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Building Body Parts In The Lab

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WINSTON-SALEM, N.C. (Ivanhoe Newswire) - Need a body part? Just have scientists make you one.

It may sound too good to be true, but researchers are doing just that. The lab that's changing lives right now could change many more in the future.

The world's first engineered urethra was created at the Wake Forest Institute for Regenerative Medicine. First, researchers take a very small piece of tissue from a patient's bladder. Then, they grow the cells outside the body and put the tailor-made urethra right back in the patient.

"Very much like baking a layer cake if you will, we do this one layer at a time," Anthony Atala, MD, Director of the Wake Forest Baptist Medical Center, Institute for Regenerative Medicine, told Ivanhoe.

Doctors were able to give five boys in Mexico who suffered pelvic injuries new urethras. And check this out: researchers are using printers to create lab-grown ears. So far it's worked in animals.

"We can make it match very closely to a native ear," John Jackson, PhD, Associate Professor at Wake Forest Institute for Regenerative Medicine, told Ivanhoe.

A CT scan of the existing ear generates a pattern that scientists replicate. A 3D image is made – then layer by layer – the machine prints the ear.

In another project , researchers are engineering muscle. First, they take muscle biopsies and isolate cells that have the potential to multiply. They then seed them onto a scaffold, teaching the cells to become muscle.

"Think of as exercise, as if you were exercising at a gym or something like that," George Christ, PhD, Professor of Regenerative Medicine at Wake Forest Institute for Regenerative Medicine, told Ivanhoe.

The next step is to implant the muscle in the body, where it will regenerate and repair an injury. The new muscle could help many ailments including neuropathy, cleft palate, and facial paralysis.

"It's life-changing even in the simplest cases," said Dr. Christ.

While the urethras have already been used in human patients and are currently in clinical trials, the engineered muscle and bio-printed ears have not. Scientists hope to be using them in humans in the next two years or so. Hoping their work could one day help injured soldiers, researchers at Wake Forest have also teamed up with the military on a few projects.

RESEARCH SUMMARY

BACKGROUND: According to the U.S. Department of Health and Human Services, regenerative medicine is the "next evolution of medical treatments." Regenerative medicine offers the potential for the body to heal itself. Scientists at the Wake Forest Institute for Regenerative Medicine in Winston-Salem, N.C., were the first in the world to engineer lab-grown organs that were successfully implanted into humans. Now, the team of researchers is working to engineer more than 30 different replacement tissues and organs to develop cell therapies with the goal of curing a variety of diseases. (SOURCE: Wake Forest Institute for Regenerative Medicine)

LAB-GROWN URETHRAS: Researchers from Wake Forest were the first in the world to use patients' own cells to build tailor-made urine tubes in the lab and successfully replace damaged tissue in five boys in Mexico. The boys were unable to urinate due to a pelvic injury. After receiving the lab-grown urethras, all the boys continue to do well with normal or near-normal urinary flow. The urethras were grown on biodegradable mesh scaffolds made of a polyester compound. The scaffolds were seeded with cells taken from the patients' own bladders and incubated in the lab for four to seven weeks. They were then used to repair damaged segments of the boys' urethras. "For us, really, our goal here at the Institute is really to try to complete technologies that we can get to patients to make their lives better, so anytime that we're able to do that, improve the quality of patients' lives, we feel like that's part of our mission," Anthony Atala, M.D., Director, Wake Forest Institute for Regenerative Medicine, told Ivanhoe. (SOURCE: Ivanhoe interview with Dr. Atala and WebMD article)

GROWING EARS: Scientists are working on "printing" ears in the lab. "What we can do is we can take any three dimensional image of an ear, and it can be put into the computer, and that will generate an image within the printer that then prints that specific three dimensional structure," John Jackson, Ph.D., Associate Professor, Wake Forest Institute for Regenerative Medicine, told Ivanhoe. Right now, implants that are commercially-available are hard and rigid. They also cause problems with erosion through the skin. The new, tailor-made ears are flexible and patient-specific. In animal studies, the lab-grown ears have been shown to cause less erosion. The next step is to print the ears for use in humans. "To be able to take a structure, generate a 3D implant and have that as a potential treatment for a patient who has lost an ear, that's very exciting," Dr. Jackson told Ivanhoe. (SOURCE: Ivanhoe interview with Dr. Jackson)

ENGINEERING MUSCLE: Researchers are also looking to see if they can engineer tissue that resembles muscle to repair small injuries in the body. They take biopsies from skeletal muscles and culture out the stem cells from the muscle. They then seed the cells onto a scaffold and condition the scaffold and a bioreactor to exercise muscle in-vitro. Then, they use that construct as an implant to accelerate regeneration and repair of injured muscle in the body. Scientists have been studying the engineered muscle in animals, and the next step is to try it in humans. "For me, personally, it's fantastic because you don't often get an opportunity to do research that's not only compelling but that can result in therapies that can help people on a daily basis and really improve their quality of life," George Christ, Ph.D., Professor of Regenerative Medicine, Wake Forest Institute for Regenerative Medicine, told Ivanhoe. (SOURCE: Ivanhoe interview with Dr. Christ)

INTERVIEW

Anthony Atala, M.D., Director of the Wake Forest Institute for Regenerative Medicine, talks about how regenerative medicine could change the lives of millions of people.

Tell me a little bit about the urethras that you engineered. How did you do that?

Dr. Atala: The urethra is the channel that connects your bladder to the outside of the body. It's a tubular structure. We took a very small piece of tissue, less than half the size of a postage stamp. We expanded the cells outside the body and we then created a tubularized scaffold, a mold if you will, and we then placed the cells onto that scaffold to generate the new tissue.

This is actually from a person's body?

Dr. Atala: Yes.

And then from the lab it goes back to the person's body?

Dr. Atala: Yes. What we do is we actually take a very small piece of tissue from the same patient, we grow the cells outside the body, place the cells in this three dimensional mold, and put it right back in to the same patient.

What led to this discovery being possible?

Dr. Atala: We've been engineering tissues now for a number of years and the simplest tissuesto engineer are the flat structures such as skin. Now structures like the urethra are more complex because they are tubular, and also they have two different cell types instead of just one cell type. We've actually done patients in several international centers, including Mexico, where the first series was actually done. We now have a number of patients that have been done in several places using the same strategy.

Why aren't you doing it here?

Dr. Atala: We do have technologies that we've developed here at the institute and we then have aclinical strategy where we develop technologies for here and abroad. Sometimes the trials end up happening abroad before they occur here and sometimes it's the other way around.

Who is this going to help, who would be a candidate?

Dr. Atala: Many patients actually present with injuries to their urethras. They may have accidents like straddle injuries over bicycles or other types of injuries. Also, many children are actually born with abnormalities of the urethra In the initial series we had five boys that had the same type of injury and they were all treated in the same manner -- using the patients themselves to recreate the new tissue.

How long does it take?

Dr. Atala: From the time that we take this small piece of tissue from the patient and to the time that we put an engineered organ back in to the patient, it's about a four to six week period. That works well because usually these patients do need to be stabilized and they need to wait on their wounds to heal some before we can actually go for the reconstructive surgery.

Take me through step by step.

Dr. Atala: We take a very small piece of tissue from the patient, and then expand the cells outside the body. The tissue is made up of two different cell types. We create a tubular structure and we put one cell type on the outside, which are the muscle cells, and we then place the other cell type inside which are the lining cells. Very much like baking a layer cake if you will. We do this one layer at a time. We then put the structure in an oven-like device where we let it cook if you will. But it has the same conditions as the human body. We then are able to take that engineered tissue and put it back in to the patient. One of the important concepts of these technologies is that you're taking the tissue from same patient, creating the organ using those cells and you put them right back in to the same patient so there is no rejection.

How long do you think it would be before anybody who has this kind of issue could have this procedure?

Dr. Atala: Right now these technologies are under clinical trial, but we're working very hard to make that happen.

What's the goal for this in the upcoming years?

Dr. Atala: Our goal for these types of tissues is really to get them to as many patients as we can and to expand the number of indications that we use these tissues for.

How would you say this discovery is for you?

Dr. Atala: Our goal here at the institute is really to try to complete technology so we can make patients' lives better. Any time that we're able to improve the quality of patients' lives, we feel like that's part of our mission.

Getting it from the lab to the patients is a great accomplishment I would think.

Dr. Atala: At the Wake Forest Institute of Regenerative Medicine, we're really dedicated to translating these technologies from the bench to the bedside. Everything that we do at this institute has one mission in mind and that is to get it to the patient so that they can benefit from these technologies.

FOR MORE INFORMATION, PLEASE CONTACT:

Karen Richardson
Media Relations
Wake Forest University
krchrdsn@wakehealth.edu

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