April 04, 2006
First Bioengineered Bladders Work In Humans
Grown from one's own cells in a laboratory, bioengineered replacement bladders work in humans.
WINSTON-SALEM, N.C. -- The first human recipients of laboratory-grown organs were reported today by Anthony Atala, M.D., director of the Institute for Regenerative Medicine at Wake Forest University School of Medicine. In The Lancet, Atala describes long-term success in children and teenagers who received bladders grown from their own cells.
“This is one small step in our ability to go forward in replacing damaged tissues and organs,” said Atala, who is now working to grow 20 different tissues and organs, including blood vessels and hearts, in the laboratory.
The engineered bladders were grown from the patients’ own cells, so there is no risk of rejection. Scientists hope that laboratory-grown organs can one day help solve the shortage of donated organs available for transplantation. Atala reported that the bladders showed improved function over time -- with some patients being followed for more than seven years.
The study involved patients from 4 to 19 years old who had poor bladder function because of a congenital birth defect that causes incomplete closure of the spine. Their bladders were not pliable and the high pressures could be transmitted to their kidneys, possibly leading to kidney damage. They had urinary leakage, as frequently as every 30 minutes.
The lab is working on growing bioengineered hearts and pancreases.
The success is the culmination of an idea that the team began exploring 16 years ago. Atala adds that they are also working on growing bio-engineered hearts and pancreases in the lab.
Why can old cars run for decades longer than their original design? Because when their parts break they can be replaced. Same will be true for humans. This isn't a distant science fiction fantasy. Growth of replacement organs will become very commonplace in the first half of the 21st century.
Update: The cost of growing the bladder is $4000 per patient (though the New York Times quotes an even higher figure of $7000). That doesn't include the cost of the surgery to implant it or other fees for doctors. The bladder grows on a scaffold.
To grow new bladder tissue, his team biopsied cells from the muscle and lining of the bladder walls in individual patients. These cells were cultured in the lab, then seeded onto a specially constructed, biodegradable mould, or scaffold, shaped like a bladder.
Over the next two months, the cells continued to grow into the mould, which was then sutured to the patient's original bladder. (The mould degrades as the bladder tissue integrates with the body.)
Cost is a big problem, especially since all the organs age and will need either replacement or rejuvenation in place. The ability to grow replacement organs in pigs genetically engineered to have many human genes will some day greatly lower the costs of making replacement organs..The work of genetically engineering pigs for this purpose ought to receive much higher levels of funding.
Stem cell therapies, gene therapies,and assorted nanotech devices will eventually provide the means to repair and rejuvenate organs in place.
80 researchers are working at Wake Forest to develop this same technique to grow other types of organs.
Dr. Atala added that 80 researchers in his regenerative medicine institute at Wake Forest were trying to apply the scaffolding techniques to build new hearts, livers, kidneys, pancreases, nerves and other tissues.
The huge historical turning point where human bodies become repairable is within sight.
Yes, this is all very good. Maybe I can start a company where I grow organs for people. My customers come in, pay a fee, and deposit some cells. I then culture those cells and grow organs for them for transplant. When I lived in Taiwan in 2000, there was a guy (Dr. Tsai) who figured out how to grow corneas for people. He could make them big, like 4-5cm in diameter, way bigger than is needed for transplant.
Anyways, the next trick is to figure out how to get the body to regenerate itself, in sitsu. That way, you don't need to grow the organs and other tissues in a vat, then transplant them into the recipient by hiring an expensive transplant surgeon.
I'm waiting for the "Grow a Heart" home hobby kit. I can just see it now: you harvest the cells and place them carefully in the growth matrix. You provide purified, sterile water, growth medium and trace chemicals (careful: don't over feed!). Every day, you come home, tap the side of the tank and watch your little heart growing inside. Once it gets big enough, you carefully attach the electrodes and start it pumping, easily at first, then more strenously - have to build up those muscles!
After months of patient waiting, your heart is ready. You carefully put the kit on the carseat next to you (better belt it in!) and drive down to the surgery center. They test your heart and, if everything is a go, they crack your chest and install it. By the next day, you're up and walking around with your new, unclogged, healthy heart.
Next: a new liver to make up for all that bourbon!
First, just a little housekeeping. I posted on this article early in the day on another forum and used the spelling, pancreases for more than one pancreas. I was quickly corrected....more than one pancreas are correctly referred to as pancreata.
Great article and turn of events, though. Especially the part about the 80+ reasearchers working on growing a whole host of organs. I've got a close friend who was just diagnosed with pulmonary fibrosis which acts much like emphasema.....you eventually suffocate. His is not advanced yet so he's got some time left and is very heartened by this news. If you can grow bladders, pancreata and even hearts, it stands to reason that you should eventually be able to replace diseased lungs with healthy pink ones. My buddy certainly hopes so.
I support a shift toward more consistent and intuitive styles of spelling. Hence I'll spell pancreases and to hell with the Latin spelling. Why make the language harder to use? I do not see the point of it.
I sincerely hope for your buddy's sake that replacement lungs come in time to save him. Tell him to write to all his elected representatives arguing for more funding to do tissue engineering
Great news.. this almost sounds too good to be true. But if true we are ahead of even where I thought. Also it appears to be largely state funded. I'm a libertarian but the US model of massive rewards for innovation through strong patents.. AND substantial decentralized state financing of research is really an engine of progress.
Regenerative medicine is one of the next paradigms in human health. Along with gene therapy.
The update mentions the cost of the replacement organs. I suggest the estates of deceased organ donors should receive compensation for organs to level the playing field.
Hmmmm, but then again... what are the costs of anti-rejection medicines and the costs of diseases that take advantage of the immunosuppression?
Growing new bladders is an important breakthru.
But I see two problems with the actual experiment.
One: The bladders were regrown and placed into patients with meningomyelocoels. Fine. But people with meningomyelocoels have Neurogenic bladders: Their bladders are actually okay at first, but don't work because there are no nerve connections...and eventually the bladders are destroyed by infection etc.
So if they replace the bladders, won't the same thing happen?
Two: The patients ranged from age 4 to 19...
Which means they experimented on underage children...this is acceptable in life and death situations, but this is not life and death...the kids could live 30-40 years with an ileal loop...and the scientist could have used paraplegics over age 18 for their experiments, so why didn't they?
The children were at increased risk of kidney damage due to their bladders and existing treatments didn't work. Given their risks of kidney failure they seem good candidates for such experimental treatments.
I am very interested in bio engineered bladders as my daughter is spina Bifida. At the moment in Malta they only mention Bladder Augmentations using intestines which I am not so much convined on it at all. Talking with Pediatric Surgeaons in Malta, they said that would pass other 20 years before bladder engineered bladders have a safe warrant around the world.
Meantime, my daughter has got a vesicostomy to preserve her kidneys and avoid UTIs. The only thing that worris me that if I wait for bio engineered bladder, would that be too late for my daughter or still it can be done as her bladder is shrinking due to continious voiding of the vesicostomy, but obviously it cannot never vanish at all. Would that be enough (let say 5 or 10ml capacity bladder) for you to get tissue and grow a new bio engineered bladder.
Please if you can answer me back, I would really appreciate it.
Thanks alot and keep up the very good work. Hope you have infinite funds for your research work.
This article interests me because my daughter has a heart defect. In a few years, if all goes as the cardiologist thinks, she will need a new heart valve. What are available now are: mechanical valves that require blood thinners or porcine valves that only last a few years. Blood thinners are not a good choice for a child, especially with low white blood cell count. Open heart surgery every few years is not a very good option either! We are hoping for self-tissue valves to be available when my daughter needs the replacement. Even now, cardiac surgery has advanced enough that the aortic valve can be replaced by catheter. Perhaps in a few years, the mitral valve can be replaced by catheter too.
Thank you for the information!