Did you know that every two weeks your intestine completely regenerates its lining itself? It’s because of this incredible regenerative capacity that doctors believe intestines are the perfect organ to regrow. Now, a new medical breakthrough could help children born with gastrointestinal defects.
“I was so scared I didn’t know what was going to happen,” Stacy Lara told Ivanhoe.
At 18 weeks pregnant, Stacy Lara was told something was terribly wrong with her son.
“He had quite a bit of bowel outside of his abdomen,” Stacy said.
Nathan had a birth defect that caused his intestine to grow outside of his body.
“He really only has a few inches of intestines, whereas a baby this age would normally have maybe six to eight feet of intestine,” Russ Merritt, MD, PhD, Medical Director of Intestinal Rehabilitation Program at Children's Hospital Los Angeles, told Ivanhoe.
For Nathan that means a lifetime of being fed through a tube or a transplant, but Dr. Tracy Grikscheithopes a discovery in her lab can change the prognosis for Nathan and other children like him.
“We’ve been able to show that we can make every part of the gastrointestinal tract, we can make esophagus, stomach, small intestine, and colon,” Tracy Grikscheit, MD, Principal Investigator, The Saban Research Institute, and Surgeon at Children's Hospital Los Angeles, was quoted as saying.
After children have surgery, doctors take tissue from the waste left over and then re-grow the cells in the lab, within months an organ can be made. Dr. Grikscheit says it would eliminate risk of organ rejection and a lifetime of medication.
“If we were able to make engineered intestine from your own cells it would be part of you, grow with you. It would repair itself,” Dr. Tracy Grikscheit said.
It’s a medical breakthrough that could have patients healing themselves.
BACKGROUND: Sometimes children are born without portions of their intestines. One cause of this is necrotizing enterocolitis (NEC). NEC is a gastrointestinal disease that affects mostly premature infants. It involves infections and inflammation that causes destruction of the bowel (intestine) or part of the bowel. NEC is the most common and serious gastrointestinal disorder among hospitalized preemies. However, it affects only one in 2,000 to 4,000 premature births. It usually occurs the first couple weeks of life. Around ten percent of babies weighing less than 3 lbs., 5 oz. (1,500 grams) have NEC. (Source: www.kidshealth.org)
CAUSES: The cause of NEC is unknown, but a theory is that the intestinal tissues of premature infants are weakened by too little oxygen or blood flow. When feedings start, the added stress of food moving through the intestine allows bacteria normally found in the intestine to invade and damage the wall of the intestinal tissues. The damage can affect a short segment of the intestine or can progress quickly to involve a larger portion. Infants are unable to continue feedings. They can also develop imbalances in the minerals in the blood. In severe cases of NEC, a hole can develop in the intestine, which allows bacteria to leak into the abdomen. Some experts believe that the makeup of infant formula, the immaturity of the mucous membranes in the intestines, and the rate of delivery of the formula can cause NEC. Babies who are fed breast milk can also develop NEC, but the risk is lower. Another theory is that babies born through difficult deliveries with lowered oxygen levels can develop NEC. When babies don’t have enough oxygen, their bodies will send the available oxygen and blood to vital organs instead of the gastrointestinal tract, resulting in NEC. Babies with an increased number of red blood cells also seem to be at an increased risk for developing NEC. Too many red blood cells can thicken the blood and hinder the transport of oxygen to the intestines. (Source: www.kidshealth.org)
NEW TECHNOLOGY: Current treatment involves surgery to remove the affected portions of the intestine, or if the condition is severe, an intestinal transplant may be necessary. Both options come with significant problems. If the intestine is too short, it could be unable to perform its functions. Also, any transplant comes with sever risks. Patients who get intestinal transplants are on anti-rejection medications for the rest of their lives. The medications affect the immune system, causing infants to be more prone to other illnesses. However, researchers at Children’s Hospital Los Angeles have successfully grown a tissue-engineered human colon. The concept is still in its early stages, but their goal is to offer alternative treatment for children who are born without portions of their intestine, or who require surgery to have portions of their intestine removed. Tracy Grikscheit, MD, Principal Investigator at The Saban Research Institute and Surgeon at Children's Hospital Los Angeles, used the patient’s own stem cells from the intestine to regrow portions of the colon. Now, they used the procedure to regrow small amounts of the small intestine, a process that takes four weeks. Dr. Grikscheit received a $3.4 million grant to fund the steps required before the first trial can take place for engineered intestines. One of the steps will be to define characteristics of patients who would have the most success form the procedures. (Source: http://www.dailynews.com/marathon/ci_22341148/tissue-engineered-colon-will-help-treat-children)
Tracy Grikscheit, MD, Principal Investigator at The Saban Research Institute and Surgeon at Children's Hospital Los Angeles, talks about a new breakthrough that is building organs for children.
How many kids are affected by this?
Dr. Grikscheit: The incidences are relatively low, but it’s actually rising because it happens more in babies who are born prematurely. We are getting much better at saving those kids. So, more and more babies go on to develop a disease called necrotizing enterocolitis. Also, intestinal problems in early childhood and even in adulthood can lead to intestinal failure. However, it is primarily a problem for newborns.
What is life like for these babies?
Dr. Grikscheit: I think it’s something that’s hard to watch and that’s why my whole lab is involved in this area and why Children’s Hospital Los Angeles has an intestinal failure program. The basic problem is that because the child can’t get enough nutrition from absorbing food alone they have to receive IV nutrition. Over time, the IVs won’t last, so they have to have a central line that travels all the way to the heart to deliver nutrition. Over time those lines can break down and become infected. The child may require multiple surgeries to keep the access site open so that the nutrition can pass through the IV. So, you can imagine that a lot of effort goes into just ensuring that the child is getting proper nutrition. it is a lot to put on a kid who should be playing, not spending time in the hospital and not having all of these higher medical needs.
So how does tissue engineering come into this?
Dr. Grikscheit: Well, this won’t be the solution for every child. It’s not a solution that’s available today. Children with intestinal failure have to have some of their intestines removed.With tissue engineering, we are trying to compensate for that loss of intestine.. Just like when you get sunburned and you know that your skin is going to heal over time, there are stem cells in the intestines that can also regenerate. In fact your intestine every two weeks completely re-lines itself. That’s remarkable. We need to be able to harness that incredible regenerative capacity to grow new intestines for the children from their own cells.