Girl with trachea from stem cells?

Two-year-old receives artificial stem cell-based trachea

03/05/2013

A two-year-old girl, born in 2010 in South Korea without a trachea, has Doctors from the Children´s Hospital of Illinois (USA) implanted an artificial trachea made of synthetic fibers, which was coated with blood stem cells from the child's bone marrow. The media around the world viewed this as promising news from stem cell research. But there remain doubts about the meaningfulness and the suggested long-term healing success.

Little Hannah Warren was born in Seoul in August 2010 as the daughter of a Canadian father and a Korean mother. When the two-year-old saw the light of day, her entire body turned blue due to lack of oxygen. Hannah suffered from the extremely rare tracheal agenesis, she lacked the trachea. The doctors had to act quickly to save the child's life. They put a tube down her throat that could oxygenate her lungs. More specifically, the tube passed through the esophagus and from there was led further into the lungs. To prevent backflow of stomach acid into the lungs, the doctors shut off the esophagus in the direction of the stomach and the girl was given a feeding tube directly into her stomach, which was used to nourish her. From the beginning, however, it was clear that Hannah can not survive in this condition in the long run.

Ethical controversy over surgery
In the case of little Hannah, the US physician Dr. Mark Holterman, a professor at the University of Illinois College of Medicine at Peoria. He attracted the renowned stem cell researcher Dr. Paolo Macchiarini from the Karolinska Institute in Stockholm (Sweden), who had previously implanted stem-cell-based artificial hollow organs in the past. For the first time, the doctors wanted to try out the new technology on a two-year-old girl. After the necessary resources could be raised, intense ethical discussions ensued, as Hannah also acted as a guinea pig and her parents understandably grabbed every straw in view of the child's seemingly hopeless situation. Also, due to the use of stem cells to colonize the artificial hollow organ, the ethical conflicts of stem cell research in general have been discussed. However, as the stem cells were derived from the child's bone marrow, these concerns could be resolved fairly quickly.

Two-year old can breathe and taste normal for the first time
Eventually, all the relevant institutions gave their consent and the girl was in the Children a good month ago´s Hospital of Illinois used the plastic trachea coated with stem cells during several hours of surgery. At first, the ambitious project of the doctors seems to have succeeded. The child can breathe and, theoretically, for the first time in his or her life, eat normally, with the utmost reluctance to date. Only a Lolli was allowed to try the little one. With solid food, she will probably have to wait some time. Since the doctors have also discovered in the course of their investigations, the installation of vocal cords in the girl, they hope that Hannah may even learn to speak over the years.

Doubts about the medical benefits of the new procedure
An altogether convincing result, if there were not the doubts concerning the durability of the artificial trachea and the possible associated risks. Because two of the few adult patients who have been operated on by the procedure have died for no apparent reason and in one patient, the artificial hollow organ has proved to be unstable. In principle, there is also the question of whether this new treatment method has a medical advantage over the previously used tracheal transplantation of deceased donors. Here, the availability is to be mentioned as a clear plus of the stem cell-based artificial hollow organs, but the therapy safety actually seems higher in the conventional method. However, a donor organ does not grow with children, so in case of doubt they also need another operation or transplantation. How little Hannah's life will be left open for the time being, given the uncertainties, but looking back on the past 32 months since her birth, can be expected to improve. (Fp)