Journal
LANCET
Volume 380, Issue 9846, Pages 994-1000Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/S0140-6736(12)60737-5
Keywords
-
Categories
Funding
- Great Ormond Street Hospital NHS Trust
- Royal Free Hampstead NHS Trust
- University College Hospital NHS Foundation Trust
- Region of Tuscany
- University College Hospital NHS Foundation Trust (London)
- University College Hospital NHS Foundation Trust (England)
- Region of Tuscany (Italy) [GRT 1210/08]
- UK Department of Health's National Institute for Health Research
- National Health Service National Commissioning Mechanisms
- Wellcome Trust
- Medical Research Council Translational Stem Cell Research Committee [G1001539]
- Great Ormond Street Hospital Charity
- Medical Research Council [G1001539] Funding Source: researchfish
- MRC [G1001539, G108/596] Funding Source: UKRI
Ask authors/readers for more resources
Background Stem-cell-based, tissue engineered transplants might off er new therapeutic options for patients, including children, with failing organs. The reported replacement of an adult airway using stem cells on a biological scaffold with good results at 6 months supports this view. We describe the case of a child who received a stem-cell-based tracheal replacement and report findings after 2 years of follow-up. Methods A 12-year-old boy was born with long-segment congenital tracheal stenosis and pulmonary sling. His airway had been maintained by metal stents, but, after failure, a cadaveric donor tracheal scaffold was decellularised. After a short course of granulocyte colony stimulating factor, bone marrow mesenchymal stem cells were retrieved preoperatively and seeded onto the scaffold, with patches of autologous epithelium. Topical human recombinant erythropoietin was applied to encourage angiogenesis, and transforming growth factor beta to support chondrogenesis. Intravenous human recombinant erythropoietin was continued postoperatively. Outcomes were survival, morbidity, endoscopic appearance, cytology and proteomics of brushings, and peripheral blood counts. Findings The graft revascularised within 1 week after surgery. A strong neutrophil response was noted locally for the first 8 weeks after surgery, which generated luminal DNA neutrophil extracellular traps. Cytological evidence of restoration of the epithelium was not evident until 1 year. The graft did not have biomechanical strength focally until 18 months, but the patient has not needed any medical intervention since then. 18 months after surgery, he had a normal chest CT scan and ventilation-perfusion scan and had grown 11 cm in height since the operation. At 2 years follow-up, he had a functional airway and had returned to school. Interpretation Follow-up of the first paediatric, stem-cell-based, tissue-engineered transplant shows potential for this technology but also highlights the need for further research.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available