This was posted just a few hours ago on Telegraph.co.uk...

Transplant of windpipe grown from stem cells heralds new era in medicine

By Roger Highfield

The science of healing is developing so quickly that it has become almost a cliché to describe a particular operation as a "breakthrough". Yet there is no doubt that the first successful transplant of a human windpipe, constructed partly from stem cells, is an astonishing milestone – one that could indeed mark the start of a new era in medicine.

At long last, the glint in a researcher's eye has been turned into a significant advance in the clinic. Forget all the fuss about embryos and angst about playing God: this is unadulterated good news. We have proved that scientists can now fashion organs using a patient's own cells, eliminating the problems with rejection that have always plagued transplants. Today it is a trachea – tomorrow it could be a colon, even a heart.

The venture was a textbook example of international collaboration, drawing on the talents of teams in Spain, Italy and Britain. To recap; the operation, on 30-year-old tuberculosis patient Claudia Castillo, took place in Barcelona, where doctors also had collected a three-inch segment of trachea from a 51-year-old donor who had died of a cerebral hemorrhage. They used a technique developed in Padua to strip the windpipe of its donor's original cells, a procedure that took six weeks, to create a "scaffold". At the same time, a team in Bristol used a "bioreactor" dreamt up in Milan to grow stem cells removed from Castillo's bone marrow. These cells were "seeded" into the donated windpipe, disguising the 'foreign' tissue that remained so Castillo's body would accept it as her own.

There is a desperate need for this kind of advance. In Britain, about 8,000 people are on the waiting list for an organ transplant. Around 3,200 such operations are carried out every year – but roughly 1,000 of those on the list will die before they get a transplant. And that is only the start of the problem: after a transplant, there is a high risk of rejection as the recipient's immune system reacts against the donor organ. Immunosuppressant drugs are used to limit this but their side-effects include high blood pressure, diabetes and kidney failure, vulnerability to infections, osteoporosis, and cancer. In all, the drugs cut life expectancy by an average of 10 years.

As we now know, Claudio Castillo experienced no such problems: two months after the surgery, which took place in June, her lungs were functioning just as well as those of most young women her age. The result, says Martin Birchall, professor of surgery at Bristol University, leaves us "on the verge of a new age in surgical care". But what will that new age look like? Even before this week's announcement, there has been a steady trickle of advances that reveal the potential of this medical revolution. There are attempts to free insulin-dependent diabetics from reliance on needles, by using injections of their own stem cells. Trials are under way in Britain on more than 90 patients to test the use of stem cells to help repair damaged hearts. Prof John Martin of University College London who is leading the project, says things are "going well".

We can now routinely grow replacement skin (used to aid wound healing), using the foreskins of newborns, while Dr Anthony Atala, of the Institute for Regenerative Medicine at Wake Forest University in North Carolina, has made and successfully implanted segments of bladder in seven patients, aged between four and 19, who had a congenital birth defect.

Dr Atala's technique is a variation on that used to create Claudia Castillo's new windpipe. He began by taking biopsy samples of muscle cells and the cells that line the bladder walls. These were multiplied in the laboratory until there were enough to seed a special biodegradable "scaffold", shaped like a bladder, on which the cells could hang. About eight weeks after the biopsy, the "engineered" patches were sewn on to the patients' original bladders, dramatically improving their function.

The significance of the new work, however, is that the pan-European team was able to transplant an organ, albeit just a section of it. The implications are staggering: given that stem cells from bone marrow can be grown into any one family of tissues, such as muscle, bone, skin and cartilage (though not mucosal or nerve tissues), the team at Bristol University believes the same approach will allow it to recreate colons and bladders, too. With funding, Prof Birchall says that he hopes to engineer a larynx for transplant within five years.

The liver will be trickier. The plumbing and cells involved are intricate and the result of an equally complex series of stages of development. The process is further complicated by the fact that the liver also needs to have blood pumping through it at high pressure and volume to work properly. Even so, the science-fiction vision of organ farms in which spare body parts can be plucked off the rack may not be so far-fetched. "I do believe the various issues are soluble," said Prof Birchall, though he is reluctant to speculate on precisely when.

In much of this work, Europe is leading the way. "By putting our brains together," says Prof Martin, "we are ahead of the US in the clinical application of stem cells."

But remarkable work on the other side of the Atlantic is raising the possibility that the development of a replacement heart is closer to fruition than previously hoped. In January, the world's first beating, retooled "bioartificial heart" was unveiled by researchers at the University of Minnesota, an achievement that could pave the way for new treatments for the 22 million people worldwide who live with heart failure.

While there had been advances in growing heart tissue in the lab, the problem has been how to create a three-dimensional scaffold for the new cells that mimics the complicated architecture and intricacies of the body's circulatory system. That is why Prof Doris Taylor and her team in Minnesota resorted to "decellularisation": using detergent to remove all of the cells from an organ. In this case, they used the heart from an animal cadaver, leaving only the framework between the cells intact, along with the essential plumbing and heart valves.

After successfully removing all the cells from rat hearts, the researchers then took immature versions of those cells and introduced them to the decellularised heart scaffolds. Four days later, contractions were observed, and eight days later the new, partly artificial hearts were pumping, albeit at only two per cent of the efficiency of an adult heart.

Professor Taylor says that she is thrilled by the news of the trachea transplant. "We congratulate the Bristol team wholeheartedly – so to speak – and are excited to see this add credence to the technology used by our group in its research, and others around the world." The method, she believes, can be extended to virtually any organ with a blood supply: "We have made significant progress showing the utility of decellularisation for a number of organs including livers, muscle, skin and kidneys, and are well on the way to building complex new organs." Her own team is tackling the problems involved in rebuilding the vessels in the heart – critical if you are going to engineer something with a blood supply.

And then there is the astonishing potential of embryonic stem cells, the means by which Mother Nature fashions our entire bodies. Our understanding of how to guide the development of an embryonic stem cell is primitive – but unlike the bone marrow cells used in the Castillo case, embryonic stem cells can turn into any one of the 200 or more different cell types in our bodies, rendering the opportunities potentially limitless. As Prof Austin Smith of Cambridge University points out, much more work must be done to determine how to make them grow the right way, and then to mould them into organs. Even so, the potential in terms of replacement body parts – or even replacement bodies – is vast.

The path ahead is difficult: more funding and much testing, will be needed and there will inevitably be false starts and blind alleys. But in the long term, a brave new world beckons, where row upon row of hearts, kidneys and lungs are grown in sterile vessels, ready for transplant. Medically and ethically, the bottom line is simple: if we follow the path blazed by Claudia Castillo and her doctors, no one need ever die waiting for a donated organ again.

i heard about this today. completely amazing. it's like the scientists found a backdoor way into coding body parts. using another woman's organ as "scaffolding" for the transplant woman's own stem cells. good fucking news for a change. this on the same day they announced the first complete genome of an extinct animal (mammoth) has been mapped.

btw, what was that bit about using circumcision scraps for growing replacement skin? creepy.

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I didn't know about that! God, 2008 will be remembered as quite the year won't it? Seriously, I think the story above has more historical weight than a black man being President of the United States. This could be considered the first significant medical breakthrough since humans discovered how to safely perform surgeries.

I think just the same thing as the "scaffolding," but it doesn't seem like it would be useful for covering very large abrasions, does it? I'll be glad to have access to EBSCOhost again soon, and thus be able to research these things more in depth. Honestly, a lot of it goes over my head.

SCIENCE IS GONNA STEAL MY BAYBEEES!

It was pretty cool actually, they showed the actual windpipe on TV, when it was mostly grown but hadn't been put in yet. It looked kinda like that weird jelly stuff you get between the pastry and the meat in a sausage roll.

So yeah, fun fact for anyone who opposes this kind of research: you're a cunt.

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I don't oppose it. I think it's pretty fucking cool,actually.
However, practicality speaks and it asks what kind of impact would this have on natural resources and job markets if everyone just kept getting new parts and not dying off?

We're pretty much in the crapper right now with what we do know at this point.

Which effectively amounts to saying:

Pragmatism can be every bit as retarded as idealism at times.

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yes. if we weren't playing God with heart transplants, we definitely are now. the above news will probably go as unnoticed as signs of life being discovered on Mars, because you know it was just a bunch of germs and stuff. nothing IMPORTANT.

it's too bad my foreskin went to waste. if i knew it could be useful
is that like some super nerdy nerdclub where the nerds get each other off? i want to look around but i'm probably not smart enough. they'll never let me in

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woah there. whatchu talkin bout?

oh yeah, it's like the lexis nexis. pure sex.
I've got connections alpha, I can get you in.
why don't you have access now Mr. Beakon? Aren't you in school?

I would doubt that. You're a rare voice of reason on KR (and reason = smart), and somewhat of a skeptic if I recall? But actually, EBSCOhost it's a database that's available to college students and libraries (and to whomever wants to pay an arm and a leg for a subscription). You can search for thousands upon thousands of peer-reviewed and case studies in any and every field. Awesome for writing academic papers and the like......or for finding out the gory details of stem cell transplants.

No, herekitty, I'm going back in January to Portland State. Yay.

well what was that thing i saw on discovery where they used a laser printer to print out a heart? using stem cells it literally printed a 3D heart??


anyway. my mom had a stem cell transplant in 1999 and it didn't work. hopefully this is for real.

also, overpopulation is a real problem. we should probably start limiting births if this is really going to take off.
and, it pains me to say it, but maybe we need to do something about fertility treatments and really push adoption. like, make it more affordable and open to single parents and gays.

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Nazi!!!

willis.
oh you academics... i don't know if i want to join your filthy little club. um, sure, hook me up?
prime crackheadedness..

i think this knowledge should be FREE. i understand why they want money, but seriously, this is like paying premium for lima beans. we need to encourage enlightenment, not put a price on it

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On a related note, can the scientific types agree that, when we're accused of playing God by pseudo-ethicists, they will as one declare: "We are not playing God, we are playing WIZARDS."

I dunno, I just figure God doesn't and shouldn't have the monopoly on doing cool things.

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Let's get everyone fed first, then we'll talk.

And so on.

This was basically my point: you don't get to just let people die* in order to solve problems. If politics were that easy, we'd all be doing it!


*unless you can make it look unavoidable.

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