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Thread: Dr. Wise; Laboratory Grown Bladder

  1. #1

    Dr. Wise; Laboratory Grown Bladder

    Dr. Oz talked about this on Oprah the other day. This sounds great for all of us that will be needing this surgery. I wonder how hard it will be to qualify as a candidate for the surgery? Have you heard much about this?

    www.wfirm.org

    Wake Forest Physician Reports First Human Recipients of Laboratory-Grown Organs
    --------------------------------------------------------------------------------

    WINSTON-SALEM, N.C. -- The first human recipients of laboratory-grown organs were reported today by Anthony Atala, M.D., director of the Institute for Regenerative Medicine at Wake Forest University School of Medicine. In The Lancet, Atala describes long-term success in children and teenagers who received bladders grown from their own cells.

    “This is one small step in our ability to go forward in replacing damaged tissues and organs,” said Atala, who is now working to grow 20 different tissues and organs, including blood vessels and hearts, in the laboratory.

    The engineered bladders were grown from the patients’ own cells, so there is no risk of rejection. Scientists hope that laboratory-grown organs can one day help solve the shortage of donated organs available for transplantation. Atala reported that the bladders showed improved function over time -- with some patients being followed for more than seven years.

    The study involved patients from 4 to 19 years old who had poor bladder function because of a congenital birth defect that causes incomplete closure of the spine. Their bladders were not pliable and the high pressures could be transmitted to their kidneys, possibly leading to kidney damage. They had urinary leakage, as frequently as every 30 minutes.

    The main goal of the surgery was to reduce pressures inside the bladder to preserve the kidneys. In addition, urinary incontinence, which was a problem before the surgery, improved in all patients.

    “It is rewarding when you can see the improved quality of life in these patients,” said Atala.

    The patients were candidates for a procedure to repair the non-functioning bladder tissue with tissue from the intestines. This 100-year-old procedure is also used to “build” bladders for patients with bladder cancer. But because the intestine is designed to absorb nutrients and a bladder is designed to excrete, patients who have the procedure are prone to such problems as osteoporosis, increased risk of cancer and kidney stone formation.

    Atala had been working since 1990 to build bladders from patients’ own cells and in 1999 implanted the first organ in a patient. His current report discusses the long-term results with seven children who had the surgery.

    “We wanted to go slowly and carefully and make sure we did it the right way,” said Atala. “This is a small, limited experience, but it has enough follow-up to show us that tissue engineering is a viable tool that will allow us to tackle problems of similar magnitude.”

    The report involves children who were treated at Boston Children’s Hospital when Atala was director of the Tissue Engineering and Cellular Therapeutics at Harvard Medical School. In 2004, Atala’s program moved to Wake Forest.

    The process for growing each patient’s organ began with a biopsy to get samples of muscle cells and the cells that line the bladder walls. These cells were grown in a culture in the laboratory until there were enough cells to place onto a specially constructed biodegradable mold, or scaffold, shaped like a bladder.

    The cells continued to grow. Then, seven or eight weeks after the biopsy, the engineered bladders were sutured to patients’ original bladders during surgery. The scaffold was designed to degrade as the bladder tissue integrated with the body. Testing showed that the engineered bladders functioned as well as bladders that are repaired with intestine tissue, but with none of the ill effects.

    “We have shown that regenerative medicine techniques can be used to generate functional bladders that are durable,” said Atala. “This suggests that regenerative medicine may one day be a solution to the shortage of donor organs in this country for those needing transplants.”

    Atala said the approach needs further study before it can be widely used. Additional clinical trials of the bladders are scheduled to begin later this year.
    Last edited by sreneet; 03-30-2009 at 04:06 PM.
    Renee

  2. #2
    This is already being used at a few research centers for bladder augmentations in people with SCI (instead of using bowel or stomach). It of course does not restore normal bladder function (it doesn't fix the neurologic bladder function), but it should be a much less traumatic way to do this surgery.

    (KLD)

  3. #3
    Moderator Obieone's Avatar
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    Bill has a stage 4 pressure ulcer on his left ischium that we have been treating (seems like) forever. I have been trying to get our doc to look at trying this treatment and it looks like my determination has paid off. The surgeon who is doing Bill's debridement is going to try the porcine cellular mesh - http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum ... which I believe is related to this research .
    We're trying to avoid another flap surgery if possible ..... seeing Dr.Oz on Oprah with the guy who's finger tip grew back really got me excited about the possibilities.

    Obieone
    Last edited by Obieone; 03-30-2009 at 12:25 PM.
    ~ Be the change you wish to see in the world ~ Mahatma Gandi


    " calling all Angels ...... calling all Angels ....walk me through this one .. don't leave me alone .... calling all Angels .... calling all Angels .... we're tryin' and we're hopin' cause we're not sure how ....... this .... goes ..."
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  4. #4
    Obieone, we have been using porcine intestinal matrix dressing (Oasis) for pressure ulcers for at least 5 years. It is not magic, and would not necessarily replace flap surgery, esp. if it is for a stage III or IV wound, but we do use it if the person is not a surgical candidate, and sometimes have even had wounds close, although they are unlikely to be able to tolerate weight bearing such as you can do after a flap.

    (KLD)

  5. #5
    Senior Member lunasicc42's Avatar
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    it's weird, I had "life threatening" stage IV pressure sores and I had oasis wound matrix applied at a doctors office a few times and my Mom does excellent wound care and now I think they're all pretty much closed. My Mom also applied some substance to them every morning.
    I will e-mail this to her so she can explain more in-depth
    "That's not smog! It's SMUG!! " - randy marsh, southpark

    "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "


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  6. #6
    Yes Anthony's Dr. told us about the oasis wound matrix back in about 2004 after coming home from the hospital with horrible wounds. I did not put anything else on with the matrix. It worked wonders. It jump started the healing process right away. All his wounds are healed now and have been since about 2006. We found out that wounds tend to get stagnant to any treatment after a while of use and you have to change treatments occassionally. Toward the end when they were almost healed we used Promogran a foam type substance you put on with dry gauze and paper tape and leave on for a couple of days and repeat and this healed them up nicely.

    http://www.healthpoint.com/divisions/tm/prodOASIS.cfm
    Cindy Waters
    mom to Anthony, right c5, left c4 (24yo)
    injury march 2003

  7. #7
    Senior Member lunasicc42's Avatar
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    Hope that can help something and sorry for highjacking this thread, the conversation like morphed
    "That's not smog! It's SMUG!! " - randy marsh, southpark

    "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "


    2010 SCINet Clinical Trial Support Squad Member
    Please join me and donate a dollar a day at http://justadollarplease.org and copy and paste this message to the bottom of your signature

  8. #8
    Quote Originally Posted by sreneet View Post
    Dr. Oz talked about this on Oprah the other day. This sounds great for all of us that will be needing this surgery. I wonder how hard it will be to qualify as a candidate for the surgery? Have you heard much about this?

    www.wfirm.org

    Wake Forest Physician Reports First Human Recipients of Laboratory-Grown Organs
    --------------------------------------------------------------------------------

    WINSTON-SALEM, N.C. -- The first human recipients of laboratory-grown organs were reported today by Anthony Atala, M.D., director of the Institute for Regenerative Medicine at Wake Forest University School of Medicine. In The Lancet, Atala describes long-term success in children and teenagers who received bladders grown from their own cells.

    “This is one small step in our ability to go forward in replacing damaged tissues and organs,” said Atala, who is now working to grow 20 different tissues and organs, including blood vessels and hearts, in the laboratory.

    The engineered bladders were grown from the patients’ own cells, so there is no risk of rejection. Scientists hope that laboratory-grown organs can one day help solve the shortage of donated organs available for transplantation. Atala reported that the bladders showed improved function over time -- with some patients being followed for more than seven years.

    The study involved patients from 4 to 19 years old who had poor bladder function because of a congenital birth defect that causes incomplete closure of the spine. Their bladders were not pliable and the high pressures could be transmitted to their kidneys, possibly leading to kidney damage. They had urinary leakage, as frequently as every 30 minutes.

    The main goal of the surgery was to reduce pressures inside the bladder to preserve the kidneys. In addition, urinary incontinence, which was a problem before the surgery, improved in all patients.

    “It is rewarding when you can see the improved quality of life in these patients,” said Atala.

    The patients were candidates for a procedure to repair the non-functioning bladder tissue with tissue from the intestines. This 100-year-old procedure is also used to “build” bladders for patients with bladder cancer. But because the intestine is designed to absorb nutrients and a bladder is designed to excrete, patients who have the procedure are prone to such problems as osteoporosis, increased risk of cancer and kidney stone formation.

    Atala had been working since 1990 to build bladders from patients’ own cells and in 1999 implanted the first organ in a patient. His current report discusses the long-term results with seven children who had the surgery.

    “We wanted to go slowly and carefully and make sure we did it the right way,” said Atala. “This is a small, limited experience, but it has enough follow-up to show us that tissue engineering is a viable tool that will allow us to tackle problems of similar magnitude.”

    The report involves children who were treated at Boston Children’s Hospital when Atala was director of the Tissue Engineering and Cellular Therapeutics at Harvard Medical School. In 2004, Atala’s program moved to Wake Forest.

    The process for growing each patient’s organ began with a biopsy to get samples of muscle cells and the cells that line the bladder walls. These cells were grown in a culture in the laboratory until there were enough cells to place onto a specially constructed biodegradable mold, or scaffold, shaped like a bladder.

    The cells continued to grow. Then, seven or eight weeks after the biopsy, the engineered bladders were sutured to patients’ original bladders during surgery. The scaffold was designed to degrade as the bladder tissue integrated with the body. Testing showed that the engineered bladders functioned as well as bladders that are repaired with intestine tissue, but with none of the ill effects.

    “We have shown that regenerative medicine techniques can be used to generate functional bladders that are durable,” said Atala. “This suggests that regenerative medicine may one day be a solution to the shortage of donor organs in this country for those needing transplants.”

    Atala said the approach needs further study before it can be widely used. Additional clinical trials of the bladders are scheduled to begin later this year.
    Renee, this is a relatively old story (i.e. Dr. Atala has been working on this for over a decade and the data from this study came from when he was working in Boston before he moved to Wake Forest in 2004). What he has been able to do is to grow something similar to a bladder wall in the laboratory, using the patient's own cells, and then transplanted the cells into the patients. I don't think that it restored control of the bladder. It is similar to what is done when the bladder is augmented with intestine. For example, at the present, when doctors use intestine to augment the bladder when they do a Mitrofanoff, they cut a piece of intestine to do so. The piece of intestine (or in the case of Atala's study, a piece of this tissue) is sewn so that it becomes part of the wall of the bladder, the bladder can no longer contract as well, thereby reducing the pressures that are produced within the bladder during episodes of bladder spasticity. This increases the volume of the bladder and reduces medications required for bladder spasticity. Sorry for this long explanation. If you don't understand, let me try again.

    Wise.

  9. #9
    Senior Member Rollin Rick's Avatar
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    So what happens to all of us Foley catheter users in the future, those of us that can only hold 100-200 CC in our tiny bladders?

  10. #10
    Rick, if you want to change bladder management methods to intermittent cath, then an augmentation could be done. This procedure (which is often NOT combined with a Mitrofanoff in spite of what Dr. Young said above) has been available for 20 years. It uses your own bowel (or stomach) or in some studies, the scaffold grown bladder tissue from your own body to make your bladder larger and have less pressure. It does not restore neurologic function and control though, so emptying must then be done by intermittent cath.

    By the way, most people with long term indwelling catheters and a SCI have much less capacity than 100-200 cc. 30-50 cc. is much more common, even for those who have used anticholergic medications to try to prevent this. This is generally not a problem as long as the catheter is kept in place and does not clog up.

    (KLD)

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