British boy receives trachea transplant built with his own stem cellsBMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c1633 (Published 23 March 2010) Cite this as: BMJ 2010;340:c1633
A 10 year old British boy has become the first child in the world to receive a transplanted organ that is being rebuilt inside his body using his own stem cells.
Doctors hailed the surgery as a milestone in the development of regenerative medicine, bringing closer the prospect of replacing damaged or worn-out organs with functioning replacements that are not rejected by the body or of treating damaged organs in situ with stem cells to stimulate self repair.
The nine hour operation was carried out at Great Ormond Street Hospital, London, last week by a British and Italian team of specialists. Doctors said that the boy, who has not been identified, was out of bed, breathing freely and speaking.
Martin Birchall, a specialist in regenerative medicine at University College London, who was part of the surgical team, said, “Only a few hundred children and adults will benefit directly from this operation, but we can immediately apply the technique in other settings. It will be many years before it replaces [conventional] transplants, but it is a serious step on the way.”
The boy was born with congenital tracheal stenosis. His windpipe measured 1 mm across, and he could not breathe unaided. Over the past decade he had repeated operations but had a serious haemorrhage last November. Doctors said he had run out of options, and the revolutionary transplant was his only hope.
He was given a donor trachea that was stripped down by an enzymatic process to the fibrous collagen scaffold. The organ was injected with stem cells isolated from bone marrow taken from his hip, which were programmed with growth factors to turn into the appropriate tissues to coat the trachea’s inner and outer surfaces. The “seeded” organ was then implanted.
The operation follows pioneering surgery conducted by the same team in Spain 18 months ago on Claudia Castillo, 30, who became the first person to receive a transplant customised with her own stem cells. Her trachea, which had been damaged by tuberculosis, was replaced by one seeded with her stem cells and grown in a “bio-reactor” in the laboratory before being implanted. She remains well and has not needed immunosuppressant drugs.
In the case of the British boy the seeded trachea was transplanted immediately and will grow in the “bio-reactor” of his body, making the procedure simpler and cheaper and putting it within reach of many more centres around the world, doctors said.
The surgical team was led by stem cell pioneer Paolo Macchiarini, of Careggi University Hospital, Florence, who took charge of seeding the boy’s trachea, which was then implanted by Martin Elliott, a paediatric cardiothoracic surgeon at Great Ormond Street Hospital.
Professor Macchiarini said, “Rather than wait till an organ fails we may [in the future] be able to use stem cells to repair it—by trying to replace the function not the organ. The question is: can we avoid replacing the organ by just improving the function?”
The operation on the boy is the second in which the seeded trachea has been transplanted immediately and the third since Claudia Castillo’s. The team used the same technique of immediate implantation on a 53 year old woman in Barcelona last year and were preparing to announce the results when details of the British case leaked to the Italian media, forcing the team to hold a hastily organised press conference in London last week.
The doctors said it would be months before it was clear whether the operation on the boy had been a success.
Anthony Hollander, professor of rheumatology and tissue engineering at the University of Bristol, who took part in Ms Castillo’s treatment but was not involved in the boy’s case, welcomed the advance but said that the method was “inherently more unpredictable” than the method used on Ms Castillo.
Cite this as: BMJ 2010;340:c1633