The medical miracle

Mother-of-two becomes first transplant patient to receive an organ grown to order in a laboratory

Health Editor,Jeremy Laurance
Wednesday 19 November 2008 01:00

A 30-year-old Spanish woman has made medical history by becoming the first patient to receive a whole organ transplant grown using her own cells.

Experts said the development opened a new era in surgery in which the repair of worn-out body parts would be carried out with personally customised replacements.

Claudia Castillo, who lives in Barcelona, underwent the operation to replace her windpipe after tuberculosis had left her with a collapsed lung and unable to breathe.

The bioengineered organ was transplanted into her chest last June at the Hospital Clinic in Barcelona.

Four months later she was able to climb two flights of stairs, go dancing and look after her children – activities that had been impossible before the surgery. Ms Castillo has also crossed a second medical frontier by becoming the first person to receive a whole organ transplant without the need for powerful immunosuppressant drugs.

Doctors overcame the problem of rejection by taking her own stem cells to grow the replacement organ, using a donor trachea (lower windpipe) to provide the mechanical framework. Blood tests have shown no sign of rejection months after the surgery was complete.

Speaking at a press conference in London yesterday, called to announce the results, Professor Martin Birchall, an ear, nose and throat surgeon from the University of Bristol who collaborated on the case, said: "This is just the beginning. I think it will completely transform the way we think about surgery.

"In 20 years' time the commonest surgical operations will be regenerative procedures to replace organs and tissues damaged by disease with autologous [self-grown] tissues and organs from the laboratory. We are on the verge of a new age in surgical care."

Professor Birchall said the technique could initially be extended to growing other hollow organs such as the bowel, bladder and reproductive tract but could later be extended to solid organs including the heart, liver and kidneys. "They have all got scaffolds [natural frameworks] on which new cells can be grown," he said. "We will need units next to hospitals to generate the cells. The trick is turning it into a therapy for thousands of patients – [the process] will have to be automated."

Four teams of researchers collaborated on the case led by Professor Paolo Macchiarini of the Hospital Clinic and involving academic centres in Spain, Italy and the UK. The results are published today in the online edition of The Lancet.

Professor Macchiarini said: "Claudia was unable to play with her children, work or perform her normal social duties. Now she is able to do that [after the transplant]. It was and is the most beautiful gift we can perform in our career."

Two further patients, from Germany and the United States, are in hospital in Barcelona, awaiting transplants of their windpipes, which had been damaged by cancer, he said. It would take two to three months to grow the replacement organs and "put them in good shape" before operating, he added.

The surgery could be suitable for up to 3,000 patients similarly affected by damaged trachea and bronchus (the lower part of the windpipe) in Europe, and tens of thousands if it were extended to include the larynx (the upper part), researchers said.

The operation takes transplant surgery a step closer to the goal of replacing damaged or worn-out organs with functioning replacements that are not rejected by the body, which are in increasing demand as life expectancy grows. Conventional transplant surgery involving the transfer of organs from dead donors means the living recipients have to spend the rest of their lives on powerful drugs to suppress their immune systems, putting them at risk from infections and diseases such as cancer.

Two years ago, doctors in the US claimed a world first after transplanting seven patients with bladders grown in the laboratory. Yesterday, British researchers involved in the new case said that development had been a "major advance" which had "paved the way" for the new technique. But they said the bladder transplant had been of a "cellular patch" of tissue, not a whole organ.

The new technique of customising organs so that they are indistinguishable from the body's own tissues not only overcomes the problem of rejection but also greatly extends the range of organs and tissues that can be transplanted. Only one attempt had been made previously to transplant a windpipe – by surgeons in Ohio in 1998 – and the operation had not been repeated because the immune response had been too severe, requiring very heavy doses of immunosuppressant drugs. Transplant of other body parts, such as limbs, had been restricted by concerns over immunosuppression.

Professor Anthony Hollander, of the University of Bristol, said the advance had been achieved as a result of developments in stem-cell technology. "For stem-cell science, this is really exciting," he said. "Without stem cells this procedure would not have been possible."

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