Megagrant, the Russian docu-novel of Paolo Macchiarini

На русский язык рецензию перевел Илья Ясный для Троицкий вариант — Наука (29.01.2019)

This is my review of the Russian book “Megagrant“, published in 2015, which tells of Paolo Macchiarini‘s adventures with the plastic trachea, which left at least 8 people dead. Much of it played out in Russia, funded by a state mega-grant of €4.5mn. The author is Macchiarini’s grant manager, Elena Kokurina. Don’t buy it, it is full of distortions and dishonesty which will make your head spin. But I dug out some useful information in it anyway. Despite Kokurina’s sycophantic adulation, Macchiarini comes across as the lying manipulative narcissistic tyrant he is. But it it not only his lies which become evident. Some biographies like this “docu-novel” are namely quite useful as potential court evidence.

In my own personal case, I once even submitted a book titled “Patient of my Life“ by a German journalist to a German court as evidence, to try and prove that I was sentenced behind my back (this being standards German injunction practice), for merely quoting from it. That story of tracheal transplants performed by former Macchiarini partners was originally narrated in that book as a success, a miracle cure, done by a dedicated genius surgeon. Some years later, that responsible surgeon Thorsten Walles and his wife Heike (who made the tracheal transplant in her lab at a Fraunhofer Institute in Stuttgart) wanted nothing to do with that and sued me, for referencing the book they dictated, and even for citing their own interviews. It turned out that the patients were deliberately misled, there was no previous animal testing, no toxicity assays, and even no ethics approvals whatsoever. The Fraunhofer Society was actually even proud of such innovative approach, repeatedly refused to investigate and instead assisted Walles in suing me. German law being as it is, I was lucky to escape with a costly court settlement followed by a threat on behalf of the German People never to report on that subject again. But it was that very book “Patient of my Life” which led me onto that Walles case, which is still being investigated by the University of Würzburg.

The book Megagrant was not helpful in my other court troubles, where I was not lucky at all, simply because Macchiarini chose not to tell his biographer (and Megagrant manager) Kokurina what he and his team were up to in Italy between 2010 and 2012. Wisely so, it was namely a carnage which left at least 5 people dead. But the book is extremely valuable as evidence of Macchiarini’s other crimes. All one had to do is to read this nauseating torrent of sycophantic adulation critically, with the background knowledge of the horrendous patient abuse and the massive fraud committed by that miracle surgeon.

Indeed, this was also what the Swedish journalists Bosse Lindquist and Johannes Wallström did, when they made their groundbreaking TV documentary “Experimenten“ for the Swedish channel SVT. Wallström speaks several languages almost as a native, Russian is one of them. This was how the Swedish team learned of other, unoffiical victims of Macchiarini’s plastic trachea transplants. In parallel, another journalist team from Germany was parading the (by now dying) patient Yulia Tuulik as Macchiarini’s success story on French and German television Arte.

I also speak Russian, having grown up in the Ukraine of the Soviet period. Some time ago, I contacted Kokurina over Facebook and asked for a copy of that book. Her publisher Boslen sent it to me to Germany free of charge. I was initially even afraid to unwrap it, but it turned out Macchiarini’s gang prefers to deal with its enemies in German courts, where they can always count on arrogant elitism, pigheaded incompetence and history-ignorant xenophobia of certain judges.

So here is my review, with my translated quotes from Megagrant put into perspective of my own journalistic investigation. There are likely to be discrepancies with regard to the English originals as things were said or written, what with my re-translation of Kokurina’s translation. My review follows the book’s chapters.

Foreword: 2008. Claudia.

Megagrant opens with a foreword which tells the story of the Macchiarini’s first trachea transplant in Barcelona in 2008, the patient was Claudia Castillo. She survived, despite and not thanks to the graft, which was eventually removed together with her lung (read about Claudia here and here). Yet back then it was presented worldwide as a success story, which promoted Macchiarini to subject 10 or even more patients to that method of decellurised cadaveric trachea transplant. After that, he moved on to an even more lethal tool, the plastic trachea.

Back in 2008, Macchiarini performed this feat of regenerative medicine together with his loyal German doctorate student Philipp Jungebluth (who then had me sentenced in court, with Macchiarini as his expert witness), and his English partners (then at University of Bristol) Anthony Hollander and the laryngologist Martin Birchall, the latter is well known to my regular readers, for his own questionable exploits in the field of regenerative medicine of trachea and larynx transplants.

The book Megagrant gives some clues of how Macchiarini got his patient to agree to the novel, never before tested transplant. Claudia suffered from a bronchus constriction due to tuberculosis after-effects. Yet Macchiarini is quoted to have told her (page 8):

“Transplantation is the only way out”

Claudia was a young mother, separated from her husband who was granted temporary custody of their children. She was fighting to get her children back and is quoted with:

“Donor organ and the necessity to take anti-rejection medicine will make me officially a disabled person, and then I might lose my children”

In fact, it becomes obvious Macchiarini created a highly unprofessional dependency of his patient which involved inappropriate proximity and manipulation. He even intervened into Claudia’s custody litigation (page 12):

“The transplantation itself was not as difficult as the series of court hearings where he [Macchiarini] was proving that inside the body of his patient – is her own organ, from the medical and legal point of view. Which means, she was in her right to demand return of child custody. Speaking in front of the judges, assembling an argument after argument, he perfectly understood that he was fighting not just for Claudia’s happiness (though he was sentimental and truly shed a tear when the judge gave a positive verdict) – his victory meant victory of science, recognition of the birth of a new branch, where he was one of the pioneers.”

Claudia had no choice but to agree to whatever plans Macchiarini had with her, because the good doctor told her she would otherwise either die or become a cripple, either way never to see her children again. Medically, that was a lie, made up to bully a patient into submission. Macchiarini is not that kind of a man to accept a “no” for an answer, his superficial charm and seducing pleasantness can swiftly change to choleric rage and vengeful aggression if he doesn’t get what he wants (read a patient’s experience here).

With her constricted left bronchus, Claudia was the perfect subject to test the technology: young, cancer-free, and if her bronchus replacement failed, she would just lose one lung, and not her life, as it soon became the case for Macchiarini’s trachea transplant patients. And of course the Columbian was a foreigner in Spain, desperate and easy to control.  The book presents her situation as a turning point for Macchiarini (page 9):

“And Paolo decided that now the time has come to realise his long carried bold idea. Donor trachea must be stripped of all cells and genetic material associated with the previous “owner”, leaving just the faceless scaffold. Scaffold will be be filled with Claudia’s cells, and to transplant her with her own(!) organ. He tested this more than once in laboratory, on animals”

The latter claim is actually not true at all. The only evidence of any previous animal experiments with trachea transplant are Macchiarini’s and Jungebluth’s own words. All Jungebluth’s medical doctorate thesis has to show for, are some subcutaneous inflammation tests with bits of decellurised trachea, confirmed by a newspaper article. Never an actual trachea transplant on a human or on an animal, this was also proudly confirmed by Hollander in an interview. Claudia was their Guinea pig.

The University of Bristol and Birchall’s current employer UCL still deny that what is described in Megagrant is what really happened (page 10):

“The work on the donor trachea – its decellurisation and generation of a scaffold – took place in Italy. After that, the scaffold was sent to England, to Bristol, where also the cells were sent to, extracted from Claudia’s bone marrow, and where the manufacturing took place – “”seeding” of the scaffold. This is not all: to let the cells adjust to their new “home”, the construction had to be kept inside a special device, a bioreactor. This setup was a cylinder, in which a trachea was placed and inside which a certain temperature and moisture was maintained, and also – a special vibration was applied: in this way, the cells had it easier to attach to the scaffold and penetrate its pores.

The bioreactor was specially manufactured in Italy and also sent to Bristol. The scaffold with cells remained in such “incubator” for four days, after which it was ready to be sent to Barcelona. The hour struck! Operation was scheduled for the next day.”

The book goes on to narrate how the Easy Jet airline refused to fly the trachea as hand luggage to Barcelona and the heroic feat of how Jungebluth saved the day. Coming from a wealthy and well-connected German family, the young medicine student asked a family friend to fly the trachea to Barcelona with his private airplane. The University of Bristol reimbursed Birchall the pilot’s fee of GBP 14k (read here and here).

Here is the main problem: Birchall only had a veterinary lab in Bristol, where he operated pigs. Nobody in his right mind, aside of an utter criminal, would bring any patient tissues or cells intended for transplantation into a veterinary lab, not even to store them in a freezer, and Birchall was strictly told that by the UK Human Tissue Authority. He of course did not mention to them that he was actually regenerating a trachea in secret, in his veterinary lab where pig carcasses were dissected. This is why the University of Bristol and UCL insist even now that the trachea never was in Bristol, because it would mean Birchall and his colleagues (including the student Jungebluth) broke all possible British laws and might even have to face a criminal prosecution. The powerful British universities simply deleted their old press releases and massaged the media (like The Guardian) to write some alternative truths.

Chapter 1: 2009-2010. Zhadyra

That chapter tells how Macchiarini, after his success with publishing Claudia’s case in The Lancet,  was brought to Russia in 2010, first to give a Master-Class lecture, and then to perform a show trachea transplant on a young woman, Zhadyra Iglikova. Which was of course declared a success, the truth did not matter once again. Macchiarini became a star in Russia, a governmental Megagrant funding was eventually procured to bring him to Krasnodar, the book is dedicated to narrating that grant-angling enterprise in minute detail. Zhadyra died just recently, in June 2018, one month after Macchiarini’s then-partner in Moscow Vladimir Parshin fixed her with a second trachea transplant.

The organiser of that Master-Class lecture, the operation on Zhadyra and the Megagrant project was the Russian businessman and anti-ageing enthusiast Mikhail Batin, those interested can compare Kokurina’s lengthy account in the book Megagrant with Batin’s own (possibly drunk) Facebook rant (here a backup of the original). To make the long story short: Batin sent Kokurina to Barcelona to win Macchiarini over.

Officially, there were no other trachea transplants happening after Claudia’s until Macchiarini moved to Careggi University Hospital in Florence, Italy, in 2010. There is only my site with collected evidence of one definitely proven and another likely trachea transplant which Macchiarini performed in Barcelona in 2009, both patients died. And of course there is the useful book Megagrant, where Kokurina narrates of her second visit to Barcelona from 2009, on a Tuesday (page 18):

“Back then I did not know that I am witnessing a historic event: Paolo decided to perform a second trachea transplant, this time without the use of cultivation or a bioreactor. He started to realise his concept that the best bioreactor is the human body which can “direct the cells where needed and give them the possibility to develop into the required tissue type”.

-Human body – it is the most intelligent and most beautiful creation of nature, -he said, smiling, after exiting into the clinic’s backyard after a nine hour operation. [..]

-All went well?

-Of course, how could it be different

-You never have doubts?

-No. – then he switched to business. -What is your offer?”

That trachea transplant patient died, her name is not known, and nobody in Spain or abroad seemed to care, and doesn’t care even now. Certainly not Macchiarini.

The official version of Macchiarini history, convenient to all parties involved, is that he decided to switch from decellurised cadaveric trachea to plastic material when already working at Karolinska Institutet (KI) in Stockholm, in 2011. As a kind of emergency solution, pressured by his colleagues and superiors to deliver once again some novel and exciting results to justify his questionably pushed-through employment.  A victim of “publish and perish” atmosphere in academia. That is not true. Macchiarini switched to plastic for two main reasons: to save on time, costs and paper work associated with donor organs, and because saw his patients die after he replaced their trachea with a decellurised cadaveric graft.  The book Megagrant helps here, Macchiarini is quoted discussing with Kokurina in 2009 his idea of plastic grafts (as well as his work on larynges with Birchall) for his upcoming Master-Class lecture in Moscow (page 20, highlights mine):

“Round 1. Regenerative medicine – principles and tasks

Round 2. Technology of work with difficult tissues and whole organs. Donor scaffolds.

• Decellurised scaffold.
• Tissue engineered human trachea for in vivo implantation.
• Generation of bioengineered human larynx.
• Decellurisation of oesophagus.
• Decellurisation of other human tissues/organs.

Questions and discussion 15 min. break 30 min.

Round 3. Necessary ingredients for regeneration of tissues and organs

• Cells, key factors for tissue engineering strategies.
• Bioreactor.
• Biomolecules/Pharmacological effects.
• Regeneration of airways: approaches in vitro and in vivo.

Round 4. lessons which we drew after applying in clinic transplantations of tissue-engineered airways.

Round 5. Synthetic scaffolds.

• Tracheo-bronchial transplantation using artificial polymer scaffold, seeded with stem cells.

Round 6. Transplantation of stem cells for regeneration of damaged organs.

Questions. Discussion. 30 min.”

After that, the book tells of the success of the Master-Class, and how peer critics were silenced for saying things like that:

“You say that four days after trachea transplantation there is a vascularisation. Forgive me, but I cannot believe that”

The person who asked that sceptical question was Zhadyra’s future surgeon in both 2010 and 2018 operations, Vladimir Parshin (this irony was pointed out to me by the translator Ilya Yasni, hence update). Also present at the lecture was the head of Krasnodar clinic Vladimir Porkhanov, he was the one who played his excellent connections to get both Macchiarini and the huge Megagrant funding to his Kuban State University.

Otherwise, we learn bits and pieces, like Macchiarini declaring to have been financially dependent on his wife Emanuela Pecchia till he got the job in Barcelona in 2004. Presumably she had to pay for her husband’s affairs in France and Germany, until he was rich enough to buy a huge villa for his new family in Cabrils, a Barcelona suburb, where he still is registered. What Emanuela got in return, was a free trip and a tour of Russia for the whole family, this was Macchiarini’s condition to give that Master Class lecture. Zhadyra’s operation in December 2010 costed €250k, and we only learn from Batin’s Facebook rant that €130k of it went into Macchiarini’s personal pocket.

Chapter 2. Mister Beyene

The chapter carries on with the story of how Macchiarini came to work in Krasnodar, including anecdotes of banquets in Porkhanov’s “dinner room“, near his office. The negotiations started in February 2011. Porkhanov loved to dine lavishly during at work, like with some feudal lord, his opulent lunches were also used for political strategies and thus naturally including vodka, wine and other booze. Foreigners apparently called it “Porkhanov’s Kitchen- best restaurant in Krasnodar“. All that was deployed to entice Macchiarini, who at the end of such a banquet declared to his Krasnodar hosts:

“This is one of the best clinics I ever saw in Europe!”

Already then Macchiarini was discussing how to put his long-carried idea of a plastic trachea into practice. What also is not known: his first patient in this regard was intended to be the little girl Hannah Warren from USA, whom Macchiarini eventually operated in April 2013. The girl died 3 months  after the operation, and 3 years after her death, the man who prepared that trachea, Philipp Jungebluth, used the New York Times article which appeared in between, to convince a German court to sentence me for damaging his pristine and shiny reputation.

Five patients received a deadly trachea transplant at KI and in Krasnodar before the US authority FDA let Macchiarini operate on Hannah, 2 years after the first request. Macchiarini’s future business associate Mark Holterman, paediatric surgeon from University of Illinois and a devout Catholic without much grasp of ethics and morality,  contacted his Italian colleague on behalf of Hannah’s parents in February or March 2011. It is not clear if by then Macchiarini already performed the trachea transplant operation on another child, Ciaran Lynch, together with Birchall at UCL on 10 March 2010. Hannah was at that time 7 months old, born without a functional trachea, the book narrates how excited Macchiarini was to learn they had the same birthday: August 22.

Again, Hannah was in principle an ideal patient for Macchiarini: a cadaveric trachea transplant would not be doable on a tiny child, for lack of properly sized donor organ. Ciaran was already 10 years old and thus received an oversized adult graft (this is also why he still survived, the obviously dead scaffold doesn’t grow, despite the authority of the journal Lancet). Macchiarini wanted to use a plastic graft on Hannah, because he apparently expected the plastic scaffold to morph into a living  growing trachea. And the parents “worshipped Professor Macchiarini“.

Where to operate? South Korea, where Hannah’s mother was from, was not an option: as the book says, because of “numerous scientific and medical scandals connected to stem cell research“, which could have “damaged the scientific recognition of the results” Macchiarini intended to generate. One wonders if Kokurina ever got the irony of that. KI hospital in Sweden was too expensive for Hannah’s parents, the price tag would have been €200k. The remaining option was USA, at Holterman’s paediatric hospital at the University of Illinois, Peoria.

This is what brings us to the main focus of the chapter, on Macchiarini’s first plastic trachea transplant, performed at KI hospital in Stockholm on the Icelandic patient Andemariam Beyene in June 2011, which led to another Lancet paper, Jungebluth et al, 2011, now retracted as fraudulent. The book Megagrant is in many cases a torrent of made-up fantasies, for example by claiming Beyene had only days to live (his cancer diagnosis was in reality very benign, and manageable palliatively for many years). In other cases, the book is quite revealing. This was how Macchiarini reacted to this potential patient (page 61):

“Once again an argument to use an artificial scaffold.- Paolo was thinking. -And also an extra chance: if everything works out with him, all will be well with Hannah”.

Macchiarini organised everything: a plastic trachea from UCL, and a bioreactor from the US company Harvard Apparatus (which is presently being sued by the family of one of Macchiarini’s victims). By now we know how it all happened, how the Icelandic surgeon Tomas Gudbjartsson played a key role in delivering his patient Beyene to Macchiarini at KI and operating him there, and in extracting enough data out of him for a big paper as requested by Macchiarini and Jungebluth. But before the Iceland investigation, the book Megagrant provided some clues.

Beyene was scared to commit to an utterly untested operation. According to the book, it was Gudbjartsson who talked him into agreeing to the plastic trachea transplant (page 66):

“Do you want to see you children grow up? In this case even one-two years of life – this is already lucky. After that – nobody can know”.

It is a quote of a quote of a quote. Namely, what Macchiarini told Kokurina what Beyene allegedly told him about what Gudbjartsson told his patient. The Icelandic surgeon denied having said this to Beyene in an email to me, but then again many things Gudbjartsson said to weasel out of his responsibility were not true, as the Icelandic investigation proved. It is truly a problem whom to believe when you have one liar pitted against another.

Beyene’s graft was incubated for 48 hours in a bioreactor, with Jungebluth turning it regularly like a shish kebab. After a 12 hour operation in June 2011, Beyene’s fate was sealed. He became Lancet fodder, and then sent back to Iceland to die. Professor Macchiarini namely lost interest.

Chapter 3: 2011. Chris

In that chapter, the heroic story of recruiting Macchiarini to Krasnodar and getting the Megagrant funding of 150 Million Roubles continues. We learn that at those times (ie, when oil was expensive and before Russia declared an undeclared war on Ukraine and got sanctioned by the West and also sanctioned itself) this money was worth €4.5 Million. Not bad, especially for Russian standards. Paolo, always the gentleman, saw other opportunities in Russia. When meeting the rector of Kuban State University in Krasnodar (page 74):

“Paolo whistled: “Wow” – and addressed his female translator: “tell the Rector that he should be paid for working in dangerous conditions, there are so many women around”.

The female faculty members at the table did not think that was funny, the book mentions. Later on, the chapter tells of how the Professor recruited his personnel. His concluding question to each candidate was:

“Are you prepared to work 25 hours a day?”- Everyone convincingly answered “Yes”. After that Macchiarini always added: “I am not joking- 25 hours, this is how it will be”.

Alexandr Sotnichenko was described by Macchiarini as “a proper postdoc” and git a slap on his shoulder. Elena Gubareva was promised the position of Macchiarini’s deputy in the lab (indeed she took over his lab in Krasnodar after the Russians got rid of their troublesome Italian guest and started to parade the decellurisation technology of trachea as their own invention). Two more young women were recruited. Finally, one female applicant, described as a “young beauty“, arrived without any knowledge of English or regenerative medicine, but wearing a mini-skirt. Macchiarini recruited her anyway, with these words:

“One must give a chance to someone starting completely with a clean sheet”.

That candidate is said to have left after some months, “having married and gotten pregnant“. Other trainees were send to KI to learn the regmed magic. The Swedish state paid for all of it, but the book never mentioned that.

The main subject of that chapter is also a patient of Macchiarini’s, Chris Lyles from USA. The book claims he only had weeks to live, allegedly having exhausted all therapies after 3 cycles of radiation therapy and 7 cycles of chemotherapy. Nobody can prove anything now, because Chris’ own trachea was removed and destroyed during the transplant in November 2011, while no autopsy was performed after his death less three months later. Kokurina, but also Jungebluth and Macchiarini were free to tell any fairy tales on why Chris died, and how his life prospects were nevertheless exceeded by the transplant: these lies are still being believed, at least by the Swedish police and state prosecutor.

The book quotes a letter Chris wrote to Macchiarini, where the patient describes being impressed by the claims of Macchiarini’s colleagues: Anthony Atala (who even now is celebrated for some obscure claim of having successfully transplanted a bit of decell-recell bladder into a patient) and Macchiarini’s very special friend from Texas, Doris Taylor (who pretends she can grow hearts in her lab). I won’t quote the letter here, but here is how Macchiarini has dictated his thoughts from that time to his biographer Kokurina (page 84):

“Maybe it is a sign? A sign that I am not yet ready to do the transplantation on Hannah? Another opportunity?”

So Chris Lyles became Guinea Pig Nr 2 for the plastic trachea, as part of Macchiarini’s schedule to operate little Hannah. The Lyle family collected the money to pay the operation at KI hospital. The book mentions that prior to the operation, Chris and his executor, pardon, life-saver surgeon, “exchanged tiny tattoos“.

Chapter 4 and 5: 2012. Yulia and Sasha

The two characters these both chapters are identically named after, are two Russian patients Yulia Tuulik and Alexandr (Sasha) Zozulya. Both were healthy, aside of a tracheostoma, a hole in the throat due to a damaged trachea. They both had excellent life expectations of many years and even decades, unless they went for a swim. Well, aside of the fact that Zozulya was a smoker and an alcoholic, who admitted to have been drinking 2 litres of beer in one go (daily consume apparently a multiple of that), and as such unfit for any experimental therapy, but Macchiarini and his Krasnodar colleagues operated Sasha anyway. Yulia’s story is particularly tragic, because she ignored the warnings of her mother and husband and begged Macchiarini to operate her, so she could enjoy the time with her little child in full. Yulia died horribly, slowly and painfully, her story is the main feature of two documentaries: the Swedish “Experimenten” and the German “Super Cells!“. The latter presented Macchiarini as a genius scientist and surgeon, and Yulia as a grateful patient whose life was saved by a miracle transplant. “Super Cells!” went to premiere after Yulia wrote to the German film-makers that she was dying.

After Chris died, first criticisms of Macchiarini’s plastic trachea technology came and are referenced in the Megagrant book. One of them was Joseph Vacanti (brother of the STAP-cheater Charles Vacanti), who said Macchiarini was operating “in a grey area” (same Joseph Vacanti now supervises plastic oesophagus technology for Harvard Apparatus, now renamed as Biostage). We learn though why Macchiarini always avoided animal tests (page 101):

“Even on large animals you cannot prove how long a scaffold will work”. They use mostly pigs, which have a completely different anatomy, a different mechanist of respiration, everything is different when you talk about trachea.”

As aside, also Birchall used to denounce pigs as unsuitable and called for airway transplant research on patients instead. Except in those rare cases when he and Macchiarini had to provide some preclinical data, and the unsuitable pig suddenly evolved into excellent model organism for human airway studies.

Regarding the two Russian patients: Megagrant describes a multidisciplinary videoconference from early 2012 which the KI maintains even now, never took place as such. There are actually even photographic records of it, to help KI remembering it. This was the invitation Macchiarini sent to the participants (page 120):

“Dear colleagues,

I am excited to invite you to the international videoconference which will take place on February 15th. There will be presented potential candidates with airway diseases (adults and children) for transplantation. I would suggest that the priority will be given to most urgent cases. Suggestion is to present from 4 to 6 cases (one or two from each center), duration of the conference – around 2 hours.

Considering that the invited centers -Stockholm and Florence (EU), Houston and Burlington (USA) [read about that here, -LS] and Krasnodar and moscow (Russia), we must set a time. David (Rice) and Daniel (Weiss) are at least 6-9 hours back from Europe…”

KI, Careggi University Hospital in Florence and Moscow presented one patient each. MD Anderson: two, one of them a child. Krasnodar surgeon Igor Polyakov presented two local candidates: Yulia and Sasha (page 121):

“All participants agreed that transplantation was the only approach to cure these patients”

All was ready, as Macchiarini himself described in a letter to partners, quoted in the book (page 128):

“Dear all,

in the name of Professor Vladimir Porkhanov I invite you to Krasnodar. This is the last letter before we meet, and I would like to “refresh” the situation and discuss organisational moments.

1 Bioreactors and scaffold arrived on time, and Thomas Gross [engineer with the German company Hugo Sachs Elektronik, a branch of Harvard Apparatus, the book goes on to assert that Gross was in charge of supplying the trachea grafts and bioreactors from Germany, and was present at both operations. Even Gross’ letters to Macchiarini are quoted. -LS], who is already in Krasnodar, tested at least trice if all is in order.[…]

4 Philipp Jungebluth is responsible for the process of seeding the scaffold with cells, he will be assisted by Irina Gilevitch, who was appropriately trained at KI.[…]

6 Samples will be delivered to a clean lab, to which only Philipp and Irina will have access, to avoid contamination. Thomas Gross must be nearby, but outside the clean lab.[…]

11 Please understand you are part of the first ever in history transplantation of a tissue-engineered trachea and part of the larynx [for Yulia, as discussed at the videoconference. -LS] and it is a places a huge responsibility on all of us, but primarily upon myself.

I sincerely apologize for such a long letter in “German” style, but it seems to me this is important to achieve a positive result. Again, all the best and see you soon.

Paolo”

Yulia Tuulik was Macchiarini’s Guinea pig to test a transplant of a plastic larynx, something what Birchall always wanted to do, and was at that time trying on pigs, which responded by dying. By then in 2012 the two surgeons long ceased being friends. Macchiarini’s experiment on Yulia was probably also part revenge on Birchall and his UCL. We also learn what a hero Jungebluth was: he was rotating the tracheas shish-kebab-style inside the bioreactor for 48 hours inside a tiny clean room, while on crutches with a damaged knee after a soccer injury. In truth he did it because Macchiarini ordered him to, as the book admits at some point. Regardless of that: a selfless life-saving angel in white is how Dr Jungebluth wants to be seen, which worked well in German court when sentencing a journalist.

This was the travelling circus which arrived to Krasnodar in June 2012 to watch Macchiarini experiment on two more patients (page 132):

“Aside of Philipp Jungebluth and Thomas Gross, directly involved in the [preparation of] transplantation, arrived – David Green, who as company’s CEO [Harvard Apparatus] was present also at previous operations, Mark Holterman – he wanted to see how Paolo works, to see all details of the preparation before they operate the little Hannah (scheduled in autumn). Finally two thoracic surgeons from Norway indicated their interest, Prof Axel and Dr Lund, to learn the technology [not sure about correct transcription of names from Russian, -LS]”

And of course the German TV crew, shooting “Super Cells!”. They even helped Holterman get a Russian visa on time.

After the operations, Yulia went home, and Sasha had no home to go to. He was given some job at the hospital and a promise of a gift bicycle. Kokurina writes excitingly on Macchiarini’s behalf (page 157):

“The journal “Nature” is preparing an overview of all his transplantations, and the editor would like to get an interview from one of the Russian patients – over Skype. Yulia left home long ago, and it was decided that Sasha should answer the questions of the famous international journal”.

Sasha was instructed not to mention his smoking, before he was interviewed over Skype by an unnamed female Nature journalist, to whom Sasha announced his intentions to use his restored health and presentability in order to start dating women.  Some weeks later Sasha got in a fight over some woman he met on one of his secret trips, and ended up in emergency room for a week. Guess how Macchiarini reacted? Page 159:

“If after such most complex transplantation, with a lab-engineered organ graft, a patient was able to get into a fight over a woman, this is the best advertisement for my method.”

Chapter 6: 2012-2013. Hannah

Finally, enough Guinea pigs were operated with plastic trachea for Macchiarini to get an FDA permission for Hannah. The book mentions the professor was performing “many routine, but no less demanding operations in Florence“: we know of 5 cadaveric trahcea transplants, but those took place from July 2010 till January 2011. Were there more? Possibly. It is once again a pity Macchiarini was reluctant to tell Kokurina of a blood bath he caused in Careggi with his cadaveric tracheas, apparently even he could not spin that into anything even remotely positive. The book mentions this lecture in Moscow, where Macchiaini admitted the decellurised tracheas to be a failure and where my readers noticed mismatch between his presentation and his papers:

Right after the lecture, Macchiarini boarded a plane to operate another patient in Florence. You can see from that presentation how little that thoracic surgeon understood biology or biomedicine, yet he was simultaneously running two clinically-oriented biomedical labs, at KI and in Krasnodar. His Russian trainees, unlike their elitist KI colleagues, apparently figured out they were turning laboratory bullshit into (deadly) clinical bullshit, while being constantly berated, humiliated and made to write up weekly progress reports by their tyrant professor. Macchiarini was disappointed for them “to lack a spark” and to only socialise with his KI group for “beer evenings” when the boss was in town. Jungebluth, who was in charge of their training, complained to Macchiarini (page 162):

“they do work as told, but are not interested to understand it for themselves, to become a part of this new world”.

Basically, these Russians saw both Macchiarini and Jungebluth through. Soon after, in September 2012, Macchiarini was arrested in Florence, for blackmail and extortion of patients and their families, an article in Corriere della Sera is quoted. That was not about trachea transplants, those were never investigated by the Italian state, despite at least 5 (and likely more) dead victims. Macchiarini namely demanded cash from terminally ill, incurable patients for operations in Hannover and London, we learn that a nurse present at those “consultations” reported him. Even on those extortion charges, the surgeon was eventually acquitted, but only after the book was published. That angry at his home country, Macchiarini is reported to have quit his position at Careggi, left behind his tissue decellurisation lab ran by Silvia Baiguera, and announced never to work in Italy again (I heard rumours though that this is actually exactly what he might be doing presently, in secret).

The date for operation on Hannah was set: 9 April 2013, Macchiarini was assisted by Holterman (turned out he was Hanna’s godfather) and Peoria’s head paediatric surgeon Richard Pearl. Before and after that, Macchiarini was busy butchering a young Turkish woman at KI hospital, Yesim Cetir. As there was nothing even remotely positive to make out of her suffering, her two plastic trachea transplants are somehow not mentioned in the book’s chronological account. Maybe Kokurina and her boss deemed Yesim as not important enough on the road to operating Hannah.

Megagrant offers an alternative fact version of why Hannah died just 12 weeks later: her oesophagus was defect, if only Macchiarini also replaced that with a bit of some regmed magic! The trachea is described to have worked as a miracle (page 182):

“Tissue samples taken on the fourth day after the transplantation showed presence of the epithelium”.

Whoever did that fraudulent analysis, we do not know, but maybe the US authorities will eventually bother to find out. Macchiarini was invited by Chris Lyle’s family to visit them after Hannah’s death, which the good doctor did. Later on, he invited both Chris’ and Hannah’s to his fake wedding in Vatican, that is not in the book, but on my site.

Chapter 7: Yulia, Sasha and others

Macchiarini’s Russian lab, whose members were now generously allowed to address their master informally as “Prof”, was busy growing organs. Sotnichenko was in charge of growing hearts (and ordered by the Prof to deliver in “two, maximum 3 years“), Kuevda made lungs, and Gubareva was producing the respiration muscle called diaphragm. Why nobody was bioengineering brains (The Prof could sure use some), is anyone’s guess.

Macchiarini moved into the newly opened Hilton Krasnodar hotel, where he was busy flirting with (or maybe harassing) the personnel. Cheap Hilton wasn’t, but this again was Macchiarini, so others had to pay.

His patients were dying, both Yulia and Sasha received a second plastic trachea transplant. Kokurina portrays Yulia as an ungrateful psychotic troublemaker, constantly demanding attention from busy doctors. We learn of the patient Sadiq Kanaan from Jordan, whose only indication for a trachea transplant was a tracheostomy, just like with Yulia and Sasha. The Jordanian patient went back home after the operation and died there, but the book pretends he simply stopped writing and is still alive (later on Macchiarini is quoted admitting that Kanaan died, and when). There were also great news: Doris Taylor was coming to visit Krasnodar! The woman who pretends to all and sundry she created a “beating heart” in a lab! Plus the Megagrant was extended for two more years. So this is what the chapter celebrated.

Macchiarini had big plans with his friend Doris: torturing monkeys to test his array of artificial organs. The grand dame (who at around that time was busy trying to help Paolo to a professorship in Texas) gave a lecture, the Russian audience remained largely unimpressed, as Kokurina criticised. Maybe they had enough of their daily bullshit as it was.

Chapter 8: 2014: Patient

Andemariam Beyene died in January 2014, as Kokurina explains (page 217):

“it was not a bad result, especially since the cause of death was not directly connected to failure of trachea, and by extension, to the transplantation”

Yulia died in September 2014, before that, Kokurina insisted she was doing “quite well“, and hence the distance diagnosis of “bilateral pneumonia“. At least Kokurina admitted that Sasha had some problems. And then he is described to have had a bicycle accident, of which he didn’t recover and died on 21 February 2014. In case you dared to question something (page 212):

“yes, cause of death was internal haemorrhage, but from the area unrelated to the trachea”

Macchiarini’s way to deal with that setback was to go terrorise his “postdocs” and make them work in the lab even more, while declaring:

“I regret all those gigantic efforts invested into a patient, who was unable to make use of them.”

A paper about plastic oesophagus was published in Nature Communications, the book celebrates that (it became three years later Macchiarini’s and Jungebluth’s first big retraction, for fraud). One of the co-authors was Sotnichenko, the paper apparently saved his job, because Macchiarini declared:

“I didn’t have it easy with Alex, at some point I was thinking we will have to separate, but together we overcame the difficulties”

Criticism became stronger, New York Times reported. And then the book serves us a letter Macchiarini gave an email interview to Nature, in late 2014, apparently when this Nature News article was prepared. The journalist there confirmed to me having received it, the interview transcript was never published or released by Nature. The book Megagrant holds the only publicly available copy, in Russian translation. It is Macchiarini presenting his alternative reality (page 218). He admits 6 out of 8 plastic trachea patients died,

“in every concrete case, the cause of death was different and cannot be connected directly to the outcomes of transplantation“.

He tells this about his 3 KI patients:

Beyene: had “no more than 6 months to live, the result exceeded all expectations“, grateful to Macchiarini for “second chance on life“, and his death was anyway Gudbjartsson’s fault.

Chris Lyles: “regeneration process worked very well, he died suddenly of acute pneumonia“.

About Yesim Cetir, the first time and only she is ever mentioned in that book, without ever being named, a torrent of lies (her medical reality is here):

“Finally, third patient, was probably the most difficult. It was a young woman from Turkey, whose condition was most difficult from the very beginning. When she arrived from Istanbul to Stockholm, the first bronchoscopy determined a wide fistula between middle bronchus and right lung artery. Because already in Turkey she experienced multiple and increasing haemorrhages from that site, the multidisciplinary team decided to first try to stabilise her. Her life expectancy at that time point was between three and six months. Trachea transplantation could only be scheduled if the first “stabilising” operation was successful. I performed that operation, and in the process we unfortunately determined total absence of the trachea, something we didn’t know before, and which we couldn’t see during previous examinations. She has multiple problems, which remained also after the transplantation in 2012 and because of which she had to remain in the hospital all that time. It is a miracle she is still alive”.

Hannah: died “of multi-organ failure“, after a follow-up operation on her oesophagus, with which Macchiarini had nothing to do.

Sadiq Kanaan: according to his doctor in Jordan, “regeneration worked normally“. Died of “liver failure, caused by alcohol abuse“, confirmed by Kanaan’s family members. Macchiarini was appalled:

“Imagine how the news shocked us – all those enormous efforts to save his life were in vain”

Sasha: the patient was not following the “prescribed regime on smoking and alcohol“, another “failure  of our efforts to save his life“.

About Yulia Macchiarini weaselled most, claiming her situation deteriorated suddenly, that unfortunately her second trachea transplant couldn’t save her. That was in the interview to Nature. Talking to Kokurina, Macchiarini later adds that without the transplant, Yulia wouldn’t have lived longer than she did with his plastic tracheas. He declares (page 225):

“What kind of life would she have had otherwise? Some short life. Without the possibility to move, without love, without sex, her child was afraid of her hole in her throat”.

Suffocating on a disintegrating, trachea, chronically clogged with pus and mucus, coughing blood and bits of plastic, in and out of emergency care, while nobody will come close to you due to a disgusting rotting stench from your breath, is apparently what the lady-killer Macchiarini saw as his generous gift to the young mother Yulia.

To distract himself of such negativity, Macchiarini was using his time in Russia to learn piano and dancing, and to write theatre plays.

Epilogue. 2015

If you think all that death and suffering stopped Macchiarini: no. As other patients were dying, Crimean resident Dimitri Onogda was operated in June 2014 with a plastic trachea. He had a “lucky” escape: the graft was removed soon enough, Onogda survived (status 2017).

And of course Kokurina asserts us once again that Claudia Castillo is doing well, 6 years after the operation. Zhadyra Iglikova also. Not that the truth matters any in that book.

Don’t buy Megagrant, unless you are a police officer or state prosecutor in need of evidence. I told you here everything which matters, the rest was inane adulation of Macchiarini and his partners in crime and abettors.

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