Airway Transplant Aided by Stem Cells a Medical First

(HealthDay News) -- In a medical first, a 30-year-old mother of two has successfully undergone the first transplantation of a breathing passage fashioned from a donor's airway and her own stem cells, researchers report.

As of now, the woman, Claudia Castillo, who lives in Barcelona, Spain, with two children aged 15 and 4, does not need immunosuppressive drugs to prevent rejection of the new organ.

She reported that she is able to take care of her two children, can climb two flights of stairs, and even go out dancing some evenings.

"The possibility of avoiding the removal of my entire lung and, instead, replacing only my diseased bronchus with this tissue engineering process represented a unique chance for me to return to a normal life that I am now enjoying with my children and family," Castillo said in a news release.

The doctors who performed the procedure -- from the Hospital Clinic of Barcelona; the University of Bristol, in England; Politecnico di Milano, in Italy, and the University of Padua, in Italy -- reported the feat online Nov. 19 in The Lancet.

"This was a really good opportunity to demonstrate the effectiveness of adult stem cells, which don't have the issues of immunological rejection," said Paul Sanberg, distinguished professor of neurosurgery and director of the University of South Florida Center for Aging and Brain Repair in Tampa. "We clearly need to find ways to really help patients and move into the clinic in these devastating diseases. This demonstrated the utility of bioengineering."

Other experts issued some words of caution.

"Success or failure depends on how much stem cells can take over the function of the donor cells, which have a certain life span. Stem cells have, in theory, a longer life span," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. "There are more questions in my mind than answers to this, and it's difficult to be able to say, this is definitely the dawn of the future, and this is going to work. We have to see if it's going to work and works in more patients before we can say this is a mainstream approach."

Four years ago, Castillo developed a cough that wouldn't go away; it was eventually diagnosed as tuberculosis. That cough led to a collapsed lung.

By March of this year, Castillo's condition had deteriorated to the point where she was unable to care for her children. Removing a lung was one treatment option, which would have allowed her to live, but seriously impaired her quality of life.

Instead, Castillo received a "new," bioengineered airway.

The scientists essentially created epithelial and cartilage cells from stem cells from Castillo's own bone marrow. Those cells were put on a 7-centimeter piece of trachea from a 51-year-old woman who had died of a brain hemorrhage. Four months later, the scientists had a "hybrid" organ that they used in June to replace Castillo's left main bronchus, which connects the main trachea (windpipe) to the left lung.

The donated organ underwent 25 "washing cycles" to remove donor antigens, which could cause the new tissue to be rejected by the recipient.

Castillo suffered no complications from the surgery and left the hospital 10 days after the procedure.

Tissue bioengineering has already been used to provide organ replacements in other parts of the body, but not in the airway, the study authors said.

"Hopefully the [stem] cells of this woman that were mixed will somehow coat or become integrated [with the donated trachea] so the graft won't be rejected with the assurance that most human tissues are," Horovitz said. "This is the first transplant of this kind. You're using stem cells as an immune modulator, almost to convert the organ from what it was to what you want it to be."

Dr. Ronald Kuppersmith, clinical assistant professor of surgery with the Texas A&M Health Science Center College of Medicine, called the new procedure "exciting" because the "patient didn't have to take immunosuppressant medication."

This approach could eventually have a role in patients who are dealing with weakened immune systems, such as lung cancer patients, he said.

"They could remove the lung, reconstruct it and not have to put them [patients] on something that would lower the immune system," Kuppersmith said.

More information
The U.S. National Institutes of Health has more on stem cells.

My Immune System Confronts a Virus

After a stem cell transplant, it's a little scary to run into a familiar old enemy
by Jason Carpenter

As I reached Day 21 of my stem cell transplant, my recovery hit a very scary wall. I woke up with a fever of 102 and could barely lift my head off my pillow. I felt that little tingle in the back of my throat and knew right away what it was: the common cold.

For a stem-cell-transplant patient, though, a cold is anything but common. Quoth the International Myeloma Foundation: “Even a minor infection...can lead to serious problems because the body’s immune system is so weakened by the effects of the high-dose chemotherapy and the loss of blood cells.”

Translation: I could die. Continue reading »

A Bone Marrow Disease With a Brighter Prognosis

(HealthDay News) -- Blood is life. And the rare disease known as aplastic anemia robs the body of life by robbing the body of blood.

The aplastic anemia patient's blood thins as the bone marrow slows its production of blood cells. The results can range from chronic fatigue to heart disease or from endless infections to cuts that won't clot, depending on the type of blood cells that are lacking.

But there's hope: Considered fatal as recently as two decades ago, aplastic anemia is becoming a far more manageable disease. Advances in drug therapies and improvements in the field of transplantation have slashed the death toll, allowing patients to live longer, fuller lives.

"We are getting better at treating aplastic anemia, either in getting rid of it or treating its symptoms," said Dr. Jaroslaw P. Maciejewski, with the Cleveland Clinic's Department of Hematologic Oncology and Blood Disorders.

And those advances are helping doctors gain greater insights into other, more prevalent, health conditions, such as heart disease and leukemia.

An estimated 50,000 people develop aplastic anemia in the United States each year, according to the U.S. National Institutes of Health. (A related blood disorder, myelodysplastic syndrome, or MDS, occurs when the bone marrow begins to produce poorly functioning or immature blood cells. About 20,000 to 30,000 new cases of MDS occur each year.)

It's important to note that many symptoms of aplastic anemia, such as fatigue and infection, can also be caused by other diseases, said Dr. Ronald Paquette, a blood disease researcher with the University of California, Los Angeles' Jonsson Comprehensive Cancer Center.

"If everyone who was fatigued thought they had aplastic anemia, we'd be swamped," Paquette said.

Bone marrow -- the spongy material inside bones -- produces stem cells that normally develop into the three main types of blood cells -- red blood cells, white blood cells, and platelets.

"Essentially, the bone marrow is a factory of blood," Maciejewski said.

In patients with aplastic anemia, the stem cells have been damaged, slowing or stopping the production of all blood cells.

The cause of the damage to stem cells remains unknown in more than half of people with aplastic anemia. Some research has suggested that stem cell damage occurs when the immune system attacks the body's own cells by mistake, according to the National Institutes of Health.

Aplastic anemia has also been linked to exposure to toxins such as pesticides, arsenic and benzene. Some infectious diseases also can cause the disorder, including hepatitis, Epstein-Barr virus, cytomegalovirus, parvovirus B19, and HIV, as well as autoimmune diseases like lupus and rheumatoid arthritis. Finally, some genetic disorders have been linked to it.

Symptoms vary depending on the type of blood cells in shortage:

• Too few red blood cells can mean not enough oxygen is carried to the body, according to the NIH. People who have a low red blood cell count often feel tired. Because the heart has to work harder to pump blood to get enough oxygen to the body's organs and tissues, heart disease can develop over time.
• Too few white blood cells weaken the body's defense against infection. The patient may become ill more often, and the illness can be severe.
• Too few platelets hamper the blood's ability to clot. Patients with a low platelet count may bruise or bleed easily, and their bleeding may be hard to stop.
• Once aplastic anemia is detected, swift treatment is essential, Paquette said. "Because it's a rare disease, it's important to be treated at a specialized center," he said. "The most important thing is to be seen by someone with a lot of experience treating the disease early on."

For patients younger than 30, stem cell transplantation is often the preferred treatment. For those with a matched sibling donor, stem cell transplantation replaces the defective bone marrow with healthy cells, and as many as 80 percent of patients enjoy a complete recovery, according to the Aplastic Anemia & MDS International Foundation Inc.

Advances in stem cell research and anti-rejection drugs have meant that transplantations from unrelated donors also are becoming more successful, Paquette said.

One promising avenue of treatment involves transplantation using stem cells harvested from the umbilical cord of new mothers. "The cells can be cryopreserved [frozen] and saved, then given to unrelated donors," Paquette said. "It's quite encouraging."

For these patients, again, speed is of the essence. "The data show the earlier you do a transplant, the better the outcome," Paquette said.

Patients whose transplants fail, or for whom transplantation is not an option, often receive successful immunosuppressive therapy with agents like anti-thymocyte globulin and cyclosporine. Response rates typically range from 70 percent to 80 percent, according to the Aplastic Anemia & MDS International Foundation Inc.

Blood transfusions from matched donors also are used to keep blood counts high and help relieve symptoms, although they are not an effective long-term treatment.

"Whether we cure the disease or not, patients are getting better across the board," Maciejewski said. "We now can maintain life, keep these patients alive longer."

More information
To learn more, visit the Aplastic Anemia & MDS International Foundation Inc.