Bioengineered trachea saved a child's life for the first time
The trachea was implanted "for growth"
The transplantation was carried out in the USA by the leading scientist of the Megagrant of the Government of the Russian Federation, Professor Paolo Macchiarini.
According to Elena Kokurina, coordinator of the project "Regeneration of the respiratory tract and lung" of the Megagrant of the Government of the Russian Federation and Shelly Dankoff, press secretary of the St. Francis Medical Center, a unique operation was performed on April 9.
The trachea grown by scientists and doctors did not replace the affected organ, but was implanted almost "into an empty place" – the patient, a little girl from South Korea Hannah Warren, was born with a rare congenital anomaly – an undeveloped trachea.
The operation was performed at the Illinois Children's Hospital of St. Francis Medical Center, USA. The international team of surgeons and researchers was led by Paolo Macchiarini, Professor of Regenerative Medicine at the Karolinska Institute (Sweden). Paolo Macchiarini is also a professor at the Kuban State Medical University and carries out a research project on the regeneration of the respiratory tract within the framework of the Megagrant of the Government of the Russian Federation.
Little Hannah was bedridden from birth and was in the neonatal intensive care unit at Seoul Hospital. Unable to breathe on her own, the girl became a prisoner of a breathing tube inserted through her mouth into her lungs.
The 32-month-old baby could not breathe, speak, swallow, eat or drink on his own. The transplant was her only chance to survive.
In order for the girl to get this chance, it took the combined efforts of many specialists in different countries – literally at every stage they had to solve new tasks. Transplant surgeons have developed the technical details of this most difficult operation. Engineers and chemists have been designing and testing various variations of the tracheal framework for a small child for many months, taking into account the fact that the child will constantly grow.
The production of a frame made of non-degradable nanofibers, as well as a bioreactor, where the primary formation of the bio-artificial trachea took place, was provided by Harvard BioScience. Biologists seeded the patient's stem cells isolated from her bone marrow onto this skeleton and studied the interaction of the skeleton with living cells. The work was carried out mainly in the USA and Sweden, but they were also attended by young researchers from the Kuban Medical University, who were interning at the Karolinska Institute as part of the Mega-Grant.
On the eve of the transplant, in March, Hannah made a 13-hour flight from Korea to the United States, accompanied by a medical team and her family: father Darryl, mother Jung–mi and older sister, four-year-old Dana. Darryl said in an interview, "Hannah is a brave amazing little girl. We are very happy, we bless God and the doctors. We've been dreaming about this for 32 months. Without this operation, our daughter would have died. It's a miracle!".
The unique operation lasted 9 hours. It is noteworthy that this is the first case in the world when a child received, with the help of tissue engineering, a bio-artificial trachea created on the basis of non-absorbable nanofibers and stem cells isolated from his own bone marrow. Since the donor organ was not used at the same time, the procedure practically eliminates the possibility of rejection of the implant.
Now, three weeks after the operation, Hannah feels well and is recovering quickly.
Photograph: St. Francis Medical Center Press Office"At the moment, Hannah is being monitored and assisted by doctors of various specialties – pulmonologists, hematologists, otolaryngologists, speech restoration specialists and many others.
We hope that in the coming months she will be able to start a normal life at home and will develop like all children," said Margaret Gustafson, president of the Illinois Children's Clinic.
"The main thing for me is that we all managed not only to save the life of this little girl, but also to give her the opportunity to eat, drink, swallow and even talk like any other child. She will stop being a prisoner of the hospital and will be able to run and play with her sister and enjoy a normal life, which is wonderful in itself!" said Professor Paolo Macchiarini.
For doctors and scientists, this case is interesting because it opens up new horizons for the development of regenerative medicine. "The Hannah project is an excellent example of the international community working together, when new methods are being created to save the life of a particular patient that will be applicable to other people in the future," said Dr. Mark Holterman, professor of surgery and pediatrics at the University of Illinois Peoria Medical College, a surgeon who performed the operation with Dr. Macchiarini.
"We have become part of this incredible combination of efforts – the most advanced pediatric care and scientific research, translational medicine to date," added Dr. Richard Pearl, chief surgeon of the clinic.
"The ultimate goal of cell therapy and tissue engineering," says Professor Macchiarini, "is that we can, avoiding organ donation and lifelong immunosuppression, replace complex tissues and whole organs with completely artificial ones created in the laboratory. And now we have taken another step forward in this direction."
For the same purpose – the study of regeneration mechanisms and the development of techniques for the creation of organs and tissues – Paolo Macchiarini led a project in Krasnodar within the framework of the Megagrant of the Government of the Russian Federation. After receiving the grant in 2011, two transplants of the trachea and part of the larynx have already been carried out in Russia using nanocomposite scaffolds seeded with patients' own cells isolated from bone marrow, which were reported by Gazeta.Ru». An international scientific, Educational and Clinical Center for Regenerative Medicine has been established on the basis of the Kuban Medical University, which has become part of a broad international collaboration.
Paolo Macchiarini answered the questions of the Newspaper.Ru»– Please explain the main secret – how will the artificial trachea grow as the child grows?
– We expect that some of the nanofibers that form the synthetic frame, polyurethane, will eventually biodegrade, and this will allow the new trachea to lengthen, so that it will live in this way for several years. Then we will have to renew the connection of the larynx with the grown-up trachea.
– Have you used new technologies for tracheal transplantation to a child?
– Yes, we used a completely different synthetic frame, and we improved this technology during two operations carried out last year in Krasnodar. Thus, the composite composition of the frame has become better: more adapted to interaction with stem cells, more durable and more flexible. Moreover, at the Kuban State Medical University, we learned how to check how many stem cells are needed to seed a transplant, how many of them survive, and what proportion of the surviving cells are functioning. So, thanks to Megagrant.
– Are you planning further operations in Russia?
– Yes, we are planning operations and starting a new program next month.
Paolo Macchiarini's press conference will take place today, April 30. The live broadcast will begin at 19.00 Moscow time, it can be viewed on the childrenshospitalofillinois website.
You can also get information on Twitter (@ChildrensHOI).
Portal "Eternal youth" http://vechnayamolodost.ru30.04.2013