TB Patient Gets New Windpipe Made With Own Stem Cells

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TB Patient Gets New Windpipe Made With Own Stem Cells

19 Nov 2008

A 30-year old Columbian woman living in Spain whose airway was

damaged from tuberculosis is the first person in the world to receive

a new airway engineered from tissue that was grown from her own stem

cells which means she is likely to have a much better quality of life

because she will probably not have to take drugs for the rest of her

life to stop her immune system rejecting the tissue.

The operation is described in a paper published in the early online

issue of the The Lancet on 19 November. Specialists from four

European institutions came together to carry out the operation: the

Hospital Clínic of Barcelona, part of Universitat de Barcelona in

Spain, the University of Bristol in the UK, the Politecnico di Milano

in Italy, and the University of Padua, also in Italy. Professor Paolo

Macchiarini of the Hospital Clínic of Barcelona led the procedure.

As well as producing a good outcome for the patient,

Castillo, who said thanks to this operation she has the opportunity

to " return to a normal life " , the significance of this innovative

procedure is that it shows it is possible to create a cell-based,

tissue-engineered airway that not only works properly but is also

free of the risk of rejection, opening the way for treating other

serious diseases by using biomaterials combined with tissue cultured

from patients' own stem cells.

Castillo said in a press statement that she was scared at first

because she would be the first person in the world to receive such a

treatment, but she said she trusted her doctors and had confidence in

them. The alternative to replacing her diseased bronchus with the new

tissue engineered airway would have been complete removal of her

lung. Castillo said she had the unique chance to return to a normal

life with her two young children and family.

" I am now enjoying life and am very happy that my illness has been

cured, " she said.

Traditional attempts to replace damaged airways often meet with

serious problems such as life-threatening infections, lethal bleeding

and dying off (necrosis) of the grafted tissue.

In this case the doctors used the trachea of a human donor and

removed the donor's cells in order to get rid of the antigens that

the recipient's immune system might react to and reject. This left

just a decellularized " scaffolding " which was colonized with two

types of cell from the recipient: cartilage cells (chondrocytes) and

epithelial cells. The cartilage cells were grown from the recipient's

own stem cells and the epithelial cells were taken from a healthy

part of her trachea.

The doctors then performed an operation that took out the damaged

section of the patient's airway - the left main bronchus that joins

the windpipe to the left lung (this had collapsed irreversibly, known

as malacia) - and replaced it with the new tissue engineered graft.

Castillo had no post-operative complications and was discharged ten

days later. Four months later her graft appears normal and has grown

its own blood supply, her body has not produced anti-donor

antibodies, and she is not taking drugs to suppress her immune system.

Her health is described as good: she can walk 500 m (nearly a third

of a mile) without stopping, she can climb two flights of stairs, and

care for her children.

The authors concluded that:

" The results show that a cellular, tissue-engineered airway can be

produced with mechanical properties that allow normal functioning,

and which is free from the risks of rejection. This patient provides

new evidence that autologous cells combined with appropriate

biomaterials might provide, in future, successful functional

solutions for serious clinical disorders. "

" We think that this first experience represents a milestone in

medicine and hope that it will unlock the door for a safe and

recipient-tailored transplantation of the airway in adults and

children. We hope that these future patients will no longer suffer

the trauma of speech loss, severe shortness of breath and other

limited clinical and social activities, " they added.

Drs Toshihiko Sato and Tatsuo Nakamura, from the Institute for

Medical Sciences at Kyoto University in Japan wrote in an

accompanying comment that this achievement in such difficult

circumstances should be highly regarded, but they cautioned that more

follow up over longer periods of observation were still needed

to " better evaluate the results " of the findings.

" Clinical transplantation of a tissue-engineered airway. "

Paolo Macchiarini, Philipp Jungebluth, Tetsuhiko Go, M Adelaide

Asnaghi, Louisa E Rees, Tristan A Cogan, Dodson, Jaume

Martorell, Silvia Bellini, Pier Paolo Parnigotto, Sally C Dickinson,

P Hollander, Sara Mantero, Conconi, A

Birchall.

The Lancet, Early Online Publication, 19 November 2008

doi:10.1016/S0140-6736(08)61598-6

Click here for Abstract.

Sources: The Lancet.

Written by: Catharine Paddock, PhD

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

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