{"id":21947,"date":"2026-07-12T15:28:19","date_gmt":"2026-07-12T11:28:19","guid":{"rendered":"https:\/\/medscriptum.org\/?p=21947"},"modified":"2026-07-12T15:48:46","modified_gmt":"2026-07-12T11:48:46","slug":"the-organ-builder-medicine-at-the-frontier-of-architecture","status":"publish","type":"post","link":"https:\/\/medscriptum.org\/en\/the-organ-builder-medicine-at-the-frontier-of-architecture\/","title":{"rendered":"The Organ Builder: Medicine at the Frontier of Architecture"},"content":{"rendered":"

“When we started this work, in Tbilisi, not just science, electricity, and water were luxuries. We were doing something that had no shape, no contours. Years later, all of it was given a name: tissue engineering. But back then, people like me were considered madmen by half the world.”<\/span><\/p>\n

It is no great surprise that the first thing to hit a young scientist arriving in New York from late-1990s Tbilisi was the skyscrapers. Standing on Fifth Avenue, looking up at the narrow strip of sky trapped between those giants, the first thing I felt was how small I was, Eka Berishvili recalls, years later. But the greater world of wonders lay a little further on: in the Stem Cell and Liver Research Center of Yeshiva University’s Albert Einstein College of Medicine. Young scientists from Georgia, locked in the grinding difficulty of transformation, were astonished by everything they saw, and yet what mattered most was the research and the ideas they had carried across the Atlantic.<\/span><\/p>\n

“At that point in Georgia, it wasn’t just science that was in crisis; general education was in freefall too. We had practically nothing in 1990s Tbilisi. A cracked glass Petri dish, a pipette held together with makeshift ‘bandages’ as we used to joke. For me, arriving there was like stepping into a land of wonders. We had maybe a hundred or a hundred and fifty dollars between us, but we managed to bring research that would hold its own in competition. That was how we met Professor Sanjiv Gupta.”<\/span><\/p>\n

What was the key motivation on her path to becoming a scientist? The most important thing is to believe in what you are doing, even if no one else in the entire world believes in it. We are fighters for human life, and the only weapon we have is science. And science is driven by curiosity. A curious, mischievous, and remarkably reckless child, that is how she describes her younger self. Now a leading scientist at the University of Geneva, she has chosen a research challenge as audacious as her nature: type 1 diabetes, but from an entirely different angle. She wants to become an organ architect.<\/span><\/p>\n

Type 1 diabetes is a global challenge affecting more than nine million people. When we use the word “fighting” in that context, it evokes the extraordinary journey science has made in recent decades, from effectively nowhere to the full management of this disease. The journey that began with the synthesis of insulin has, today, reached automated pump systems capable of both monitoring blood glucose and releasing precisely calibrated doses of insulin. This revolution has transformed diabetes from a death sentence into a manageable condition. But science has set itself a new task: to build an organ that produces insulin on its own.<\/span><\/p>\n

Organ building is, quite genuinely, engineering at the boundary of biological science. It is architecture: form defining function. In the case of diabetes, that form and content means constructing the pancreas not in its entirety, but its most critical component: the islets of Langerhans. These unique clusters of cells are scattered throughout the pancreas in millions of tiny, independent islets, and the different cell types within them provide precise regulation of blood glucose levels.<\/span><\/p>\n

“When we talk about beta cells, the cells that produce insulin, we have to remember that they are part of these tiny islets, but not the whole story. This is a micro-world that includes other cell types, the extracellular matrix, and blood vessels. It is an interconnected micro-environment that accounts for only one to two per cent of the total pancreatic mass, yet it is so powerful that it consumes up to twenty per cent of the organ’s entire blood supply. The technique for isolating and collecting them, which we can now perform, is extraordinarily complex and took years to master.”<\/span><\/p>\n

Eka Berishvili learned the islet isolation technique in 2003 in Miami, working with Professor Camillo Ricordi. In her own laboratory today, it has become, in effect, routine. Each individual islet is no larger than a grain of sand. Collecting them grain by grain from a cadaveric organ takes approximately eight hours; they are then transplanted into the patient’s liver, which, unlike the pancreas, which simultaneously produces aggressive digestive enzymes, offers a more hospitable environment for the islets.<\/span><\/p>\n

“Our cell isolation and transplantation laboratory is one of the best in the world. We serve not only Switzerland but also clinics in France as well. We perform around a hundred isolations and approximately fifty transplantations per year.”<\/span><\/p>\n

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Hospitable is not the same as ideal. What so often undoes decades of scientific effort is the very thing that makes evolution and all living things possible: the immune system. The same system whose “fault” type 1 diabetes actually is. It is what physicians call an autoimmune disease, when your own defenders turn on your own cells; in this case, destroying the beta cells of the islets of Langerhans and eliminating any chance of producing insulin. The immune system is like a guard dog that must not only catch thieves and intruders but, first and foremost, tell its owner from a stranger. A dog that bites its owner as readily as it bites a burglar is no use to anyone.<\/span><\/p>\n

“Today we have two strategies for managing diabetes. The first is insulin replacement therapy, the gold standard. We have no beta cells producing insulin, so we supply insulin to the body from outside. The second is cellular therapy: islet transplantation. If we have the ability to transplant these islets into a patient and allow beta cells to produce insulin on their own, why don’t we offer this to every patient?”<\/span><\/p>\n

Risk and benefit: for every physician, a near-sacred combination of words. Where does risk outweigh benefit, and where does benefit tip the scale? As with any transplantation, the immune response to islet transplantation is merciless. There will always be an immune reaction to anything foreign, and in the case of transplantation, this means rejection of the transplanted organ or cells, explains Eka Berishvili. The only solution is immunosuppression: a combination of drugs that artificially suppresses the patient’s immune system and prevents rejection. But this is where the calculation becomes difficult because immunosuppression brings a host of other serious problems.<\/span><\/p>\n

In 2019, when the European Commission announced a competitive grant in regenerative medicine, Eka knew that winning and securing funding would not be easy. The project proposal began to take shape. A multidisciplinary team of leading specialists proposed not transplanting cells but building an organ from scratch. Of 217 competing projects, fourteen were funded. Eka Berishvili’s project placed in the top three and was awarded seven million euros. At the University of Geneva, a Laboratory of Tissue Engineering and Organ Regeneration was established.<\/span><\/p>\n

When you think about organ engineering, it really is less like building a house and more like building a city. It is not enough to put up individual buildings. You need planning, communications, and a concept. The same is true here. An organ is not simply a mass of cells packed into a scaffold; it is a cytoarchitecture in which form and function are mutually defining. If you set out to build an organ from nothing, you must think not only about individual cells in isolation, but about how they interact with one another, how they communicate, how they live together in this artificial miniature city.<\/span><\/p>\n

“The micro-environment is everything. When we isolate islets of Langerhans and sever the connections between them, some undergo programmed cell death, apoptosis. This is a complex three-dimensional system of cells, matrix, and their interactions. Disconnect any one component and the entire system ceases to function.”<\/span><\/p>\n

Today, at the Geneva laboratory under Eka’s direction, they know how to artificially recreate this miniature system. A hydrogel replaces the extracellular matrix and forms the scaffold. They can embed blood vessels and reprogramme stem cells to produce insulin-secreting beta cells. But the challenges do not end there. Even after building this miniature city, the critical question remains: can you successfully hide it from the immune system?<\/span><\/p>\n

One strategy, being developed in Geneva by a Georgian doctoral student working alongside Eka, involves embedding molecules into the matrix that actively repel immune cells from the artificially constructed organ, creating, in effect, a dome that shields the entire miniature city from immune bombardment.<\/span><\/p>\n

When the conversation turned to Georgian students, it inevitably led somewhere else: where is Georgian science today, more precisely, is Georgian science creating anything of genuine value? To answer that properly, the question needs to be sharpened. Where? If the answer is outside the country, then Georgian intellectual capital is a remarkable asset for any nation that receives it, the scientist reflects, but within Georgia itself, science has been in a state of deep stasis for so long that its competitive capacity has been all but extinguished. If Georgia has anything to offer the world, it is its intellectual resources, says Eka, especially now, when knowledge and communication are the fundamental sources of wealth everywhere.<\/span><\/p>\n

“Our young people are our national wealth. But it is deeply troubling that these minds are draining out of the country, and that other nations are benefiting from that capital. Intellectual capital has a directly proportional effect on a country’s capacity for innovation, economic growth, and competitive standing. The loss of intellectual power, therefore, strikes directly at national development. Maximum investment and effort must go into building intellectual capital, and that process has to begin in school.”<\/span><\/p>\n

Georgian science faces many problems today, but Eka is an optimist who, alongside her academic and scientific work in Geneva, also lectures at Ilia State University in Georgia, trying to open a path for young people toward serious science. Her own infection with what she calls the “virus of science” came in the distant 1990s, transmitted by Professor Zurab Kakabadze, a man full of the same enthusiasm. Now she is trying to pass that virus on to others.<\/span><\/p>\n

“When I was starting out, there was no light anywhere, literally and figuratively. But we believed we could do it. We had big plans. In general, you have to set big plans and stubbornly start walking toward them. Mistakes? Don’t be afraid of mistakes. Every mistake I’ve made has served me well in the end. The important thing is to analyze them. And yes, science cannot be created without freedom. Originality, curiosity, and freedom.”<\/span><\/p>\n

As it turned out, free time had run out. To give us this interview, the scientist who leads one of Europe’s foremost laboratories had surrendered her Sunday, the one day she keeps entirely for her family. Eka’s husband, Thierry Berney, is also a scientist: he leads the Transplantation Division and the Cell Isolation and Transplantation Center at Geneva University Hospitals. Can you imagine how fortunate I am to do the work I love and get paid for it? She had told her husband on the way to work that morning, she confided to us, laughing. Yes, really, what more could a person want?<\/span><\/p>\n

She spent her holiday in Georgia, of course. Tomorrow morning, she goes back to work. As the laboratory director, there is a great deal of routine. The thing I dread most tomorrow morning is opening my emails, she laughed, who knows how many messages are waiting for a reply… It’s a five-year project. We have to build it well. Then the clinical testing of the construction will come. The scaffold has to be durable and, above all, protected and fully functional.<\/span><\/p>\n

At the close of our conversation, I caught myself: the skyscrapers of New York had risen in my mind. I lost track of the boundary somewhere between diabetes and engineering; my thoughts had lodged themselves at the frontier of medicine and architecture.<\/span><\/p>\n

By Zura Petrosiani<\/b><\/p>\n","protected":false},"excerpt":{"rendered":"

“When we started this work, in Tbilisi, not just science, electricity, and water were luxuries. We were doing something that had no shape, no contours. Years later, all of it was given a name: tissue engineering. But back then, people like me were considered madmen by half the world.” It is no great surprise that […]<\/p>\n","protected":false},"author":2,"featured_media":21946,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1594],"tags":[6256,5450,6257],"class_list":["post-21947","post","type-post","status-publish","format-standard","has-post-thumbnail","category-news","tag-eka-berishvili","tag-ekaterine-berishvili","tag-zura-petrosiani"],"acf":[],"_links":{"self":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/21947","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/comments?post=21947"}],"version-history":[{"count":2,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/21947\/revisions"}],"predecessor-version":[{"id":21950,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/21947\/revisions\/21950"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/media\/21946"}],"wp:attachment":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/media?parent=21947"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/categories?post=21947"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/tags?post=21947"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}