全球首例 自体骨髓干细胞培育人造气管
| 瑞典卡洛林斯卡大学医院七日宣布，完成全球首例干细胞人造气管移植手术。该院指出，这项手术的成功为等不到合适捐赠器官的病患带来一线生机，特别是对获取捐赠气管率远不及成人的儿童。
自体干细胞重建 无排斥问题 该手术由卡洛林斯卡大学医院医学教授马基亚里尼组成的一个国际医疗团队进行。他们采用伦敦大学学院研究人员利用塑胶材料与奈米科技所打造出的一个支架，并利用美国麻州哈佛生物科技公司所制造的一种特殊生物反应器（提供体外细胞培养生长反应的容器），将患者的干细胞播散在支架上，而当干细胞在支架上生长两天后便进行移植手术。 卡洛林斯卡大学医院声明说︰「由于用来重建气管的细胞是患者自己的细胞，所以没有移植排斥问题，病患也没有服用抗排斥药物。」 这起在瑞典进行的气管移植手术是使用人造器官的首例，在此之前的一起气管移植用的是捐赠气管与患者自己的干细胞，而主持的医师也是马基亚里尼，他利用患者的骨髓干细胞制造数以百万计的上皮与软骨细胞，并将之覆盖在哥伦比亚病患的新气管上。 此外，比利时医疗团队曾将一个捐赠气管埋入患者的手臂，以恢复其供血并生长新的组织，之后再移植入患者的喉部。这两起病例都是利用患者自己的细胞来覆盖捐赠气管，因此无须服用抗排斥药物。 专家指出，人造结构可被用来打造单纯的器官，比如气管、食道或膀胱，然而要在实验室中打造出心脏、肾脏等较为复杂的器官，可能还需数年之久。 被用来做成人造气管的塑胶聚合物之前也被用来制成泪管与血管，其多孔的表面可加速细胞生长。人造气管制造者认为，可立即受惠于该技术的当属气管癌与喉癌患者，这类癌症病患通常被诊断出罹病时已属末期阶段，可做的治疗选择已无多。马基亚里尼指出，今年底前预计再进行三例类似的人造气管移植手术，其中包括两名成人、一名儿童。 |
卡洛林斯卡大学医院指出，一名罹患气管癌的三十六岁男子因末期癌症几乎完全阻塞气管，加上无法取得合适的捐赠气管，因此他别无选择的于上月九日接受该移植手术，目前他的康复情形十分良好，并定于八日出院。资料来源:http://www.taiwandaily.net/gp2.aspx?_p=kSF1c9zU9HScIqpKVIuqsf5xU80xv+d3
Patient gets world's first artificial trachea
A patient will be discharged from a hospital in Sweden on Friday after his cancerous windpipe was removed and replaced by the world's first artificial trachea, made of his own stem cells grown on a man-made plastic matrix.
Just as remarkable as the man-made windpipe, he says, is how quickly it was produced. Collaborators in Sweden, London and the U.S. created the trachea from scratch in just two days for a 36-year-old man whose cancer was so far advanced that only emergency surgery offered him any chance of survival.
Macchiarini performed a similar procedure in 2008 in Barcelona. A patient named Claudia Castillo received a windpipe that had been removed from an organ donor and, over a period of weeks, cleared of all of its original cells, leaving just a matrix that could be coated with the patient's own stem cells. He has performed about 10 implantations using donor windpipes since then, he says.
He says he began by removing the patient's bone marrow and filtering out certain cells, called mononucleocytes. These cells, when treated with growth factors and other substances, morph into the cells that form the rings on the trachea. Then a team led by Alexander Seifalian at the University College of London worked round-the-clock to produce a Y-shaped matrix that would replace the cancerous portion of the patient's windpipe and connect with his lungs.
David Green's team at Harvard Biosciences in Holliston, Mass., traveled to Stockholm and placed the matrix and the solution of cells into a custom-made device called a bioreactor. The bioreactor keeps the body temperature constant at 98.6 degrees and rotates the matrix once per minute just as a rotisserie turns a chicken.
With every revolution, the lower part of the matrix dips into the cell broth, coating it and at the same time exposing the living cells to oxygen.
Within 48 hours, the man-made windpipe was ready for implantation. Doctors not only replaced Teklesenbet's windpipe, they gave it a blood supply by sliding a section of tissue from his stomach up through his diaphragm, which is a standard technique, Macchiarini says.
Green says similar bioreactors are being used to engineer heart and lung tissues, which so far have been tested only in rodents. Macchiarini says, "My dream as a surgeon is, rather than doing transplants of the heart, liver and lungs, is to use regenerative medicine to restore the function of cells damaged by aging and disease."
Teklesenbet says the dream has come true for him. "It is a wonderful thing for me," he said in a telephone interview, still hoarse from surgery. "I know about transplantation, but I never thought transplantation of the airway could happen."