Lab-grown vein transplant marks another milestone in stem cell research
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The core team that performed the procedure was led by Dr Suchitra Holgersson, a transplant medicine scholar originally from Mumbai, and included four other doctors from India. The landmark transplant was published in the British medical journal The Lancet on Thursday.
The child had a blockage in her extrahepatic portal vein, which was obstructing blood supply to her liver. Options available to doctors included a liver transplant or taking a vein graft from the umbilical cord of a donor, which would have led to lifelong dependence on immunosuppressants.
A third alternative was to graft another vein — usually from the leg or neck — onto the liver vein. This is associated with risks of lower limb disorders, and was not considered a viable option due to the girl's young age.
Speaking to The Indian Express by telephone, Dr Holgersson, a professor in the department of transplant and regenerative medicine at Sahlgrenska Science Park in Gothenburg University, said: "We took a 9-centimetre graft from a deceased donor and removed all its original cells, leaving a hollow piece of vein. We then extracted stem cells of two kinds from the bone marrow of the little girl — endothelial and smooth muscle cells — gave it necessary growth factors, and let it incubate for two weeks."
This "manufactured vessel" was then transplanted into the girl. "Blood flow to the liver started immediately after the procedure, and since the stem cells were the patient's own, there was no fear of an adverse immune reaction either, and she needs no drugs," Dr Holgersson said.
A year after the procedure, the girl is a "happy child", Dr Holgersson said. "She had been repeating classes for the last few years, but now she goes to school regularly, her father says she has been doing somersaults, and she is generally very happy."
Dr Holgersson — a graduate of Mumbai University who moved to Sweden for an M Sc. and has been working on transplant medicine for 25 years — and her team see the success of the procedure as a breakthrough that would pave the way for manufacturing other blood vessels and, eventually, organs.
But she cautions against jumping to conclusions. Even in this particular case, blood flow from the artificial vessel was obstructed nine months after the procedure — when it started pushing against the colon — and a second manufactured vein had to be transplanted.
"We need proper controlled clinical trials, this was just one case. Especially in a country like India, with so many fly-by-night operators promising miracles through stem cells, this achievement should be dealt with some caution before it is used commercially," Dr Holgersson said.
The team will travel to India in September to meet doctors and visit centres for likely partnerships in multicentric global trials to develop the procedure further.
"If all goes well, we are also looking at the first manufactured lung transplant within a year at our centre. But now we think our success has to be validated by global trials, and considering the vast disease profile of India where stem cell procedures could help, if performed scientifically, we think it will be very good for India to participate," Dr Holgersson said.
An accompanying comment by doctors from the University College of London (UCL) has, while acknowledging the promise of the procedure, raised questions about its cost. The procedure, estimated to have cost $ 6,000- $ 10,000, was funded by the Swedish government. UCL's Martin Birchall and George Hamilton added, however, that such procedures were likely to get cheaper with wider use.
Indian experts in transplant medicine hailed the achievement but cautioned against seeking "quick solutions". Dr N K Mehra, head of transplant immunology at AIIMS, said, "Many institutions were trying to achieve this feat and trials had been under way with animals, but this is the first significant breakthrough in humans. It will open the floodgates for a whole new channel of treatment with stem cells, and it is great that an Indian-origin scientist has managed it."
A senior official from the Indian Council of Medical Research, who has been working on national guidelines for stem cell research, said, "We are having a hard time regulating 'magic' stem cell solutions in chronic disorders in neurology and cardiovascular diseases. With such an achievement, we are moving to a whole new era of stem cells in manufactured organs and vessels. Indian patients must do well to remember that this achievement has not been backed up by any population based controlled clinical trials so far."
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