First transplant of a lab grown organ

British doctors help perform world's first transplant of a whole organ grown in lab

British doctors have helped to perform the world's first transplant of a whole organ grown from stem cells, signalling a significant medical breakthrough.

By Kate Devlin Medical Correspondent
Last Updated: 11:40PM GMT 18 Nov 2008

Surgeons replaced the damaged windpipe of Claudia Castillo, a 30-year-old mother of two, with one created from stem cells grown in a laboratory at Bristol University.

Because the new windpipe was made from cells taken from Ms Castillo's own body, using a process called "tissue engineering", she has not needed powerful drugs to prevent her body rejecting the organ.

Avoiding the use of these drugs means she will not be an increased risk of cancer and other diseases unlike other transplant patients - another significant advance.

Five months after the operation was carried out she is now living normally and is able to look after her children again.

Stem cells are "master cells" which can be manipulated in a laboratory to become any other cell in the body.

Scientists hailed the procedure as a breakthrough and predicted surgeons could be regularly replacing hearts with laboratory-grown organs within 20 years.

The technique would "revolutionise" surgery, they claimed, and has the potential to save thousands of lives.

The team behind the operation hope to replicate the procedure to grow voiceboxes within five years and say that from there the door would be open to use the technology to create any organ including a bladder, kidney or even a heart.

Professor Martin Birchall, who grew the stem cells in his laboratory at the University of Bristol, said: "In 20 years time this will be the most common operation that surgeons are doing. This will completely revolutionise how we think about surgery and medicine."

Although doctors were able to carry out a similar operation on a bladder two years ago, Professor Birchall said that that had merely been a "patch", transferring part rather than the whole of the organ, a much less complex task.

"That was a major step forward," he said, "but this is another major step forward again."

Every year more than 1,000 patients in Britain die on transplant waiting lists, prompting scientists to consider other ways to produce organs. Ms Castillo's operation required a section of windpipe from an organ donor as a "scaffold" for the stem cells - meaning the technique will not immediately solve the shortage of donor organs. However, it is hoped that eventually artificial scaffolds can be made which would avoid the need for donor organs completely.

Without the operation, surgeons would have had to remove one of Ms Castillo's lungs, which would have reduced her life expectancy dramatically, said Paolo Macchiarini, who performed the surgery at the Hospital Clinic, Barcelona, in June.

"But now she can expect to have a normal life expectancy for a woman her age."

Ms Castillo, who is originally from Colombia but who now lives in Spain, is now able to look after her children, walk up two flights of stairs and even occasionally go dancing.

She said: "The possibility of avoiding the removal of my entire lung, and, instead, replacing only my diseased bronchus with this tissue engineering process, represented a unique chance for me to return to my normal life.

"I was scared at the beginning because I was the first patient but had confidence and trusted the doctors. I am now enjoying life and am very happy that my illness has been cured."

After suffering from tuberculosis, she was hospitalised in March of this year with acute shortness of breath which meant that she was unable to carry out simple domestic duties or care for her children.

With the only other option available an operation to remove her left lung, doctors decided to see if they could grow a new windpipe in the laboratory.

To create the new airway scientists originally started with a donor windpipe which they stripped of all its cells, using a new technique developed by Padua University, leaving just a form of "scaffold" which they then encouraged Claudia's cells to grow around.

After growing a 5 cm long trachea in the lab, the scientists then carried out the operation to transplant it into the patient.

Doctors have previously been unsuccessful in attempting to transplant a windpipe from one human to another, because the large amount of immune-system suppressing drugs needed to ensure that the body would not immediately reject the organ. Severe infections, bleeding and tissue death have led to other trachea transplants failing.

No such medication was needed in this case, because the airway had been grown using the patient's own stem cells, taken from her hip and nose.

Two months after the transplant, tests showed that her lung function had returned to normal, according to the findings published in the Lancet medical journal.

Around 300 patients a year suffer from similar problems as Claudia, caused by cancer, infection or tuberculosis.

Around 3,000 a year could benefit from a voicebox transplant while tens of thousands of lives worldwide could be saved if doctors were able to transplant hearts and other organs grown in the laboratory.

Professor Macchiarini, from the University of Barcelona, said: "We are terribly excited by these results. After one month, a biopsy elicited local bleeding, indicating that the blood vessels had already grown back successfully".

Anthony Hollander, also from the University of Bristol, said: "This successful treatment manifestly demonstrates the potential of adult stem cells to save lives".

Ben Sykes, from the UK National Stem Cell Network, said: "This is an excellent demonstration of the potential of adult stem cells as one of several possible avenues in regenerative medicine and shows that the funding which has been invested into, and continues to be invested into, bone marrow stem cell research over decades is worthwhile."

John Evans, president of the British Organ Donor Society, said: "This is certainly science advancing at a rate of knots.

"It is something that has great merit and great possibility.

"Creating organs from stem cells would also remove some of the emotional as well as medical problems, by preventing the need to intrude upon a recently bereaved family and their private grief."

http://www.telegraph.co.uk/health/healthnews/3479613/British-doctors-help-perform-worlds-first-transplant-of-a-whole-organ-grown-in-lab.html

Claudia Castillo gets windpipe tailor-made from her own stem cells

A woman has been given a new section of windpipe created from her own stem cells in an operation that could revolutionise surgery.

Claudia Castillo, 30, who lives in Barcelona, has become the first person to be given a whole organ tailor-made for her in laboratories across Europe.

A graft from a donor was used, but because it has been imbued with Ms Castillo’s own cells, there is no sign that her body will reject the organ.
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Researchers and surgeons from Britain, Italy and Spain collaborated to grow tissue from Ms Castillo’s own bone marrow stem cells, using them to fashion the new bronchus – a branch of the windpipe. They believe that one day the approach will be used to create engineered replacements for other damaged organs, such as the bowel or bladder. In five years they hope to begin clinical trials in which laboratory-made voice boxes are implanted into patients with cancer of the larynx.

Martin Birchall, of the University of Bristol, a British member of the team, said: “This is the first time a tissue-engineered whole organ has been transplanted into a patient. I reckon in 20 years’ time it will be the commonest operation – it will transform the way we think about surgery.”

Ms Castillo, who was born in Colombia, had suffered a tuberculosis infection that ravaged her airways, leaving her unable to do simple domestic tasks. Disease had caused her windpipe, or trachea, to collapse just at the point where it entered her lung. Without the pioneering operation in June, the lung would have been removed. Today she again has a normal life and is able to look after her two children. She can walk up stairs without getting breathless and has even been dancing.

The prospect of the patient needing powerful drugs to avoid rejection had been thought to outweigh any potential benefits of trachea transplants. Four months on, Ms Castillo’s doctors have seen no sign of her immune system rejecting the transplant, even though she has had no immunosuppres-sive drugs.

Details of the transplant, performed by Paolo Macchiarini, at the Hospital Clinic of Barcelona, are published online today by The Lancet.

First a section of trachea was taken from a donor and stripped of cells that could cause an immune reaction, leaving a grey trunk of connective tissue. Stem cells were then taken from Ms Castillo’s bone marrow and grown in Professor Birchall’s laboratory. Stem cells can develop into different kinds of tissue, given the right chemical instructions, enabling researchers to cultivate cartilage and epithelial cells to cover the 7cm graft. It was then “seeded” with the new cells using a process developed in Milan. Finally the trachea, covered in cartilage and lined with epithelial cells, was cut to shape and fitted.

Professor Macchiarini said: “The probability that this lady will have rejection is almost zero. She is enjoying a normal life, which for us clinicians is the most beautiful gift.”

The researchers said that the surgery could help some patients in Britain but admitted that the procedure was too expensive to be widely available. They are seeking EU funding and commercial sponsors for trials to create and transplant a larynx, an operation that could be more cost-effective.

Ms Castillo said: “I was scared at the beginning because I was the first patient – but trusted the doctors. I am now enjoying life and am very happy that my illness has been cured.

http://www.timesonline.co.uk/tol/life_and_style/health/article5183686.ece