Implanted Tissue Repairs Damaged Bladders
STEVE INSKEEP, host:
Researchers at Wake Forest University in North Carolina are announcing a major achievement in the medical journal The Lancet. They've grown parts of several human bladders outside the body and used them to repair damaged organs.
NPR's Joanne Silberner reports.
JOANNE SILBERNER reporting:
Sometimes babies are born with small, malfunctioning bladders. When pediatric urologist Anthony Atala was in training, he watched children struggle with surgical repairs that often led to more serious problems. You wouldn't want to transplant. Children would be on immuno-suppressant drugs their whole lives. He figured those children needed new bladders of their own.
Dr. ANTHONY ATALA (Lead Researcher, Wake Forest University School of Medicine): Why not to create the bladder outside the body, using the patient's own cells? And then put it back into the patient, so that the patient could do well with their own tissue over time?
SILBERNER: Atala figured the research wouldn't take much time.
Dr. ATALA: Being plain naïve, you know, I thought that, you know, this would be an easy thing to tackle. And, of course, there was challenge after challenge that we had to work on.
SILBERNER: It took him 16 years. The first challenge was harvesting healthy bladder cells and getting enough of them to build new tissue.
Dr. ATALA: It is well recognized that non-cancerous cells usually do not grow well outside the body. And so, the challenge for us was to try to do just that--get these cells to grow outside the body and to grow in large quantities.
SILBERNER: After lots of experiments, he and his colleagues learned how to select the fastest growing bladder cells. Ultimately, he was able to start with a million cells and grow them into 1.5 billion cells, and place them on a protein scaffold. Then came surgery to put the cells back in. His patients were seven children born with small, inelastic bladders. The bladders sometimes push urine back up into the kidneys.
Surgeons stitched in the scaffolding with the new bladder cells on it. The new tissue made up as much as two-thirds of the bladder. They nestled in a layer of fatty tissue that provided oxygen and nutrients short-term. And then, Atala explains, nature takes its course.
Dr. ATALA: And once in the body, the body will actually go ahead and re-innervate it and re-vascularize it. At the end, the body in itself is actually a terminal incubator.
SILBERNER: Now, seven years after the first surgery, his patients range in age from the teens to early 20's, and their bladders are functioning, though not at full capacity.
Dr. ATALA: We found that there was an improved quality of life. And the patients had improved continence.
SILBERNER: Atala says it's clear the organs are growing along with the patients.
Another pediatric urologist who is familiar with the research, Anton Cory in Toronto, says some of the patients really didn't improve all that much after the surgery. So he says he still needs to see proof that the new bladder tissue is functioning. Steven Chung, though, a pediatric urologist in Illinois, wrote an enthusiastic editorial in The Lancet.
Dr. STEVEN CHUNG (Pediatric Urologist): Researchers had been waiting quite some time for someone to take the next step. And we have clinical data now showing that it works.
SILBERNER: There are a lot of people trying to create new bladder tissue. Chung, himself is working with stem cells removed from the bone marrow. The process could prove useful for bladder cancer. Atala is on the board of directors of a company that hopes to market the process if it works out. And he's already working on regenerating liver, kidney, pancreas, and heart tissue.
Joanne Silberner, NPR News.
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