Engineered Vaginas Grown In Women For The First Time
Vaginas grown in a lab from the recipients' own cells have been successfully transferred to the body for the first time.
The surgery was carried out on four women who were born without vaginal canals because of a rare condition. The women, who were teenagers at the time of the operation, now have fully functioning sexual organs.
"After the operation they were able to function normally. They had normal levels of desire, arousal, satisfaction and orgasm," says Anthony Atala at Wake Forest School of Medicine in North Carolina, who led the research. He published the results only after four to eight years had elapsed following surgery, enough time for him to be sure there were no long-term complications.
The four women had undeveloped vaginas because they all have a severe form of a condition called Mayer-Rokitansky-Küster-Hauser Syndrome (MKRH), which affects about 1 in 5000 women. They also had some abnormal development of the uterus, although they did have a vulva – the external part of the sex organ which includes the labia and the clitoris. They were not able to have penetrative sex or menstruate. One of the women was diagnosed after her menstrual blood had collected in her abdomen.
As well as having physical implications, a diagnosis of MKRH is also a huge psychological burden for women.
Building on techniques the group developed in the 1990s and perfected on rabbits, Atala and his colleagues removed a small part of the vulva from each woman and grew the cells in the lab. After about four weeks they had enough cells to begin to lay them on to a degradable scaffold one layer at a time "like the layers of a cake", he says.
The challenge was how to get the cells to grow to the right level of maturity in the lab, says Atala. You need to make sure that the cells are mature enough so that when you implant them into the body, they can recruit other cells in the body to form tissue that includes nerves and blood vessels.
Working with surgeons at the Federico Gomez Children's Hospital of Mexicoin Mexico City, Atala's team used MRI scans to calculate the appropriate shape and size of the scaffolds for each patient. After cells had established themselves on these scaffolds, surgeons created a cavity in the abdomen and inserted the engineered vagina. It was then stitched in place, connected at the top to the uterus.
The women used a stent for six weeks to make sure the structure maintained the right shape.
The scaffold was made of a collagen matrix and degraded spontaneously over the months following surgery. In that time, the implanted cells matured into the normal tissue of the vaginal wall, including the right layers of muscle and epithelial cells (see video). The vagina was fully developed after six months, and the women were able to menstruate and have sex.
Better than a skin graft
Atala hopes that in the future, the technique could be used to treat not only women who have congenital vaginal defects but also those who have suffered damage through trauma – for instance, because of a car accident or cancer.
Currently it is possible to surgically create vaginas using grafts from either intestinal or skin tissue, but these can lead to severe complications. Skin cell grafts do not provide lubrication which causes pain during sex, and can thicken to the point where the vagina closes. Intestinal cells secrete mucus constantly, which is unhygienic and causes an unpleasant odour. Using the women's own cells from the vulva gets around these issues.
Knowing that the engineered tissue originates from the recipient's own body can be reassuring for them, says Sylvie Miot at the University of Basel, Switzerland, whose team has also successfully engineered new nostrils for patients who had to have skin cancers removed from their nose. Their findings are being published in the same issue of the Lancet.
Both studies involved small numbers of patients, but they provide the first strong evidence that nerve and blood vessels can reconnect to large patches of bioengineered tissues directly inside the body.
The findings also show that lab-engineered organs can grow to maturity healthily inside the body, says Martin Birchall at University College London. The women were aged between 13 and 18 years old when the surgery took place so their bodies were still developing. Birchall, who pioneered the first transplant of a human windpipe using the recipient's stem cells, calls the results "very meaningful".
One of the recipients, who wished to remain anonymous, said the treatment opened up new possibilities. "I truly feel fortunate, because I'll have a normal life – completely normal," she says. "It's important to let other girls that have the same problem know that it does not end knowing that you have the disease, because there is a treatment."
Two of the four women have a functional uterus, so the big question is whether they will be able to have children. "They haven't tried," says Atala, "but they can ovulate, so there is no reason to suspect that they cannot."
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