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Tissue-Engineered Bladder Transplants a Success

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MONDAY, April 3 (HealthDay News) -- Using tissue grown from patients' own cells, U.S. doctors have successfully transplanted engineered bladder tissue into patients with bladder disease.

In bladder disease, high pressures in the bladder can lead to kidney damage. This problem is usually treated with reconstructive bladder surgery, a procedure that uses tissue grafts from the small intestine or stomach. Using these tissues, however, can result in many complications, including unwanted secretions from the bowel tissue.

To avoid these post-surgical complications, researchers at Wake Forest University have performed the operation using bladder tissue grown from patients' own bladder cells.

"It is now possible to engineer complex tissues using the patients' own cells and grow them outside the body and put them back in," said lead author Dr. Anthony Atala, a professor of medicine and director of the Institute for Regenerative Medicine at Wake Forest University School of Medicine, Winston-Salem, N.C.

"By doing this, you avoid the use of intestine," Atala said. "When you put intestine tissue into the bladder it continues to excrete things, which can cause complications," he added.

The findings appear in the April 4 early online issue of The Lancet.

In its study, Atala's team operated on seven patients, aged 4 to 19 years, who had poor bladder function due to a myelomeningocele, a congenital bladder condition.

The researchers took bladder cells from each patient and grew muscle cells and special bladder cells, called urothelial cells, in the lab. These cells were then placed on a bladder-shaped scaffold and left to grow for seven to eight weeks.

The surgeons then attached the engineered bladder to the patients' own bladder. Over two to five years of follow-up, the researchers found that the patients' bladder function improved without any of the complications associated with using bowel tissue.

Atala thinks this technique can be used to engineer other types of tissue besides bladder tissue. But the procedure is still experimental and will take several years before it will be widely available, he predicted.

One expert thinks this procedure represents a breakthrough in treating bladder disease.

"This is a milestone," said Dr. Steve Y. Chung, of the Advanced Urology Institute of Illinois, and author of an accompanying commentary in the journal.

"For over 100 years, using bowel tissue has been the only ideal tissue available for use in the bladder," Chung said. "Using this tissue, you risk other complications, such as electrolyte imbalances and mucus secretions."

Chung also noted that using bowel tissue means the surgeon has to cut into a healthy organ, and that can cause additional complications.

"Now, with this tissue engineering, we have a substitute," he said. "That way we don't have to disrupt an organ system like the bowel, we won't have the complications of the electrolyte imbalances or mucus secretions."

Before this technique can used regularly, more patients have to be treated, and there must be longer follow-up, Chung said.

More information

The National Institutes of Health can tell you more about bladder disease.

SOURCES: Anthony Atala, M.D., professor of medicine, and director, Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, N.C.; Steve Y. Chung, M.D., Advanced Urology Institute of Illinois, Spring Valley; April 4, 2006, early online edition, The Lancet
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