备也可以打印其他生物材料。毕竟，人类细胞的大小与标准墨滴差不多。
The concept of biofabrication began in the early 2000s. Known as the “grandfather of bioprinting”, Thomas Boland, a bioengineer with the University of Texas at El Paso, used an HP inkjet printer to print a bioink made from living bovine cells. Boland concluded that if an inkjet could print genes, the same devices could print other biomaterials. Afterall, human cells are roughly the size of standard ink droplets.
博兰从一台旧的打印机中取出墨盒，并在里面装上胶原蛋白。他把一张薄薄的硅片粘在一张纸上，然后把它送进打印机。他使用一个文字程序，在黑色硅片上打印出他姓名的首字母 “TB”。当打印机弹出纸张时，名字的首字母被米白色的蛋白质标记得清晰可见。
Boland took the ink cartridge out of an old printer and filled it with collagen. He glued a thin sheet of silicon onto a piece of paper and fed it through the printer. Using a word program, he printed out his initials “TB” on the black silicon sheet. When the printer ejected the paper, the initials were clearly marked with the off-white proteins.
从那时起，科学家们开始了对3D打印、生物打印和制造工艺的研究。一些开发和研究产品的例子包括：
- 向其他器官输送营养物质的血管和管道
- 用合成聚合物和重组胶原蛋白创造的人工角膜
- 利用干细胞的生物门创造的软骨组织，以治疗骨关节炎和软骨损伤
- 在原位或体外，可以直接在烧伤患者身上重建皮肤
- 正在研究和开发更复杂的器官，如肺部和肾脏
Since then, scientists have expanded their research on 3d printing, bioprinting, and fabrication processes. Some examples of developed and research products include:
- Blood vessels and tubes that deliver nutrients to other organs
- Artificial corneas created with synthetic polymers and recombinant collagen
- Cartilage tissue created by biopens using stem cells to treat osteoarthritis and cartilage injuries
- Skin, either in situ or in vitro, can be reconstructed directly on burn victims
- More complex organs such as lungs and kidneys are being researched and developed
随着生物制造和组织工程产品逐步成为现实，医疗和卫生局开始注意到这一点。2016年，昆士兰科技大学和大都会北区医院和卫生局合作，在澳大利亚成立了赫斯顿生物制造研究所（HBI），成为世界上第一个致力于3D扫描、建模和打印人体组织、骨骼和软骨的医疗机构。
As biofabricated and tissue-engineered products become more of a reality, medical and healthcare systems are beginning to take notice. In 2016, the Queensland University of Technology and Metro North Hospital and Health Service partnered to form the Herston Biofabrication Institute (HBI) in Australia, becoming the first medical facility in the world dedicated to 3D scanning, modeling, and printing of human tissue, bone, and cartilage.
这个最先进的设施将专注于开发生物工程组织和结构，包括仿生学和生物力学装置的整合。例如，出生时患有小耳症（外耳畸形）的儿童可以接受问题区域的三维扫描，然后制作一个聚合物复合材料的假耳。临时假体可以用外科粘合剂或磁铁连接，直到孩子长大或能够获得更多的永久性治疗。
The state-of-the-art facility will focus on developing bioengineered tissues and constructs, including the integration of bionics and biomechanical devices. For example, a child born with microtia (a deformity of the outer ear) could undergo a 3d scan of the problem area, then have a polymer composite of a prosthetic ear created. The temporary prosthetic could be attached with surgical adhesives or magnets until the child is older or able to have a more permanent treatment available.
HBI于2020年初开放，并将为世界各地类似设施的开放树立先例。该设施还将为世界各地的科学家和医生提供教育和培训，其目标是成为未来生物技术的科学中心。
HBI opened in early 2020 and will set the precedent for similar facilities to open around the world. The facility will also provide education and training for scientists and doctors around the world with the goal to become a scientific hub for future biotechnologies.
会出现什么后果？
What are the consequences?
虽然这仍然是一项新兴的、大多是有前途的技术，但也有人担心生物制造可能被滥用。也许最大的担忧是政府控制和创造超级士兵。人体性能增强（HPE）研究可以成为生物打印技术的应用之一。
While this is still an emerging and mostly promising technology, there are concerns that biofabrication could be misused. Perhaps the biggest concern is government control and creating super soldiers. Human performance enhancement (HPE) research could look into the applications of bioprinting technology.
如果不仅受伤的士兵可以通过生物制造替换器官和身体部位，而且健康的士兵还能增强健康的器官和肢体以提高性能呢？想象一下，一个士兵拥有一个更耐切割的坚硬表皮外壳，皮肤的修复速度比正常情况下快上数倍，组织更耐感染。或者像漫威超级英雄金刚狼那样，增强的肌肉能够使目前的力量阈值增加一倍或两倍，骨骼也得到加强，这又如何呢？
Not only could wounded soldiers have organs and body parts replaced through biofabrication, but what if healthy soldiers could have healthy organs and limbs augmented to improve performance? Imagine a soldier with a hardened epidermal shell more resistant to cuts, with skin that can mend exponentially faster than normal and tissue more resistant to infection. Or what about augmented muscle capable of doubling or tripling current strength thresholds and bone reinforced like the Marvel superhero Wolverine?
此外，还有伦理方面的担忧：不是每个人都会被允许使用这项技术。政府可能试图控制和限制等待器官移植的人使用。富人可能试图垄断或优先为自己获得生物打印产品。一些科学家担心，生物工程组织可能有潜在的疾病，或者宿主的身体可能会排斥这种材料，结果利大于弊。需要建立法律制度以确保病人的安全和健康。
In addition, there are ethical concerns that not everyone will be allowed access to this technology. Governments could try to take control and limit access to people waiting for organ transplants. The rich could try to monopolize or prioritize access to bioprinted products for themselves. Some scientists are worried that bioengineered tissue could have latent diseases or the host body could reject the material, causing more harm than good. Legalities would need to be established to ensure the safety and health of the patients.
节省了时间与金钱，拯救了生命
Saving time, money and lives
生物制造和生物工程的器官也可以对现代社会产生积极的经济和社会影响。目前，平均而言，等待器官移植大约需要3至5年时间。截至2020年3月，有超过112,000名各年龄段的人在全国器官移植等待名单上，每天大约有20人在等待时死亡。在等待名单上的人比从捐赠者那里得到的器官还要多。
Biofabricating and bioengineering organs can also have a positive economical and social impact on modern societies. Currently and on average, waiting for an organ transplant takes around 3 to 5 years. As of March 2020, there are more than 112,000 people of all ages on the national transplant waiting list and roughly 20 people die each day waiting on that list. More people wait on the list than there are organs available from donors.
复制过程不仅可以大幅减少等待时间，还可以减缓全球器官贩运的非法贸易。不知道全世界每年有多少人仅仅因为器官贩卖而被谋杀。身体器官黑市是一个有利可图的行业，心脏等器官的价格超过13万美元，眼角膜的价格可以达到3万美元。
Not only could wait times be drastically reduced, the replication process could slow the global illicit trade of organ trafficking. It is unknown how many people are murdered around the world each year just for organ trafficking. Black market body parts are a lucrative business with organs such as hearts fetching more than $130,000 and corneas can cost as much as $30,000.
另一方面，实验室培植的器官可以使医院不再拼命寻找身体部位，这每年可以为医疗机构节省数十亿美元。据《福布斯》报道，典型的肾脏移植平均花费33万美元，而生物打印的肾脏可能只需花费其中的一小部分，大约1万美元。这笔节余可以转给保险公司和已经在经济困难的病人。
Lab-grown organs, on the other hand, could eliminate the need for desperate hospitals to find body parts and could save medical facilities billions per year. According to Forbes, a typical kidney transplant costs an average of $330,000 and a bioprinted kidney could cost a mere fraction of that, around $10,000. This savings could be passed to insurance companies and patients already struggling financially.
作为世界上第一个生物打印设施，赫斯顿生物制造研究所具有实现这些目标的潜力，并希望能将医生和工程师聚集在一起。人们还希望，在未来十年内，生物制造将成为医疗保健实践中的一个标准，并迎来对生物打印的新的认知。
As the world’s first bioprinting facility, the Herston Biofabrication Institute has potential to achieve these goals and hopes to bring together doctors and engineers. There is also hope that, within the next decade, biofabrication will become a standard in health care practices and usher in a new appreciation of bioprinting.
