Put that organ in a plastic bag!

November 19, 2008 10:35 AM

Claudia Castillo's new bronchus is the result of stem-cell research. The first hollow tube body part is transplanted with no rejection issues. A lab in Italy stripped the donor trachea of living tissue leaving a collagen matrix. Claudia's stem cells were grown in a Bristol lab, (all 6 million of them) to flesh it out, so to speak. Epithelial cells from her nose & lungs formed the lining. But......

.........the ground-breaking transplant almost didn't happen. Despite Prof Martin Birchall clearing it with EastJet management in advance, when the medical scientist turned up with the organ at the airport, they would not allow him to board.
What next? Bone banks are becoming routine, as are Corneal transplants. Prof Birchall thinks we are 20 years off every major hospital having a stem-cell production line facility for many, if not most organs.

posted by Wilder (36 comments total)

That's great news for me, some of my parts are starting to wear out and my warranty is darn near up! Thanks Wilder.
posted by Mister_A at 10:48 AM on November 19, 2008

Tracheawesomey.
posted by solipsophistocracy at 10:48 AM on November 19, 2008 [5 favorites]

Think about that for a minute. They took a donor trachea, washed the living cells off of it, then bathed it in her cells formed from her stem cells. Just let that roll around in your mind's eye for a minute. The woman has a foreign matter in her body and she's not taking immune supresssants and it's working fine!

Fuck flying cars. The future is here and it's amazing.
posted by cavalier at 10:51 AM on November 19, 2008 [4 favorites]

Amazing is exactly the word.

Now I want to see President Obama and his clear Democratic majority in both houses bring this type of research and treatment to our side of the pond.
posted by paisley henosis at 10:56 AM on November 19, 2008 [1 favorite]

I just noticed the "futurespareparts" tag. Well played.
posted by paisley henosis at 10:57 AM on November 19, 2008

It's not really that foreign, though, if it's just the collagen matrix, right? Without the immune markers, it's functionally equivalent to some bit of collagen from her own body. How long until we can simply manufacture matrices and not have to worry about donors?
posted by adamdschneider at 10:59 AM on November 19, 2008

I'd like to be a barritone. Any way they can hook me up with a new larnyx?
posted by Pollomacho at 11:00 AM on November 19, 2008

See if she'll get into heaven with her sinful throat.
posted by mazola at 11:04 AM on November 19, 2008 [3 favorites]

I'd like to be a barritone. Any way they can hook me up with a new larnyx?

OK, here you go: larynx.
And we'll do baritone at the same time, at no charge.
posted by weapons-grade pandemonium at 11:08 AM on November 19, 2008 [1 favorite]

I'd like to be a barritone. Any way they can hook me up with a new larnyx?

Tom Waits will make a fortune in the new economy.
posted by tkolar at 11:10 AM on November 19, 2008

This is pretty cool news, but I thought that TB patients' problems with breathing stemmed from the damage to their lungs and bronchi. A quick perusal of Wikipedia indicates that disseminated TB also occurs but it's unclear to me how replacing this woman's trachea resulted in a cessation of her symptoms, especially when the alternative was to remove one of her lungs. Might someone more knowledgable be willing to clarify or speculate as to why this course of treatment made sense?
posted by ooga_booga at 11:13 AM on November 19, 2008

well, it started out as a trachea in the donor but became a slightly larger than normal bronchus in the recipient. Because they had to sew it to the tracheal bifurcation, which is a larger diameter, the larger size was ideal.
(Ya'know if you want to be a baritone you just have to drink whiskey, smoke lots and live HARD!)
posted by Wilder at 11:22 AM on November 19, 2008

My hollow tube parts don't need any augmentation, but great news anyway.
posted by DU at 11:22 AM on November 19, 2008

Hey doc, whip me up a couple of these and graft, graft, baby!
posted by CynicalKnight at 11:24 AM on November 19, 2008

Ooga_booga, she had an unusual complication of TB with an extreme narrowing of her left main bronchus. There is still damage to her lungs but her left lung has now become usable again because the main air passage has been replaced. The donor trachea did not replace her trachae, it made her a new left bronchus. This shows it better than I can explain.
posted by Wilder at 11:30 AM on November 19, 2008

I wonder if this will mean anything in the future for actual bronchial transplant/repair. The cure for emphysema being replacement of the damaged bronchial passages that cause airway constriction. Lung cancer? Replacement lung, grown from stem cells instead of straight donation.

An interesting option.
posted by daq at 11:31 AM on November 19, 2008

Larry Niven predicted this -- including the part about getting rid of live donor cells -- back in 1967, in the short story "The Jigsaw Man". Well, almost.
posted by rpresser at 11:34 AM on November 19, 2008

I said I needed a new larynx, we can work on my spelling problems later!
posted by Pollomacho at 11:40 AM on November 19, 2008

paisley henosis, mazola: this was an adult stem cell treatment, no ESCs necessary. It's unfortunate that the distinction isn't often made in the media, but there you go.
posted by darkwing at 11:51 AM on November 19, 2008 [3 favorites]

Larry Niven also predicted Gil Hamilton of A.R.M. would be able to pick up things with his severed phantom limb.
posted by Astro Zombie at 11:52 AM on November 19, 2008 [1 favorite]

So, if this could happen here in the US of A and I had a nasty case of heart disease. How would this work for me? How much would it cost if it were to happen right now. Would this be something covered by insurance?
This is great and all, but can a regular ol' Joe like me take advantage of this new technology?
posted by NoMich at 11:55 AM on November 19, 2008

welcome to Metafilter Darkwing! I should have realised that Embryological stem cell research is a hot button topic in the USA and made it clear in the original post that these stem cells were from the marrow of her own pelvis.
I'll bow out now, just to say that talking to groups of surgeons in the UK here today it is clear that what really has them talking is the fact that the tube only made it to Barcelona once the researcher realised he knew a cardiothoracic surgeon in Germany who happened to have his own plane. He rang him up with 10 hours to go and the guy hopped in his plane, picked them up in Bristol and flew them to Barca to do the op. (He charged them £14,000 which the Prof had to pay out of his own pocket, but that's another story)
posted by Wilder at 12:03 PM on November 19, 2008

sorry, just to clear, this is very much an Italian success story, with Prof Paolo Macchiarini performing the surgery, and the Milan & Padua labs doing the critical first stages. It's just here in the UK at the moment the focus is very much on the Bristol side of the joint effort.
posted by Wilder at 12:10 PM on November 19, 2008

Thanks Wilder! That helps a lot!

I only hope that this new technique will help the Democrats in Congress to grow a spine.
posted by ooga_booga at 12:36 PM on November 19, 2008 [1 favorite]

I particularly enjoyed this bit:

The airline had said it would carry the cells, but on the day check-in staff refused, leading medics to charter a private jet for £14,000.

Easyjet said it had no record of the request, but would refund the doctors.

I presume that by "refund", they mean refund the cost of the low-cost ticket, a couple of hundred pounds at the very most, not the 14,000 of the private jet. WTF Easyjet? And what is Ryanair waiting for to make fun of them?
posted by Skeptic at 12:40 PM on November 19, 2008

(Ya'know if you want to be a baritone you just have to drink whiskey, smoke lots and live HARD!)

Hasn't worked for me yet.

Wilder, I am pretty sure mazola was snarking, but admit, it's hard to tell sometimes.

I doubt you'll see much against stem cells (adult or otherwise) on metafilter.

The video seemed to be of a very nice woman.
posted by cjorgensen at 1:14 PM on November 19, 2008

Oh, and Wilder, was that duct tape at minute 1:40 of the video you linked to? Cover the beakers?
posted by cjorgensen at 1:15 PM on November 19, 2008

cjorgensen, it's duct tape I guess but it indicates by the colour of the stripes whether something has been sterilised or not. The stripes turn from yellowish, almost invisible to brown once it's sterile. Routine in labs.
posted by Wilder at 1:35 PM on November 19, 2008

I wonder if this will mean anything in the future for actual bronchial transplant/repair. The cure for emphysema being replacement of the damaged bronchial passages that cause airway constriction. Lung cancer? Replacement lung, grown from stem cells instead of straight donation.


The tissue to be replaced would be the alveoli rather than the bronchi, but the basic technique sounds feasible. In fact, one of the areas of research that Dr. Macchiarini is working on is an artificial lung, based on the articles he has published.

This is really exciting; there are a number of conditions (trauma, cancer, and a host of less common diseases including the rare but fatal tracheal atresia) that could benefit from this type of surgery; there have been no artificial substitutes for the trachea that that work very well; it is more complex than simply a hollow tube. If the site of surgery scars down too much you end up obstructing the airway and dying, for example.

Any way they can hook me up with a new larnyx?

Macchiarini is apparently working on that as well. Unfortuantely it appears the whole paper is not publicly available, but I am able to get it at work and in it he makes a good case for tissue engineered airways. One of the big advantages is that without the need for immunosuppresion they become a realistic option for cancer patients, who would probably be the majority of recipients.
posted by TedW at 2:14 PM on November 19, 2008

I'm a bit confused -- does her trachea continue to grow? If so, what about the blood vessels? How did they hook up the donated collagen+cells to the patient's circulatory system?
posted by mhh5 at 3:47 PM on November 19, 2008

~ this was an adult stem cell treatment, no ESCs necessary. It's unfortunate that the distinction isn't often made in the media, but there you go.

Oh, brilliant, thanks for the info. My understanding was that George W. had effectively banned all stem cell research, regardless of origin, but it seems that I was mistaken in that.
posted by paisley henosis at 4:47 PM on November 19, 2008

This is awesome.
posted by homunculus at 5:48 PM on November 19, 2008

I mentioned this to one of our residents tonight and he told me about Dr. Anthony Atala, who apparently does the same thing with bladders.
posted by TedW at 5:51 PM on November 19, 2008 [1 favorite]

Are you saying I can drink twice as much without having to go pee? Where do I sign up?
posted by spacewrench at 7:37 PM on November 19, 2008

I just talked to a guy this evening who is working on turning stem cells into insulin producing beta cells. He said there was some risk of teratoma if the cells aren't fully differentiated.
posted by BrotherCaine at 1:21 AM on November 20, 2008

This got reported as absolutely ground breaking, "scientific discovery of the century" stuff, but to be me it's far less impressive than the Wake Forest Institute. They have been implanting stem cell coated organs, (I think mostly bladders) for 2-3 years. They just don't use decellularised donor tissue as the scaffold.
posted by roofus at 3:16 AM on November 20, 2008