Stem-cell-based, tissue engineered tracheal replacement in a child: A 2-year follow-up study

Department of Cardiothoracic Surgery, Great Ormond Street, Hospital for Children, London, UK.
The Lancet (Impact Factor: 45.22). 07/2012; 380(9846):994-1000. DOI: 10.1016/S0140-6736(12)60737-5
Source: PubMed


Stem-cell-based, tissue engineered transplants might offer 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.
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 β 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.
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.
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.
Great Ormond Street Hospital NHS Trust, The Royal Free Hampstead NHS Trust, University College Hospital NHS Foundation Trust, and Region of Tuscany.

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Available from: Edward R Samuel, Jan 08, 2015
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    • "There are 5 major types of scaffold materials that are currently used: (1) metals (such as titanium, although few metallic scaffolds are used due to the lack of degradability) (Ryan et al.2009; Elliott et al.2012), (2) synthetic organic materials (polymers and copolymers) (Tseng et al.2013; Lakshmanan et al.2013), (3) synthetic inorganic materials (hydroxyapatite) (Wei et al.2013; Schumacher et al.2013), (4) natural organic materials (collagen, fibrin, and hyaluronic acid) (Campbell et al.2011; Shoae-Hassani et al.2013), and (5) natural inorganic material (coralline hydroxyapatite) (Rosa et al.2008; Mygind et al.2007). Hanjaya-Putra and Gerecht have provided a detailed review of the different characteristics of each kind of scaffold. "
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    • "Tissue engineering has already found clinical applications in a number of organs including the bladder [3], urethra [4], and trachea, both in adults [5,6] and children [7]. However engineering of complex organs is still limited. "
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