Tag Archives: transplant

Scientists transplant pig kidney into a human – Again

Credit: Pixabay.

Just two months after they successfully grafted a pig kidney to a human, researchers at NYU Langone Health have performed a second surgery. In both instances, all went according to plan, which suggests that perhaps not too far into the future, animal-to-human transplants, or xenotransplantation, could become the norm, solving our organ donation crisis that kills thousands each year on the waiting lists.

“We have been able to replicate the results from the first transformative procedure to demonstrate the continued promise that these genetically engineered organs could be a renewable source of organs to the many people around the world awaiting a life-saving gift,” says Dr. Robert Montgomery, Professor of Surgery and chair of the Department of Surgery at NYU Grossman School of Medicine. “There is much more work to do before we begin living human trials, but our preliminary findings give us hope.”

During the first transplant, the kidney of a genetically modified pig was attached via a large blood vessel to a brain-dead patient from outside the body. Out of all mammals, a pig’s organs are the most compatible with those of humans in terms of size and metabolism, which explains why scientists chose this animal. 

However, the pig from which the kidney was sourced still required genetic modification because the animals produce a sugar molecule called alpha-gal that humans do not. Biocompatibility can make or break a transplant and issues can appear even between organs sourced from humans, not to mention those belonging to an entirely different species. The pigs used in this transplant were bred by biotech firm Revivicor and lacked the alpha-gal gene.

In this recent, second procedure, the kidney was transplanted into a functionally dead organ donor whose vital functions were kept operational using a ventilator. The kidney was attached externally through a blood vessel in the upper leg. This was rather out of practical reasons. The kidney could have been placed internally in its normal position just as well.

The pig kidney was covered in a protective shield and kept under observation for the 54 hours the life-support machines were running. It functioned as expected with urine production and creatine at normal levels, equivalent to what you’d expect to see in a human kidney transplant. There were no signs of organ rejection throughout the procedure and observation period.

“We continue to make progress with the single-gene knockout xenotransplantation,” says Dr. Montgomery. “With additional study and replication, this could be the path forward to saving many thousands of lives each year.”

Clinical trials with live patients are probably a long time into the future as scientists still have to jump through many regulatory and safety hoops before they can attempt crossing such a truly revolutionary milestone. But the efforts are worth it. More than 90,000 people are on a kidney transplant waiting list in the United States alone, and many die before they get their turn. 

Newborn in Japan receives first treatment with liver STEM cells

A team of doctors in Japan have successfully transplanted stem liver cells into a newborn baby who required transplant, marking a world first.

Stock image via Pxfuel.

This approach could be used in the future for other infants who require organ transplants but are still too young or frail to bear such an intervention, the team explains. The patient suffered from urea cycle disorder, a condition where the liver is not able to break down ammonia, a toxic compound, in the blood, but was considered too small to survive a surgical intervention.

Infant cells to treat infants

“The success of this trial demonstrates safety in the world’s first clinical trial using human ES (embryonic stem) cells for patients with liver disease,” said a press release of Japan’s National Center for Child Health and Development (NCCHD) following the procedure according to todayonline.

At only six days old, the infant (whose sex has hot been disclosed) was too small to undergo a liver transplant, which is not considered safe for patients under 6 kilograms (13 pounds), according to the NCCHD, which usually means they have to be around three to five months old.

However, the baby’s condition would have been fatal until then, so the doctors had to find an alternative way of treatment.

They settled on a “bridge treatment” meant to manage the condition until the baby was big enough for transplant. This procedure involved injecting 190 million liver cells derived from embryonic stem cells into the blood vessels of the liver. And it worked.

They report that the baby “did not see an increase in blood ammonia concentrations” after the procedure and grew up to “successfully complete the next treatment”, namely a liver transplant from its father. The patient was discharged from the hospital six months after birth.

This course of treatment can be used for infant (and perhaps adult) patients who are also waiting for a transplant in other parts of the world. Doctors at the NCCHD note that Europe and the US have a relatively stable supply of liver cells from brain-dead donors, while Japan only has a limited quantity to work with. So they had to use ES cells, which are harvested from fertilized eggs, which has caused some controversy regarding how ethical their use is.

The NCCHD is one of only two organisations in Japan allowed to work with ES cells to develop new medical treatments. It works with fertilised eggs whose use has been approved by both donors having already completed fertility treatment, according to the institute.

The treatment so far isn’t meant to replace transplants, but that’s definitely an exciting possibility for the future. Transplants save lives, but they rely on donors (whose numbers are limited) and require highly specialized equipment, doctors, and medicine to be successful. We can, however, hope that in the future a simple injection may replace the transplants of today.

Canadian researchers develop hand-held skin printer to treat burn patients

Researchers from the University of Toronto (UoT) Engineering and Sunnybrook Hospital, Canada, have developed a new 3D printer that can create sheets of skin to cover large burns and accelerate the healing process.

A simple schematic detailing the use (a) and general structure of the device (b).
Image credits Richard Y Cheng et al., (2020), Biofab.

Nobody likes to get burned — literally and figuratively. So a team of Canadian researchers has developed a handy new tool to take care of our literal burns. This hand-held 3D printer churns out stripes of biomaterial meant to cover burn wounds, promote healing, and reduce scarring. The bio-ink it uses is based on mesenchymal stromal cells (MSCs), a type of stem cell that differentiates into specialized roles depending on their environment.

Don’t feel the burn

“Previously, we proved that we could deposit cells onto a burn, but there wasn’t any proof that there were any wound-healing benefits — now we’ve demonstrated that,” says Axel Guenther, an Associate Professor of Mechanical Engineering at the UoT and the study’s corresponding author.

The team unveiled their first prototype of the printer in 2018. It was quite the novel gadget at the time, the first of its kind to form tissues on-site, deposit them, and have them set in place in under two minutes.

Since then, the team has redesigned the printer 10 times, in an effort to make it more user-friendly and to tailor it to the requirements of an operating room. The current iteration of the design includes a single-use microfluidic printhead (to ensure the part is always sterile), and a soft wheel that’s used to flatten the material and tailor it to wounds of different shapes and sizes.

The MSCs in the ink are intended to promote regeneration and reduce scarring, the team explains. In broad lines, the authors explain, the method is similar to skin grafting, but it doesn’t require for healthy skin to be transplanted from other areas of the patient’s body — it’s printed on the spot. This is especially useful in the case of large burns, they add.

“With big burns, you don’t have sufficient healthy skin available, which could lead to patient deaths,” says Dr. Marc Jeschke, director of the Ross Tilley Burn Centre and study co-author.

The team tested their printer in collaboration with the Ross Tilley Burn Centre and the Sunnybrook Hospital, successfully using the device to treat full-thickness wounds. Such burn wounds involve the destruction of both layers of the skin and often cover a significant portion of the body. While the results were encouraging, the team wants to further refine their printer and improve its ability to prevent scarring.

“Our main focus moving forward will be on the in-vivo side,” explains study leader Richard Cheng, a teaching assistant at the UoT.

“Once it’s used in an operating room, I think this printer will be a game changer in saving lives. With a device like this, it could change the entirety of how we practice burn and trauma care,” adds Jeschke.

The paper “Handheld instrument for wound-conformal delivery of skin precursor sheets improves healing in full-thickness burns” has been published in the journal Biofabrication.

Defeating HIV: second patient in history goes into sustained remission after stem cell transplant

After the famous ‘Berlin patient’ ten years ago, a second person has now experienced remission from HIV. After a stem cell transplant (intended to treat cancer), the patient appeared to be HIV-free and has remained so for 18 months so far. The patient, whose case is presented in the journal Nature, is a man in the UK who has chosen to remain anonymous.

It’s a case of the “happy side effect” in a very unfortunate situation: after the patient was diagnosed with HIV in 2002, he was also diagnosed with advanced Hodgkin’s lymphoma in 2012. To treat the cancer, researchers at the University of Cambridge and University of Oxford carried out a stem cell transplant. However, just like in the case of the ‘Berlin patient’, the stem cell transplant came from donors with a protein mutation known as CCR5. HIV uses the protein to enter immune cells, but the mutated version renders the virus unable to attach itself to the cell walls — essentially protecting the body from the HIV.

The transplant proceeded without major complications. The patient also underwent chemotherapy, which can be somewhat effective against HIV as it kills cells that are dividing, but the key aspect here is the CCR5 receptor, which prevents HIV from rebounding after the treatment.

After 18 months, the patient appeared to be virus-free, although researchers are still skeptical of using the word ‘cured’.

It’s still only a sample size of two, but it’s the first time the ‘Berlin patient’ results have been replicated.

“By achieving remission in a second patient using a similar approach, we have shown that the Berlin Patient was not an anomaly, and that it really was the treatment approaches that eliminated HIV in these two people,” said the study’s lead author, Professor Ravindra Gupta (UCL, UCLH and University of Cambridge).

The study is even more exciting as reactions from the research community were very positive.

“This is good quality research and the authors used the best available technology to demonstrate with the highest degree of certainty currently possible that the patient is free of the virus,” says Prof. Áine McKnight, Professor of Viral Pathology at Queen Mary University of London.

“This is a highly significant study. After a ten year gap it provides important confirmation that the ‘Berlin patient’ was not simply an anomaly.”

Unfortunately, this is not really a scalable treatment option for HIV. Large-scale stem cell transplants would be impractical and risky. However, it represents something that might be incorporated into future treatments. Some teams are examining whether gene-therapy techniques to induce mutations on the immune system could be an option. However, there are also considerable risks, particularly when it comes to affecting other genes in detrimental ways.

Furthermore, the patient had a rare variant of HIV. There are two main variants: one uses the CCR5 co-receptor and the other uses the CXCR4 co-receptor. The vast majority of cases are in the first category, whereas this British patient fell in the second category.

“The authors clearly point out that the technique will not necessarily be effective for all HIV infected individuals, specifically those infected with CXCR4 viruses. However, the principal of targeting co-receptors may be of universal benefit,” adds McKnight.

There are currently around 37 million people living with HIV worldwide, and the only available treatment is to suppress virus — but even this treatment is only reaching 59% of the patients, and drug-resistant HIV is a growing concern. Almost one million people die annually from HIV-related causes.

“At the moment the only way to treat HIV is with medications that suppress the virus, which people need to take for their entire lives, posing a particular challenge in developing countries,” said Professor Gupta.

The study ‘HIV-1 remission following CCR5Δ32/Δ32 haematopoietic stem-cell transplantation’ was published in Nature.

Fluorescent 3d-printed tissue.

New 3D-printing process creates ligaments, tendons for transplant — paves the way for replacement organs

New research is merging 3D printing with human stem cells to provide on-demand tissues such as ligaments and tendons for transplant.

Fluorescent 3d-printed tissue.

Fluorescent cells the team printed to showcase their new process.
Image credits Robby Bowles / University of Utah College of Engineering.

It’s a tough life, and sometimes, our bodies pay the price. Such tolls, however, needn’t be permanent — and, new research from the University of Utah is making it easier than ever before to repair the damage. The team’s efforts pave the way to 3D-printed human tissues such as ligaments and tendons that can be used from transplant.

Break a leg! We can fix it later

“This is a technique in a very controlled manner to create a pattern and organizations of cells that you couldn’t create with previous technologies,” says University of Utah biomedical engineering assistant professor and paper co-author Robby Bowles.

“It allows us to very specifically put cells where we want them.”

Patients that require replacement tissues currently also need to supply it themselves from another part of the body or receive it from a cadaver. Such procedures carry their own risks, involve quite a lot of discomfort on the part of the patient, and (especially in the case of cadaver-sourced tissues) may be very off-putting for certain people. There’s also the risk that replacement tissue is of poor quality, either due to wear and tear or complications in the material’s retrieval from the body.

In an effort to work around these issues and reduce the total number of surgeries a potential patient would have to go through to receive a replacement, Bowles’ team worked on developing a 3D-printing method which can produce viable biological tissues.

Development of the process took two years to complete, the team reports. It relies on stem cells harvested from a patient’s body fat, which are printed on a hydrogel layer to form a tendon or ligament. These cells are grown in vitro (in the lab) in a culture and then implanted. According to the team, the technique can be used to create replacements for connective tissue such as ligaments, tendons, or cartilage — even complex structures such as spinal disks. Such disks are very complex structures that include bony interfaces (transitional areas), and must be reconstructed completely for a successful transplant, they add.

“[The 3D-printing process] will allow patients to receive replacement tissues without additional surgeries and without having to harvest tissue from other sites, which has its own source of problems,” says Bowles.

Much of the research went exactly into tackling complex structures such as spinal disks. Connective tissue is never ‘pure’ — it always includes multiple and complex patterns of interweaving cells. The tendons that flank your muscles, for example, must have transition zones to gradually shift into and attach to adjacent tissues, be them bone or muscle.

Bowles and his co-author David Ede, a former biomedical engineering master’s student at Utah, teamed up with Salt Lake City-based company, Carterra, Inc., which develops microfluidic devices for medicine. They developed their printer starting from a piece of hardware that Carterra typically uses to print antibodies for cancer screening applications. Bowles’ team developed a new printhead for the device that can lay down human cells with a high degree of control. The printhead, Bowles adds, could be adapted for any kind of 3-D printer.

As a proof of concept, the duo printed genetically-modified, fluorescent cells, so they could analyze the structure of the final tissue.

Bowles, with a background in musculoskeletal research, said the technology currently is designed for creating ligaments, tendons and spinal discs. However, he excitedly adds that “it literally could be used for any type of tissue engineering application”. Eventually, the team hopes their technique can be used to print out whole organs, which would be a major breakthrough for patients on transplant waiting lists the world over.

The paper “Microfluidic Flow Cell Array for Controlled Cell Deposition in Engineered Musculoskeletal Tissues” has been published in the journal Tissue Engineering Part C: Methods.

Transplant.

Young vet wounded by I.E.D. receives a transplanted penis

A young army veteran, left maimed by an improvised explosive device (IED), received a large section of tissue as a transplant last month. The unusual bit is that this tissue included the penis, scrotum, and a portion of the abdominal wall. This is the second successful and most complex penis transplant to be carried out in the US.

Operating room.

Operating room.
Image credits David Grant / USAF Medical Center – HL&VC.

The 14 hour-long procedure took place at the Johns Hopkins Hospital in Baltimore, Maryland last month, according to The New York Times. This is the third ever successful penis transplant ever performed, the second successful one to be performed in the US, and the first complex penis transplant ever performed — it involved the scrotum and surrounding tissue as well as the penis.

The doctors expect nerve regrowth will take some time, but they’re hopeful the patient will eventually regain the ability to urinate, have spontaneous erections, and achieve orgasm. For ethical reasons, the surgeons removed the testicles prior to the procedure; else, the recipient could have fathered children that genetically belonged to the donor, who is deceased.

Transplant.

The IED took both his legs above the knee and destroyed his genitals. But, the latter injury hit him the hardest.

“I feel whole again,” said the patient for The New York Times. He asked to remain anonymous due to the stigma around genital injury.

“That injury, I felt like it banished me from a relationship,” he recounts. “Like, that’s it, you’re done, you’re by yourself for the rest of your life. I struggled with even viewing myself as a man for a long time.”

He now has plans to go to medical school, settle down, and meet someone. “Just that normal stuff,” he said.

Prior to his operation, the transplant procedure was still highly experimental and only involved the penis. The first successful transplant of its kind took place in 2014 in South Africa. In 2016, Johns Hopkins performed the first successful penis transplant in the U.S. for a Boston man who lost his penis to cancer. Over the years, doctors there have refined their knowledge, seeking to provide transplants for young veterans returning from the battlefield with devastating, life-changing injuries.

The doctors performed this transplant, which Lee estimated to cost $300,000 to $400,000, for free. In the future, they hope the DoD will cover the expenses for their veterans. Ars Technica reports that According to the Department of Defense, 1,367 men, nearly all under the age of 35, returned to the U.S. from Iraq and Afghanistan with genital injuries between 2001 and 2013. Of those, 31% had injuries to the penis, and 20% had severe injuries.

Child’s brain rewires following double hand transplant 

This is the incredible story of Zion, the first quadruple amputee child in whom researchers observed massive brain reorganization before and after the hand transplant.

Zion was only two years old when he lost both his hands and feet due to a grave generalized infection. At the age of four, his mother donated one of her kidneys to him, allowing doctors to consider him as a candidate for a bilateral hand transplant. Zion had already been on immunosuppressant drugs.

Hand transplants in children are rare and difficult to perform, due to the extremely small size of the vessels and nerves that need to be reconstructed. Zion’s surgery was the first pediatric hand transplant in the world. The medical team included twelve surgeons, divided into four smaller teams that had to find and label all the structures that were to be sewn together. The whole procedure lasted 11 hours.

Now, Zion can do all the things he always wanted to: feed himself, scratch his nose, wave goodbye, shake hands, even play baseball. One special thing he is really eager to do is to write, with his own hands, a letter to the parents that had donated their child’s hands to him.

How it all began

The researchers recorded the child’s brain activity two years before the surgery, and then monitored the way his brain rewired after the amputation — a process called massive cortical reorganization (MCR).

“We had hoped to see MCR in our patient, and indeed, we were the first to observe MCR in a child. We were even more excited to observe what happened next — when the patient’s new hands started to recover function. For our patient, we found that the process is reversible.” said Gaetz.

For each part of the body that transmits sensitive information to the brain, there is a specific region of the cerebral cortex that is activated. This biological phenomenon is known as somatosensory representation.

“We know from research in nonhuman primates and from brain imaging studies in adult patients that, following amputation, the brain remaps itself when it no longer receives input from the hands,” said first author William Gaetz, PhD. “The brain area representing sensations from the lips shifts as much as 2 centimeters to the area formerly representing the hands.”

Zion, age 10. Credit: Children’s Hospital of Philadelphia.

Magnetoencephalography (MEG) is a neuroimaging technique that measures the magnetic activity of elected areas in the brain. Using MEG, scientists studied the location, timing, and strength of Zion’s reactions to sensory stimuli (differently sized monofilaments) applied to his fingers and lips. Four such MEGs were performed in the year following the transplant, using five children the same age as Zion as controls.

“At visits 1 and 2, index fingertips were insensitive to tactile stimulation with even the largest monofilaments. At visits 3 and 4, the patient was able to sense light touch on the fingertips,” the authors wrote in the paper published in the journal Annals of Clinical and Translational Neurology. 

The first two times, researchers found that the signal transmitted from Zion’s lips was recorded in the hand area of the cortex, but with a 20 milliseconds delay, compared to controls. At the latter two MEGs, the lip stimuli had returned to the lip-designated area, indicating that the brain map was regaining its previous configuration but with higher-than-normal signal strength.

“The sensory signals are arriving in the correct location in the brain, but may not yet be getting fully integrated into the somatosensory network,” said Gaetz. “We expect that over time, these sensory responses will become more age-typical.”

Gaetz added, “These results have raised many new questions and generated excitement about brain plasticity, particularly in children. Some of those new questions include, what is the best age to get a hand transplant? Does MCR always occur after amputation? How does brain mapping look in people born without hands? Would we see MCR reverse in an adult, as we did in this patient? We are planning new research to investigate some of these questions.”

The teams from the Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania published their findings in the Annals of Clinical and Translational Neurology on December 6th, 2017.

pig organ transplant

Pig organ transplants into humans might be two years away in China

Chinese scientists are now desperately seeking government approval to launch a clinical trial for xenotransplantation. The goal is to have genetically modified pig organs transplanted into humans. This could happen as early as 2019.

pig organ transplant

Credit: Pixabay.

Every country on Earth is in short supply of organs for transplants with some patients staying on waiting lists for years, some over a decade. Suffice to say most die from health complications before they get a chance to receive a heart, lung or kidney. This situation could go on forever unless we find a way to literally grow transplant organs.

An unbeaten path

One promising approach involves genetically modifying pigs whose organs can then be transplanted to a human patient. This procedure is referred to as xenotransplantation. Out of all mammals, a pig’s organs are the most compatible with those of humans in terms of size and metabolism.

To demonstrate how such a procedure might work, scientists working with the National Heart, Lung and Blood Institute, USA, grafted a pig’s heart to a baboon’s last year. The researchers suppressed the alpha 1-3 galactosyltransferase gene which produces an epitope that is easily recognized as foreign. This way, the baboon’s immune system doesn’t attack the pig heart although immunosuppressants still had to be taken.  Amazingly, the longest a pig heart kept beating was 945 days or nearly three years.

The leader in this field, however, is China. According to the South China Morning Post, about 1,000 cloned pigs are made inside dedicate clone farms around China.

Also in China, no fewer than ten national institutes are closely collaborating for xenotransplantation project funded by the central government. Already, there is fantastic progress. For instance, 400 cornea transplants have been performed from pigs to humans with a stunning 95 percent success rate once the Chinese government gave the green light in 2015.

Now, the same scientific consortium is looking permission from the government to make the next big step: a clinical trial for organ xenotransplantation.

This could happen as early as two years from now, South China Morning Post reported, although there’s a good chance the deadline could be extended even further. It seems like the Chinese government is delaying giving the go. Corneas, which don’t contain blood vessels, are one thing but an organ which can be mind-wrecking complex is a whole different ballgame.

“We have patients dying from organ failure and their desperate relatives pleading for them to have the chance to live,” said Zhao Zijian, director of the Metabolic Disease Research Centre at Nanjing Medical University in Jiangsu.

“But when we turn to the authorities in charge of approving the clinical trials, all we get is silence. We understand it must be very hard for the government to make a decision, but it’s time we got an answer,” he added.

Zhao admitted, however, that genetically modified pig organs are barely a 50 percent match for human organs. According to the Chinese leading scientist, it’s quite possible that a pig organ transplanted tomorrow inside a human’s body won’t get rejected. The big risk though is in the long term such as inflammation as a result of the immune system attacking the transplanted heart or lung.

Even in such an experimental stage, however, for many patients, such a procedure would be much welcomed. In the end, there can’t be progress absent clinical trials.

“Someone has to take the first step – whether it’s the US Food and Drug Administration or the China Food and Drug Administration,” he said.

First living-donor uterus transplant in the US performed in Texas

A Texas hospital has performed four uterus transplants from live donors, one of which was successful. This marks the first occasion such a procedure has been performed in the US.

Image credits Hey Paul Studios ? Flickr.

The four women underwent transplants in September. They all had a condition called Mayer-Rokitansky-Küster-Hauser syndrome, which caused them to be born without a uterus. So far, three of the organs had to be removed as they weren’t getting enough blood flow, and the doctors feared the possible complications which might have developed. The fourth patient is stable and the procedure seems to be doing well so far. A statement by BaylorScott&White, the hospital who performed the transplants, says that the surgical team was “cautiously optimistic” that the fourth uterus would be functional.

“This is the way we advance, from learning from our mistakes,” lead surgeon at Baylor University Medical Centre in Dallas, Giuliano Testa, told Time.

“I am not ashamed of being the one who will be remembered as the guy who did four [transplants] in the beginning and three failed. Even if through failure, I am going to make this work.”

The procedure is still experimental and there’s a high failure rate. More research and operations are needed before it’s deemed safe. Even if the surgery becomes widely available, it’s very likely it will take a huge financial toll on potential patients. But, for women born without a uterus or for those who’ve had it damaged or removed, undergoing such a transplant might be their only change at getting pregnant and having children. Here’s a basic run-down:

[panel style=”panel-success” title=”Here’s the basic rundown” footer=””]Surgeons take the uterus and part of the vagina from a donor, living or deceased.
This is then implanted in the patient. Surgeons connect the uterus to the body’s circulatory system, and attach it along the vagina and pelvis. No nerves need to be attached.
In case of a successful transplant, the patient should be able to safely get pregnant in about 6 to 12 months’ time. In virto fertilisation will be used (as the uterus is not connected to the ovaries).
The woman will have to deliver via a C-section.[/panel]

At this point, the doctors are sadly not sure if the fourth case will be a success or not.

UK doctors plan to perform the procedure using non-living donors in the near future, but for now, Sweden is the only country apart from the US where such transplants have succeeded. The nine procedures in Sweden used live donors — like the Texas ones — and some of the women went on to have children. The experts helped the TBaylor team during the operations.

 

surgery-676375_1280

Man receives first penis transplant in the United States

A man recovering from penile cancer is the first American citizen to receive a penis transplant. The operation, a first in the United States, was performed by doctors at the at Massachusetts General Hospital in Boston. According to the doctors involved, more transplants will occur in the coming years. This is still, however, an experimental procedure at the forefront of medicine.

surgery-676375_1280

Credit: Pixabay

Thomas Manning, 64, had his penis removed to save his life two years ago. After surgery, he was left with a one-inch stump. He had to urinate while standing, and although he was single before when he was diagnosed with penile cancer, intimate relationships were out of the question, Manning confided to a New York Times reporter.

The hospital’s team, led by Dr. Curtis L. Cetrulo, has been preparing this operation for three years. They practiced on six cadavers, meticulously training for the difficult procedure ahead. Only two penis transplants had been performed before. The first successful penis transplant was made by doctors in South Africa in 2014, but the first attempt ended in failure in 2006 in China. The South African transplant was so successful that it ultimately resulted in a pregnancy.

The operation went on pretty smoothly, despite a post-surgery complication that caused hemorrhage. Since then, recovery went well. Doctors say in a couple of weeks Manning should be able to urinate normally, and in a few months tops, should also regain sexual function. The new penis came from a donor whose family wished to remain anonymous.

“If I’m lucky, I get 75 percent of what I used to be,” Manning said. “Before the surgery I was 10 percent. But they made no promises. That was part of the deal.”

Ultimately, this experimental procedure will go on to help veterans. From 2001 to 2013, 1,367 veterans went through genitourinary injuries in Iraq or Afghanistan. Soldiers who come back home with genital trauma have one of the highest suicide rates among veterans. “They’re 18- to 20-year-old guys, and they feel they have no hope of intimacy or a sexual life,” Dr. Cetrulo said to the NY Times. “They can’t even go to the bathroom standing up.”

 

Genetically-altered pigs to become humanity’s source for “spare” organs

Among all the species with which we share the animal kingdom, pigs are the ones whose organs are best suited for transplant in human bodies — they are approximately the same size as our organs and have similar structures, making reconnecting blood vessels much easier. Pigs tend to have large litters and reproduce quickly, making them a very large, very accessible source of “spare parts.”

Never too early to start training that liver.
Image via imgur

So far so good, but why aren’t we all running around with an extra pig spleen or a couple of bonus pig kidneys cleaning our blood? Well, there is a itty bitty hurdle when using pig organs — our bodies freak out when we transplant them. Pig organs are coated with specific sugar molecules that trigger an acute rejection response in human bodies — our antibodies attach themselves to these sugar molecules and destroy the newly transplanted pig organ. Hoping to overcome this problem, researchers are working to create pigs that lack the gene that serves as a template for these sugars.

There are two research efforts being poured into this project currently — Randall Prather at the University of Missouri in Columbia created four cloned piglets from which one had one copy of the sugar-producing gene inactivated (each organisms has two copies of each gene, one from the maternal and one from the paternal side.) The piglets were born in September and October, and a description of Prather’s work was published in the journal Science. The other, a team working for PPL Therapeutics PLC of Scotland, the company that played a part in cloning Dolly the sheep, also announced the birth of a litter of five cloned piglets on December 25th, who’ve also had a copy of the gene inactivated.

The next step involves selectively breeding the pigs, to produce animals lacking both copies of the gene. Theoretically, the organs of these modified pigs could be transplanted into humans without the body rejecting the foreign tissue.

The new results are a significant advance over many other attempts at genetic modification in animals because in both of the studies, the scientists were able to modify—in this case, “knock out”—a gene at a specific location. Although genes from other organisms have been inserted into the genomes of sheep, cattle, and pigs, scientists have had little control over where on a chromosome the new gene is incorporated.

“This is the first time a specific genetic modification has been made in the pig,” said Prather.

Prather’s team, made up of fellows of the University of Missouri and colleagues at the Immerge BioTherapeutics Inc. in Charlestown, Massachusetts, worked directly on fetal pig cells, altering their genetic make-up. These cells were used to grow 3,000 embryo clones that were implanted into 28 surrogate sows, with only seven piglets born, three of which died later.

What started five years ago with the cloning of Dolly, the expectation of creating identical, genetically-controlled organs for transplant into humans, only got one step closer to reality with the cloning of these piglets.

But it’s not all roses — one concern that has dampened the prospects of xenotransplantation is the possibility of spreading viruses from one species to another. Porcine endogenous retrovirus (PERV), for example, is part of a pig’s natural genetic makeup and does not cause any disease in the animal. There is no guarantee, however, that PERV would be harmless in humans.

Still, xenotransplantation might soon become a common practice, as there is an enormous demand for organ transplants that human donors alone will never be able to fill.

A kidney in a bioreactor after seeding with cells. After transplantation it filtered blood and produced urine. Photograph: Ott Lab/Center for Regenerative Medicine

First bio-engineered kidney works after transplant in rats

A kidney in a bioreactor after seeding with cells. After transplantation it filtered blood and produced urine. Photograph: Ott Lab/Center for Regenerative Medicine

A kidney in a bioreactor after seeding with cells. After transplantation it filtered blood and produced urine. Photograph: Ott Lab/Center for Regenerative Medicine

In a milestone of modern medicine, medical researchers at the Harvard Medical School and Massachusetts General Hospital in Boston have produced the first bioengineered kidney and then successfully transplanted it in a host rat, where it become functional. Each year millions of people die of liver related diseases, and even those who go through the living hell of climbing up the waiting list and get a transplant don’t generally fair too well after the operation because of incompatibilities. Mass produced, bioengineered organs made from the patient’s own cells could save countless lives and the present research shows that we’re making huge strides towards achieving this monumental goal, albeit many more steps need to be taken.

Surgeon Harald Ott Harvard Medical School and Massachusetts General Hospital in Boston along with colleagues  first collected cherry-sized kidneys from dead rats and then employed an ingenious method relying on a detergent solution to strip away the cells. After this operation was finished, what remained were the scaffolds of material the cells were normally embedded in that maintained the original architecture of the organs – a strategy which was previously shown to work for other organs as well, like hearts and lungs.

When bioengineering is concerned, one of the biggest challenges scientists face is growing the consisting cells such that they may work together to form an organ. Armed with this simple method, the basic structure they require is easily at hand now. Next, they carefully filled the scaffold with kidney and blood vessel cells from the recipient rats, and then placed the compound into a bioreactor where liquids filled with nutrients and other essential compounds fed the cells for them grow into a kidney within 12 days.

These bioengineered kidneys were then implanted in rats that had one of their kidneys removed, and since the implants kept the complex architecture of their scaffolds this meant they could be connected to the recipients’ blood and urinary systems. Amazingly, the transplanted kidneys performed their waste filtering functions, producing urine and showing no evidence of bleeding or clot formation. The only problem, one the researchers hope to solve or at least improve on, is that the transplanted kidneys are only 5 to 10 percent as efficient as healthy kidneys.

The researchers claim that this is because the cells they used were still immature, and with a bit of work they hope they can get to 20% which is still far away from healthy kidney functions, but still helpful to a lot of people. There are currently millions of people around the world who rely on blood dialysis machines to help them survive, machines that only provide 10 percent to 15 percent of the functioning of healthy kidneys, and come with an enormous hassle, making living a normal life extremely difficult.

Of course, we’re still talking about bioengineered rat kidneys. The human liver is roughly 100 times bigger and more complex, but the researchers are confident they can scale their work. So far, they have shown the cell-removal technique they applied on rat kidneys also works on pig and human kidneys, so they only need to find a way to refine their process to grow human liver cells on the scaffolds.

“We’ve shown an initial proof of concept that has some promise,” Ott says. “Now it’s time to start the nitty-gritty work, to solve all the technical problems.”

Not long ago, scientists used stem cells to grow the first human kidneys using such a procedure, and recently great strides are made in the attempt to 3-d print fully functional organs. No matter the method, we can only hope scientists come to a functioning transplant.

Findings were reported in the journal Nature Medicine.

Doctors perform double-arm transplant on Iraq soldier

A former soldier who sadly became a quadruple amputee during his time in Iraq after an explosion three years ago has undergone a very rare double arm transplant at John Hopkins Hospital.

DoubleArmTransplantSoldier

Brendan Marrocco, 26, of Staten Island, who underwent the marathon surgery last month has gone through a lot; he was the first first service member from the wars in Iraq and Afghanistan to survive the loss of four limbs, losing both legs above the knee, his left arm below the elbow and his right arm above the elbow. All this happened then the vehicle he was driving was struck by a powerful bomb.

The determined man who underwent several surgeries, trips to the hospital and setback was waiting for this chance for years. He got his wish Dec. 18 in a complex, multi-hour operation in which bundles of his muscle, bone, blood vessels, skin and nerves were joined — at times under a microscope. Now, the critical period seems to have passed, with no major downside in sight.

“He’s doing well,” Marrocco’s father, Alex, said Monday. “Doing well. It’s been a little over a month now.”

arm transplant

He is only one of the seven people in the US to have undergone a double limb transplant; not only was this surgery extremely tedious and dangerous, but a while after that, he also had to receive an infusion of bone marrow derived from vertebrae taken from the donor’s lower spine. The infusion allows doctors to reduce the number of powerful anti-rejection drugs they use from three to one – something very important, considering the very dangerous side effects of anti-rejection drugs.

The surgery was done by a special team of transplant experts headed by W.P. Andrew Lee, professor and chairman of the Department of Plastic and Reconstructive Surgery at the hospital.

Pictures via Washington Post