A regenerative medicine breakthrough involving urinary tubes in boys has the potential for wide-ranging impact on repairing damage to organs such as the heart.
A research team from the Wake Forest Institute for Regenerative Medicine built engineered urethras for five boys, ages 10 to 14, using their own cells.
It is the first such success in the world, said Dr. Anthony Atala, the director of the institute. The research was first reported online in the British medical journal Lancet.
"These findings suggest that engineered urethras can be used successfully in patients," Atala said Monday. "This is an example of how the strategies of tissue engineering can be applied to multiple tissues and organs."
Atala said the research shows promise with blood vessels for the heart, such as bypass grafts, as well as ureter tubes that connect the kidney to the bladder, the esophagus in children, and the bile ducts that connect the gall bladder to the liver.
"All of them have one thing in common," Atala said. "Narrow tubular structures do have a tendency to collapse with a high failure rate when you put grafts in."
The children were treated at the Federico Gomez Children's Hospital in Mexico City. Three of the boys had experienced major pelvic injury, while two had previous urethra repairs that had failed.
In each case, the urethral tube — the one that allows urine to flow from the bladder out of the body — had been narrowed through injury, birth defect or disease.
Complications from the narrowing of the urinary tubes include infections, difficulty urinating, pain and bleeding, said Atlantida-Raya Rivera, the lead author and director of the HIMFG Tissue Engineering laboratory at the Metropolitan Autonomous University in Mexico City.
Because their urinary tubes had collapsed, some of the boys were required to use catheters for months.
Atala said the failure rate is 50 percent for traditional treatments, such as using a graft from skin or from the lining of the cheek.
The engineered tubes were used to replace entire segments of damaged urethra in the section that runs between the penis and the prostate, which is considered the most difficult to repair.
Following the surgery, the boys were able to empty their bladder at normal levels, as well as reduce or avoid nighttime leaking, straining to urinate and urinary-tract infections.
The research team disclosed the discovery after tracking the boys' progress for up to six years because the grafts "tend to fail either early or late," Atala said. "We are satisfied with the patients' long-term outcomes."
The team used a similar approach to engineer replacement bladders that were implanted in nine children beginning in 1998 — the first in the world to implant laboratory-grown organs in humans.
The research discussed Monday was supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases. Co-researchers from the Wake Forest institute were James Yoo and Shay Soker.
Atala said the breakthrough is not connected with Tengion Inc., a publicly traded company that is developing some of Atala's research.
Tengion is developing a neo-urinary conduit to help patients with a bladder disorder divert urine through the use of their own cells to an external bag rather than through bowel tissue.
rcraver@wsjournal.com
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