Tracheal Replacement Therapy with a Stem Cell‐Seeded Graft: Lessons from Compassionate Use Application of a GMP‐Compliant Tissue‐Engineered Medicine

• Published in: Stem cells translational medicine 2017-06, Vol.6 (6), p.1458-1464
• Main Authors: Elliott, Martin J., Butler, Colin R., Varanou‐Jenkins, Aikaterini, Partington, Leanne, Carvalho, Carla, Samuel, Edward, Crowley, Claire, Lange, Peggy, Hamilton, Nicholas J., Hynds, Robert E., Ansari, Tahera, Sibbons, Paul, Fierens, Anja, McLaren, Claire, Roebuck, Derek, Wallis, Colin, Muthialu, Nagarajan, Hewitt, Richard, Crabbe, David, Janes, Sam M., De Coppi, Paolo, Lowdell, Mark W., Birchall, Martin A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult Stem Cells; Airway management; Allergic diseases; Bioartificial organs; Bioartificial Organs - adverse effects; Bioengineering; Cells, Cultured; Children & youth; Clinical Application / Translation; Clinical trials; Congenital diseases; Coronary vessels; Endoscopy; Failure; Female; GLP/GMP Cell Culture; Good Manufacturing Practice; Human Clinical; Humans; Implants; Mesenchymal Stem Cells; Methods; Organ Transplantation - adverse effects; Organ Transplantation - instrumentation; Organ Transplantation - methods; Ostomy; Postoperative Complications - etiology; Regenerative medicine; Respiratory tract diseases; Stem cells; Stem Cells - cytology; Stenosis; Stents; Tissue engineering; Tissue Engineering - methods; Tissue scaffolds; Tissue Scaffolds - standards; Trachea; Trachea - transplantation; Tracheal Stenosis - surgery; Transplantation; Transplants & implants; Writing
• ISSN: 2157-6564; 2157-6580; 2157-6580
• DOI: 10.1002/sctm.16-0443

Tracheal replacement for the treatment of end‐stage airway disease remains an elusive goal. The use of tissue‐engineered tracheae in compassionate use cases suggests that such an approach is a viable option. Here, a stem cell‐seeded, decellularized tissue‐engineered tracheal graft was used on a compassionate basis for a girl with critical tracheal stenosis after conventional reconstructive techniques failed. The graft represents the first cell‐seeded tracheal graft manufactured to full good manufacturing practice (GMP) standards. We report important preclinical and clinical data from the case, which ended in the death of the recipient. Early results were encouraging, but an acute event, hypothesized to be an intrathoracic bleed, caused sudden airway obstruction 3 weeks post‐transplantation, resulting in her death. We detail the clinical events and identify areas of priority to improve future grafts. In particular, we advocate the use of stents during the first few months post‐implantation. The negative outcome of this case highlights the inherent difficulties in clinical translation where preclinical in vivo models cannot replicate complex clinical scenarios that are encountered. The practical difficulties in delivering GMP grafts underscore the need to refine protocols for phase I clinical trials. Stem Cells Translational Medicine 2017;6:1458–1464 Here, a stem cell‐seeded, decellularized tissue‐engineered tracheal graft was used on a compassionate basis for a girl with critical tracheal stenosis after conventional reconstructive techniques failed. We report a compassionate use case of tracheal tissue engineering using a cell‐seeded, decellularized donor trachea. The teenage recipient had critical stenosis after conventional reconstructive techniques had failed. The case involved application of full good manufacturing practice standards to create a manufactured advanced medical product for transplantation.