Hope for young women born without a vagina

Hope for young women born without a vagina: Scientists successfully implant organs grown in the lab using patients' own cells

• The new organs given to women born with a condition called MRKH
• This is rare condition in which the vagina is underdeveloped or absent
• Treatment could also help patients with vaginal cancer or injuries
• Organ is engineered using muscle and cells from the genital region

By Anna Hodgekiss

Scientists have successfully grown vaginas in a laboratory and implanted them into four teenage patients. The new organs have been given to women born with MRKH - Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a rare genetic condition in which the vagina and uterus are underdeveloped or absent. The treatment could also potentially be applied to patients with vaginal cancer or injuries, according to the U.S. researchers.

Pioneering: Scientists have successfully grown vaginas in a laboratory and implanted them into patients born with a condition called MRKH - where the vagina and uterus are underdeveloped or absent

HOW THEY DID IT

The organ structures were engineered using muscle and epithelial cells (the cells that line the body’s cavities) from a small biopsy of each patient’s external genitals. The cells were extracted from the tissues, expanded and then placed on a biodegradable material that was hand-sewn into a vagina-like shape. These scaffolds (pictued below) were tailor-made to fit each patient.

About five to six weeks after the biopsy, surgeons created a canal in the patient’s pelvis and attached the scaffold to reproductive structures.

At the same time the scaffolding material is being absorbed by the body, the cells lay down materials to form a permanent support structure – gradually replacing the engineered scaffold with a new organ. The researchers, from the Wake Forest Baptist Medical Center's Institute for Regenerative Medicine, say four teenage girls have successfully received vaginal organs that were engineered with their own cells.Writing in The Lancet, programme leader by Dr Anthony Atala, said: 'This pilot study is the first to demonstrate that vaginal organs can be constructed in the lab and used successfully in humans.

'This may represent a new option for patients who require vaginal reconstructive surgeries. In addition, this study is one more example of how regenerative medicine strategies can be applied to a variety of tissues and organs.' The girls were between 13 and 18 years old at the time of the surgeries, which were performed between June 2005 and October 2008.  Data from annual follow-up visits show that even up to eight years after the surgeries, the organs had normal function. The vaginas were engineered using muscle and epithelial cells (the cells that line the body's cavities) from a small biopsy of each patient's external genitals. The cells were then extracted from the tissues, expanded and then placed on a biodegradable material that was hand-sewn into a vagina-like shape. These scaffolds were tailor-made to fit each patient.

Yuanyuan Zhang demonstrates the process where four young women born with abnormal or missing vaginas were implanted with lab-grown versions made from their own cells

 

About five to six weeks after the biopsy, surgeons created a canal in the patient's pelvis and sutured the scaffold to reproductive structures. Previous research in Dr Atala's lab has shown that once cell-seeded scaffolds are implanted in the body, nerves and blood vessels form and the cells expand and form tissue. At the same time the scaffolding material is being absorbed by the body, the cells lay down materials to form a permanent support structure – gradually replacing the engineered scaffold with a new organ. Follow-up testing on the lab-engineered vaginas showed the margin between native tissue and the engineered segments was indistinguishable. In addition, the patients' responses to a Female Sexual Function Index questionnaire showed they had normal sexual function after the treatment, including desire and pain-free intercourse.

"Tissue biopsies, MRI scans and internal exams using magnification all showed that the engineered vaginas were similar in makeup and function to native tissue, said Atlantida-Raya Rivera, lead author and director of the HIMFG Tissue Engineering Laboratory in Mexico City, where the surgeries were performed. Current treatments for MRHK syndrome include dilation of existing tissue or reconstructive surgery to create new vaginal tissue. A variety of materials can be used to surgically construct a new vagina – from skin grafts to tissue that lines the abdominal cavity. However, these substitutes often lack a normal muscle layer and some patients can develop a narrowing or contracting of the vagina. The researchers say that with conventional treatments, the overall complication rate is as high as 75 percent in paediatric patients, with the need for vaginal dilation due to narrowing being the most common complication.

WHAT IS MRKH SYNDROME?

• MRKH (Mayer Rokitansky Küster Hauser) is a congenital abnormality which affects one in 5,000 women in the UK. 
• It is characterised by the absence of the vagina, womb  and cervix. 
• Women suffering from the condition will have normally functioning ovaries and so will experience the normal signs of puberty but will not have periods or be able to conceive. 
• The external genatalia are completely normal which is why MRKH isn’t usually discovered until women are in their teenage years. 
• It’s usually discovered when the woman tries to has sex or fails to get her period. 
• Many women are able to create a vaginal canal using dilation treatment, which uses cylinder shaped dilators of different sizes to stretch the muscles. 
• However, if this is unsuccessful then surgery will be used to stretch the vaginal canal. 
• Following treatment women are able to have intercourse and can have their eggs removed and fertilised to be used in surrogacy.