North Carolina Doctor The First to Implant Lab-Grown Organs

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We are rapidly approaching a time when organ donor waiting lists and a body's rejection of donated organs will become a part of medical history. This is due to Regenerative Medicine; the practice of replacing or engineering human tissues and organs. Recently, news broke that patients have successfully received lab-grown vaginas. The study took place between 2005 and 2008 on girls who were then between the ages of 13 and 18. It was done by a team lead by Dr. Anthony Atala, MD, Director of the Wake Forest Institute for Regenerative Medicine.

The condition is called the Mayer-Rokitansky (MRKH) syndrome, which is a congenital absence, that means the babies are born with the absence of the organ. There is no opening or canal present. We picked this specific condition because it allowed us to put a new organ in a place where there had never been one before, and we could actually look at the development over time of these patients. We started doing this work a little more 20 years ago, trying to find out whether we could actually even grow the cells; you know, doing the cell biology. We embarked on the series of studies to get to the point where we could engineer these organs. We ended up doing the trials at a Children's Hospital, a joint Center with ours in Mexico City because it's a large city and there's a large population of these patients.

The new organs were built using the girls' own living cells.

What we do is we take a small biopsy of the tissue, that's a small piece of tissue less than half the size of postage stamp, and the organ is made up of two major cell types, so we basically tease the cells apart and we then grow those two cell types separately for a few weeks. We then start the process of putting the construct together by hand. We take a scaffold and we coat the scaffold with cells very much like baking layer cake if you will, one layer at a time until we will to have the construct ready three-dimensionally. It's a hollow non-tubular organ, very much like the shape of a light bulb, and then we were able to place that in an incubator, which is an oven-like device , it has the same conditions as a human body, and we were able to implant those back into the patient.

While the procedure was done several years ago, the study went on to determine the long-term functionality of the new organs.

These patients were followed very closely. They would come back for frequent visits. They had yearly x-rays. They had yearly functional questionnaires and testing that was done. Also we took small biopsies, small pieces of tissue from the engineered organs yearly and were able to show that the organs develop just like the normal organ would, and that these were able to function like normal organs throughout the duration of the study.

This success bodes well for the future of regenerative medicine, because the vagina is in a class of organs considered the second most complex of the organ types.

This same strategy we have used for a number of years to engineer many types of tissues and organs, so we kind of look at the complexity of the organ. From the least complex the most complex, with flat structure such as skin being the least complex, because they're flat architecturally they're not as complex. Tubular structures like blood vessels, for example, are one level higher complexity than flat structures like skin, for example. Tubular structures like blood vessels are slightly more complex, they're tubular architecturally, more complex, two major cell types Instead of one. The third level of complexity are hollow non-tubular organs like the stomach and the one we just implanted in these patients. And the most complex are the solid organs Like the heart, the liver, the lung, and of course we have not implanted those in patients yet.

For these young women this success has met the most important goal of regenerative medicine: vastly improving their quality of life.

Some of these patients end up also not having a uterus, but half of them do have a uterus. Those patients could potentially have a baby of their own. None of them have yet actually had a pregnancy, but we will await that for the future.

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