A ten-year-old British boy has become the first child to be given a new windpipe, which will grow inside his body, created from his own stem cells. The breakthrough surgery was conducted at Great Ormond Street Hospital for Children in London on Monday, and doctors hope that it represents the next step forward in transplantation technology.
Stem cells taken from the boy’s bone marrow were injected into a fibrous collagen “scaffold” created from a donor trachea. Only hours after the boy’s cells were mixed with a growth medium and applied to the scaffold, the trachea was stripped of the donor cells and implanted surgically into the boy.
Doctors are optimistic that the new implant will begin naturally to grow new internal and external tracheal cells inside the boy’s body. Previously, organs created from stem cells had all been grown outside the body in the lab, a process that can take months. Dr. Mark Lowdell from the Royal Free Hospital called the procedure “embarrassingly simple.”
The boy, whose identity is being kept secret, is reported to be doing well and is breathing normally. A genetic defect left the boy with a windpipe only one millimeter across. A metal implant that had assisted his breathing was pressing into his blood vessels, leaving him open to potentially life-threatening accidental bleeding.
One of the major drawbacks to traditional donor transplant organs, apart from the ethical implications, is the problem of immune system tissue rejection. Recipients of donated organs must remain on drugs that suppress the immune system response and that can shorten life expectancy. The new trachea, created from the boy’s own cells, completely circumvents this problem, the physicians said.
The work in England builds on the successful transplant of a partial trachea in Spain on a woman in 2008. Claudia Castillo received a section of a new tracheal airway rebuilt from stem cells, but using a much more complex and costly process.
Surgeons called the procedure a “milestone moment” in the development of transplant medicine, noting that because the whole procedure had taken only hours to complete, it cost only tens of thousands, not hundreds of thousands of pounds, bringing it inside the practical realm for patients.
Professor Martin Birchall, the head of translational regenerative medicine at University College London and part of the boy’s transplant team, told media, “It is the first time a child has received stem cell organ treatment, and it’s the longest airway that has ever been replaced.”
Dr. Birchall said there needs to be more research to demonstrate the process can work again, but added, “We’d like to move to other organs as well, particularly the larynx and esophagus.”
Professor Paolo Macchiarini of Careggi University hospital in Florence, who was also involved, said, “The question is do we really need to transplant the entire organ and put the patient on immunosuppression or can we stimulate stem cells to make it function again?”