Pioneering research means we could be using ‘home grown’ organs for transplant years.
ELEVEN-YEAR-OLD CIARAN FINN-LYNCH made medical history in 2010 when he became the first child in the world to have a stem-cell supported trachea transplant.
Ciaran, from County Down, was born with a very narrow windpipe and his lungs collapsed on the day he was born.
Breathing problems meant he was in very poor health. Metal stents inserted to keep his airways open had eroded his trachea and caused bleeding, and a trachea transplant was his only remaining option.
During the groundbreaking procedure, Ciaran’s own windpipe was removed and replaced by a donor windpipe laced with his own stem cells.
Stem cells are capable of developing into any type of cells and they were added to the donor organ in the hope that they would colonise the structure so his body would not reject it. The operation, carried out by a team from Great Ormond Street Hospital and University College’s London’s Institute of Child Health, was a world breakthrough.
Professor Paolo De Coppi, a Consultant Paediatric Surgeon at The Portland Hospital, led the Stem Cells and Regenerative Medicine team at the UCL Institute of Child Health. ‘We showed that we could use a donor organ as a “scaffold” to build a new trachea with the child’s own stem cells and grow it in the body,’ explains Professor De Coppi, who was recently made Chair of Paediatric Surgery at the Institute of Child Health and Great Ormond Street Hospital.
‘We stripped off all the donor’ scells leaving only a three dimensional web of collagen and the nused stem cells taken from Ciaran’s bone marrow to grow a new trachea on the structure.
‘In the past,we would have used donor transplant tissue but this would have brought with it the the risk of organ rejection. Alternatives such as synthetic scaffolds are difficult to integrate with the native tissue and do not grow with the child.’
Two years after the transplant, research published in the medical journal The Lancet revealed the graft had not triggered any immune rejection response and had formed an adequate lining.
However, most importantly, it’s helping Ciaran, now 16, to live a normal life after so many years of health problems.
‘Although the trachea is a simple organ, we hope that in the future we will be able to engineer more complex organs using stem cells including hearts, intestines, kidneys and livers,’ explains Professor De Coppi.
‘We are continuing to make advances such as our recent discovery that stem cells found in amniotic fluid surrounding the foetus show good potential for tissue engineering.The cells could one day be used to grow more complex organs which are made up of different types of tissue.
‘At the moment this work is bring done on children partly because their organs are smaller but also because they can potentially benefit the most in terms of extra years of life – each stemcell transplant costs round £250,000. In the future, they will be done on adults too.’
Professor De Coppi has recently received over £3million from the Oak Foundation, the Catapult Cell Therapy, and the UK Stem Cell Foundation to develop anoesophagus(gullet) using stemcells.
For developing this project for babies born without their oesophagus,he has been awarded this year a prestigious National Institute for Health Research (NIHR) professorship.
He is also part of a consortium awarded £10million of funding from the Wellcome Trust to develop stem cell therapies in the foetuses.
‘Congenital organ defects are usually detected in babies at the 20 week developmental scan,’ says Professor De Coppi.
‘We hope eventually to be able to harvest stem cells from the amniotic fluid of an unborn babyandgrow organs for them which will be ready bythe time they are born to be transplanted into them.
‘We hope this will happen in clinical practice within the next five years.
‘The next stage will then be performing the transplant in utero before the baby is born so they are born with everything in place.’
His team have also made progress towards engineering donated intestines so they can be implanted without rejection, but this is a more complex and challenging organ to replicate.
Other organs being studied for stem cell transplant purposes include bladder and skeletal muscle to repair congenital defects of the bladder and diaphragm.
‘We are also investigating using 3D printers to help replicate an organ and then use stem cells, polymers and gels to grow to the scaffold structure,’ he adds.
Professor De Coppi currently performs general paediatric surgery at The Portland including hernia repairs, appendix removal and treatments for gastroesophageal reflux disease and bowel problems,but says one day he hopes that stem cell organ transplants will be available at The Portland too.