Pediatric Stem-Cell-Based Tracheal Transplant Viable
(HealthDay News) – Pediatric stem-cell-based, tissue-engineered tracheal transplant seems to be feasible, with positive outcome at two years of follow-up.
Martin J Elliott, MD, from the Great Ormond Street Hospital in London, and colleagues reported two-year follow-up findings after a stem-cell-based tracheal replacement in a 12-year-old boy who was born with long-segment congenital tracheal stenosis and pulmonary sling. Bone marrow mesenchymal stem cells were retrieved preoperatively and seeded onto a cadaveric donor tracheal scaffold, together with patches of autologous epithelium. Cytokines were used to encourage angiogenesis and chondrogenesis.
The researchers found that, within one week after surgery, the graft revascularized. For the first eight weeks after surgery a strong neutrophil response was noted locally, which generated luminal DNA neutrophil extracellular traps. Cytological evidence of the epithelium restoration was seen at one year. The graft had biomechanical strength from 18 months, and since then the patient has not needed any medical intervention. A chest computed tomography scan and ventilation-perfusion scan were normal at 18 months after surgery, at which point the patient was found to have grown 11cm in height since the operation. A functional airway was seen at the two-year follow-up, at which point the patient had returned to school.
"Urgent research is needed to convert one-off, compassionate-use successes, such as the one described in this study, into more widely applicable clinical treatments for the thousands of children with tracheal stenosis and malacia worldwide," the authors write.