Emphysema and cystic fibrosis patients who need new lungs are faced with a life-threatening problem: more than 80 percent of donated lungs can’t be used—they’re inflamed and barely functional [Scientific American]. Transplanted lungs also fail at a much higher rate than other transplanted organs, as they’re more likely to be rejected by the recipient’s body. But a new procedure that makes use of gene therapy may soon double or triple the supply of undamaged donated lungs, and may also improve their function once transplanted.
In both pre- and post-transplant lungs, the problem is inflammation caused by insufficient amounts of an immune molecule called IL-10. Donated lungs are immediately chilled on ice, which destroys any IL-10 that may remain in the lungs, allowing substantial damage to occur before the organ can be implanted. And a lack of the molecule after transplantation increases the likelihood that inflammation will damage the organ and induce rejection [Los Angeles Times].
To get around these problems, the researchers first built a domed chamber where pig lungs were kept at body temperature with a steady flow of oxygen and nutrients moving through them. That arrangement alone prevented substantial damage to the lungs. Next, in the gene therapy stage, the researchers used a harmless virus to bring a gene that produces IL-10 into the lung cells.
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British doctors claim to have made an important step toward completing the first womb transplant. They say they have solved the problem of keeping the blood flowing to the transplanted uterus so that a pregnancy can be carried to term in the recipient. Womb transplants, if proven successful in humans, would offer an alternative to surrogacy or adoption for women whose own wombs have been damaged by diseases such as cervical cancer. Around 15,000 women of childbearing age are currently living with a womb that does not work or were born without one [Guardian]. The research was presented at the American Society for Reproductive Medicine (ASRM) conference in Atlanta.
However, the technique has only been demonstrated in rabbits, a far cry from successfully completing a womb transplant in humans. Using a “vascular patch technique” major blood vessels including the aorta were connected. Two of the five rabbits lived to 10 months and dissection after death showed the womb had stayed healthy [BBC News]. The research team has yet to show that the new wombs can actually support a pregnancy, which leaves some scientists skeptical that the procedure is actually an advancement.
Ethicists, medics and feminists have long argued as to whether infertility is a disease or a cultural phenomenon born of a society where women feel they have no value if they cannot reproduce. But illness or otherwise, it is not a fatal disease, and the suggestion that women could undergo major transplant surgery to fulfill their desire for a child may prompt unease [BBC News]. A woman who received the transplant would have to take drugs to suppress her immune system to prevent her body from rejecting the foreign organ. To avoid taking the drugs for life, the uterus would likely be removed again after the desired babies had been born.
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In an attempt to steer organ donation away from organs purchased on the black market or harvested from executed prisoners, China has announced a system to coordinate voluntary organ donation. The details of the new system are still under development, according to Chinese officials.
Although China is far from the only country facing a shortage of donor organs, the number of people who plan to donate is astoundingly low–since 2003, only 130 people have pledged to give up their organs after they pass away. Chinese officials estimate that 1.5 million Chinese need transplants annually but only 10,000 are performed due to donor shortages [The Wall Street Journal]. Of the transplants performed, officials estimate that at least 65 percent use organs from executed prisoners.
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Apple chief executive and all-around tech visionary Steve Jobs reportedly received a liver transplant two months ago in Tennessee, and is on track to return to work by the end of the month. Jobs presumably underwent the procedure to treat a reappearance of the cancer he was diagnosed with several years ago. In 2004 Jobs had surgery to remove a rare, slow-growing type of pancreatic cancer, called a islet cell neuroendocrine tumor, but he was thought to be in remission until last year, when a period of drastic weight loss last year led to frenzied speculation that the cancer had returned [The Guardian].
Jobs’s health has been a matter of intense interest to Apple investors, who feel that his leadership is key to the company’s continuing success, and questions have been raised about the company’s handling of the matter. In January, the notoriously secretive Jobs made a rare public statement attributing his weight loss to a “hormone imbalance”. Just a few days later, however, he was forced to admit that the situation was “more complex” than first thought, before announcing his intention to step down from day to day activities at Apple for six months [The Guardian].
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It was only a few years ago that scientists figured out how to reprogram adult cells to make them act like multipurpose stem cells, but the next discoveries are coming fast and furious. Researchers had previously transformed human skin cells into so-called induced pluripotent stem (iPS) cells that can grow into any type of tissue; now, a new study reports that the same feat has been accomplished with pig cells. The achievement raises the possibility that genetically engineered pigs could be reared as organ donors, researchers say.
The created iPS cells could be genetically altered, and then cloned to produce pigs with certain traits. By adding or deleting certain genes, for example, researchers could produce pigs whose organs can be transplanted into patients without them being recognised and rejected. Efforts to do such xenotransplants have already been under way for at least a decade, but iPS cells are easier to genetically engineer and grow in the lab than pig embryos, opening up new possibilities for xenotransplantation [New Scientist]. Pigs are considered potential organ donors because their organs are already similar to those of humans in size and function.
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The first U.S. patient to receive a face transplant came forward yesterday to show off the results and to praise the doctors and the unnamed donor who made it possible. The 46-year-old Connie Culp underwent a 22-hour surgery in December to receive her new face. Her expressions are still a bit wooden, but she can talk, smile, smell and taste her food again. Her speech is at times a little tough to understand. Her face is bloated and squarish. Her skin droops in big folds that doctors plan to pare away as her circulation improves and her nerves grow, animating her new muscles. But Culp had nothing but praise for those who made her new face possible [AP].
Culp was severely disfigured by a shotgun blast to the face that left only her upper eyelids, forehead, lower lip, and chin intact. News reports prior to her surgery say she was shot by her husband in an apparent murder-suicide attempt in 2004. He also survived and is serving a seven-year prison sentence. In the years before the transplant, Ms. Culp had 30 different reconstructive surgeries, but none effectively restored the lost functionality [The Wall Street Journal]. She was unable to breathe unaided, eat solid food, smell, or smile.
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The flexible, adaptable human brain rewires itself to accommodate a double hand transplant, even in patients who waited years for their new hands, according to a new study. But in a perplexing result, researchers found that the two right-handed patients that they studied both formed quicker connections between their brains and their new left hands.
The researchers studied the motor cortex, which devotes different areas to different body parts. When the brain is deprived of sensory input from a limb, such as after a hand amputation, that region goes unused. To stop prime real estate going to waste, the brain rewires itself, with areas representing the face and upper arm “creeping in” to take over the region formerly dominated by the hand. To find out if a transplanted hand can reclaim these brain regions, [researchers] used magnetic pulses to stimulate these areas in two people who had undergone double hand transplants. They found that muscles in the new hands responded to the stimulation [New Scientist], suggesting that the brain had rewired itself once again to accommodate the new hands.
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The first face transplant operation in the United States has been completed and initial results are positive, reports the medical team at the Cleveland Clinic. The patient, who had suffered severe facial disfigurement from trauma, had 80 percent of her face replaced with one taken from a cadaver, leaving only her own upper eyelids, forehead, lower lip, and chin. After the transplant, “I must tell you how happy she was when with both her hands she could go over her face and feel that she has a nose, feel that she has a jaw,” said the lead surgeon, Dr. Maria Siemionow [AP].
Although the woman’s identity and the nature of her trauma has not been revealed, doctors say her injuries were so severe that she lacked a nose and palate, and could not eat or breathe on her own without a special opening into her windpipe [AP]. The 22-hour-long surgery took place sometime in the last two weeks and is the most radical facial transplant ever attempted. Along with about 500 square centimeters of skin, the transplant also included bones, muscles, blood vessels, nerves, a nose, sinuses, the upper jaw, and even some teeth. The doctors hoped the operation would allow her to regain her sense of smell and ability to smile [AFP].
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In a pioneering new treatment, doctors created a tailor-made new windpipe for a woman out of donor tissue and the woman’s own stem cells, and say the new, transplanted trachea has been accepted by the woman’s immune system as a natural part of her body without the use of powerful immune-suppressing drugs. Martin Birchall, one of the surgeons, said the transplant showed “the very real potential for adult stem cells and tissue engineering to radically improve their ability to treat patients with serious diseases. We believe this success has proved that we are on the verge of a new age in surgical care” [The New York Times]. Similar treatments could soon be tried on transplants of other hollow organs, like the bowel, bladder, and reproductive tract, he said.
The 30-year-old patient, Claudia Castillo, had failing airways and severe shortness of breath due to a bout with tuberculosis. By March of this year, Castillo’s condition had deteriorated to the point where she was unable to care for her children. Removing a lung was one treatment option, which would have allowed her to live, but seriously impaired her quality of life [Forbes.com]. She opted instead for this experimental treatment, in which doctors took a piece of trachea from an organ donor and transformed it into a structure that now appears native to her body.
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A controversial proposal to switch the U.K.’s current system of voluntary organ donation to a system of “presumed consent” was rejected by the UK Organ Donation Taskforce, which said the change would not increase organ donations and could damage patient-doctor as well as donor-recipient relations. Presumed consent would designate everyone as an organ donor unless the individual or the family of the deceased opted out; the current system is just the opposite, harvesting organs only from people who opt in to organ donation.
The task force advised against the switch supported by Prime Minister Gordon Brown, the British Medical Association (BMA), and several physician groups. Nevertheless, Brown continues to support a presumed consent system. “While they are not recommending the introduction of a presumed consent system, as I have done, I am not ruling out a further change in the law,” he said [The Guardian].
The U.K. has one of Europe’s lowest rates of organ donation. Of an estimated 8,000 people on waiting lists for organ transplants, only about 3,000 receive transplants every year, and 1,000 die while waiting for a transplant. Vivienne Nathanson, the BMA’s Head of Science and Ethics, said presumed consent was not a panacea, but was likely to result in a 10 to 15 per cent increase in donated organs, if sufficient surgeons, intensive care beds and transplant coordinators were put in place. She said it would also encourage families to discuss their views, and make their wishes clear before death: “We know that the majority of the population want to be organ donors, but only 25 per cent are on the register” [Times Online].
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In a remarkable announcement, German researchers have declared that they “functionally cured” a patient of AIDS, eradicating all traces of the virus from his body. The feat was accomplished with a bone marrow transplant from a donor who had a genetic resistance to the virus, and researchers say that 20 months later they can find no trace of the virus in the patient’s blood, bone marrow, or organ tissue.
But the accomplishment shouldn’t be taken as a sign that a cure for the 33 million people living with AIDS is around the corner, researchers are hasty to add. Professor Rodolf Tauber from the [German] clinic said: “This is an interesting case for research. But to promise to millions of people infected with HIV that there is hope of a cure would not be right” [BBC News]. Reasons for this caution include the small number of potential donors with the HIV-resistant mutation, and the difficulty and expense of bone marrow transplants.
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An Israeli biotech company says it has developed a way of freezing and then thawing a pig liver that doesn’t destroy the organ, and says that the thawed out liver appeared to function normally when transplanted into a new pig. The company, Core Dynamics, says the work could lead to advances in human organ transplants, and could eventually allow for “banks” of frozen organs. Organ donation schemes have to work fast to match organs with patients who need them, as, even if kept chilled, they can become unusable within 24 hours. Researchers have been looking for ways to preserve them by freezing, to cope with delays between donation and transplant operation [BBC News].
Lead researcher Amir Arav says the key to limiting cell damage during freezing is to cool the liver very slowly, as this prevents the formation of jagged ice crystals. Some frog species employ a similar technique when they allow parts of their bodies to freeze during hibernation. “We didn’t invent this process, nature did,” says Arav [New Scientist].
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Two years after receiving a dramatic face transplant, a Chinese man who was mauled by bear can eat, drink, and talk normally, doctors reported. Another patient, a Frenchman who suffered from a rare genetic disease that deforms the face, received a similar transplant one year ago and can now smile and blink, proving that the brain is restoring facial nerve connections.
Despite recurrent episodes of tissue rejection in the first year after their transplants, neither man had psychological problems accepting their new faces and have been able to rejoin society [Reuters]. Doctors say that the successes with these two men, who are only the second and third people to ever receive the operation, suggest that the procedure is safe and could one day become routine. “There is no reason to think these face transplants would not be as common as kidney or liver transplants one day,” said Dr. Laurent Lantieri, one of the French doctors [AP].
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In a controversial new procedure, doctors removed the hearts from three severely brain damaged infants soon after the babies were removed from life support and transplanted the organs to three other infants, where the hearts were restarted. The news is raising complicated questions about when a patient can be declared dead, and whether doctors are pushing an already controversial organ-retrieval strategy beyond acceptable legal, moral and ethical bounds [The Washington Post].
The hearts of the three donor babies stopped beating soon after their ventilators were removed. In the first case, the Denver team waited three minutes after what appeared to be the last heartbeat. But because there has never been a case where the heart restarted itself after 60 seconds, they waited only 75 seconds for their next two cases [Reuters]. All three babies who received new hearts would have died without the transplants; six months after the operations, all three were doing fine. Doctors believe the swift organ removals from the donor babies increased the odds of survival for the recipient babies.
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