Claudia Castillo, the patient in the ground-breaking operation. Photo: AP
PARIS — Physicians at four European universities have completed what they say is the first successful transplant of a human windpipe using a patient’s own stem cells to fashion an organ and prevent its rejection by her immune system, according to an article in the British medical journal The Lancet. One of the physicians said the surgery could herald a “new age in surgical care.”
The transplant operation was performed on the patient, Claudia Castillo, in June in Barcelona, Spain, to alleviate an acute shortage of breath caused by a failing airway following severe tuberculosis. It followed weeks of preparation carried out at the universities of Barcelona, Spain, Bristol, England and Padua and Milan in Italy.
News of the procedure coincided with speculation that President-elect Barack Obama may reverse the Bush Administration’s restrictions on stem cell research, which has been contentious in some European countries, too. Anthony Hollander, a professor at Bristol University, said ethical concerns relating to embryonic stem cell research had not surfaced in the latest procedure because it had used only the patient’s own stem cells. “This was not embryonic stem cell research,” he said in a telephone interview.
Ms. Castillo, 30, was hospitalized in March with her windpipe so badly damaged by tuberculosis that she was unable to walk more than a few steps at a time, according to a statement from Bristol University.
“The only conventional option remaining was a major operation to remove her left lung which carries a risk of complications and a high mortality rate,” Bristol University said.
The surgery represented what the university called “pioneering work.”
“We are terribly excited by these results,” said Prof. Paolo Macchiarini of the University of Barcelona, who performed the operation. “Just four days after transplantation the graft was almost indistinguishable from adjacent normal bronchi.”
Moreover, two months after the surgery, lung function tests on Ms. Castillo “were all at the better end of the normal range for a young woman,” the Bristol University statement said.
Martin Birchall, a professor at the university, said the transplant showed “the very real potential for adult stem cells and tissue engineering to radically improve their ability to treat patients with serious diseases. We believe this success has proved that we are on the verge of a new age in surgical care.”
The Bristol University statement said a segment of trachea, roughly three inches long, was taken from a 51-year-old donor who had died of a cerebral hemorrhage. Using a new technique developed in Padua University, the trachea was stripped of its donor’s cells over a six-week period “so that no donor cells remained,” the statement said.
At the same time, at Bristol University, stem cells removed from Ms. Castillo’s bone marrow, were grown into “a large population” and used to “seed” the donated windpipe using a new technique developed in Milan to incubate cells.
Four days after the seeding, the graft was used to replace Ms. Castillo’s damaged windpipe.
Normally after transplants there is a high risk of rejection because the recipient’s immune system reacts against the foreign organ. Most transplant patients, thus, use immunosuppressant drugs to prevent rejection.
“The patient has not developed antibodies to her graft, despite not taking any immunosuppressive drugs,” the statement from Bristol University said.
By ALAN COWELL Published: November 19, 2008
Source: The New York Times
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Source: The Age
Transplant using trachea grown from patient’s own stem cells a world first
IN WHAT is being hailed as a world first that could revolutionise organ transplants, doctors in Spain have replaced a woman’s damaged windpipe using one created from stem cells in a laboratory.
Claudia Castillo, 30, a mother of two, is living a healthy life five months after receiving the transplant in Barcelona, her doctors reported in Lancet medical journal yesterday.
Scientists used “tissue engineering” to create the windpipe, or trachea – a technique that involved using a donor’s windpipe as a biological “scaffold” for Ms Castillo’s stem cells to grow around.
The donor’s trachea was essentially scrubbed clean with a high-tech detergent solution before being lined with stem cells taken from Ms Castillo’s bone marrow and cultivated in a laboratory.
Stem cells are “master cells” that can be manipulated in a laboratory to become any other cell in the body.
Professor Martin Birchall, an author of the study based at the University of Bristol in Britain, said the operation proved doctors were on “the verge of a new age in surgical care” that could radically improve surgeons’ ability to treat patients with serious diseases.
Ms Castillo, who had tuberculosis, was facing the loss of her left lung after the tube-like branch connecting it to the trachea became infected and collapsed beyond repair.
The loss of a normal airway is devastating, and attempts to replace them have met with serious problems such as rejection by the immune system, the uncontrolled die-off of cells (necrosis) and lethal bleeding.
Because Ms Castillo’s new trachea was made from her own cells, she has not needed powerful drugs to prevent her body rejecting the organ.
Avoiding the use of these drugs also means that, unlike other transplant patients, she will not be at increased risk of cancer and other diseases – another significant advance.
Scientists hailed the procedure as a medical milestone and predicted surgeons could regularly be replacing hearts with laboratory-grown organs within 20 years.
The team behind the operation hopes to replicate the procedure to grow voice boxes within five years and says that from there the door would be open to use the technology to create any organ including a bladder, kidney or even a heart.
Rodney Dilley, the principal scientist at Melbourne’s Bernard O’Brien Institute who recently created beating heart muscle cells from human fat using stem cells, said the procedure was a significant breakthrough.
“The fact that the trachea has been functional for five or six months is fabulous,” he said.
Dr Dilley said the operation was encouraging and meant scientists may now look more seriously at using biomaterial as “scaffolds” for stem cells.
Ms Castillo, who is originally from Colombia but now lives in Spain, can now look after her children, walk up two flights of stairs and even go dancing.
“I was scared at the beginning because I was the first patient, but had confidence and trusted the doctors,” she said.
“I am now enjoying life and am very happy that my illness has been cured.”
Julia Medew
November 20, 2008